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Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End 1 $1,240.00 $1,305.00 $0.00 $1,306.00 $1,370.00 $22.15 $1,371.00 $1,435.00 $24.23 $1,436.00 $1,500.00 $26.77 $1,501.00 $1,565.00 $29.08 $1,566.00 $1,631.00 $31.62 2 $1,676.00 $1,763.00 $0.00 $1,764.00 $1,851.00 $30.00 $1,852.00 $1,939.00 $33.00 $1,940.00 $2,027.00 $36.00 $2,028.00 $2,115.00 $39.23 $2,116.00 $2,204.00 $42.69 3 $2,111.00 $2,221.00 $0.00 $2,222.00 $2,332.00 $37.62 $2,333.00 $2,443.00 $41.54 $2,444.00 $2,554.00 $45.46 $2,555.00 $2,665.00 $49.62 $2,666.00 $2,777.00 $53.77 4 $2,547.00 $2,680.00 $0.00 $2,681.00 $2,814.00 $45.46 $2,815.00 $2,948.00 $50.08 $2,949.00 $3,082.00 $54.69 $3,083.00 $3,215.00 $59.77 $3,216.00 $3,349.00 $64.85 5 $2,982.00 $3,138.00 $0.00 $3,139.00 $3,295.00 $53.31 $3,296.00 $3,452.00 $58.62 $3,453.00 $3,609.00 $64.15 $3,610.00 $3,765.00 $69.92 $3,766.00 $3,922.00 $75.92 6 $3,418.00 $3,596.00 $0.00 $3,597.00 $3,776.00 $60.92 $3,777.00 $3,956.00 $67.15 $3,957.00 $4,136.00 $73.38 $4,137.00 $4,315.00 $80.08 $4,316.00 $4,495.00 $87.23 7 $3,853.00 $4,055.00 $0.00 $4,056.00 $4,257.00 $68.77 $4,258.00 $4,460.00 $75.69 $4,461.00 $4,663.00 $82.85 $4,664.00 $4,865.00 $90.46 $4,866.00 $5,068.00 $98.31 8 $4,288.00 $4,513.00 $0.00 $4,514.00 $4,739.00 $76.62 $4,740.00 $4,964.00 $84.23 $4,965.00 $5,190.00 $92.31 $5,191.00 $5,415.00 $100.62 $5,416.00 $5,641.00 $109.38 9 $4,724.00 $4,971.00 $0.00 $4,972.00 $5,220.00 $84.23 $5,221.00 $5,468.00 $92.77 $5,469.00 $5,717.00 $101.54 $5,718.00 $5,965.00 $110.77 $5,966.00 $6,214.00 $120.46 10 $5,159.00 $5,430.00 $0.00 $5,431.00 $5,701.00 $92.08 $5,702.00 $5,973.00 $101.31 $5,974.00 $6,244.00 $111.00 $6,245.00 $6,515.00 $120.92 $6,516.00 $6,787.00 $131.54 11 $5,595.00 $5,888.00 $0.00 $5,889.00 $6,182.00 $99.92 $6,183.00 $6,477.00 $109.85 $6,478.00 $6,771.00 $120.23 $6,772.00 $7,065.00 $131.31 $7,066.00 $7,360.00 $142.62 12 $6,030.00 $6,346.00 $0.00 $6,347.00 $6,664.00 $107.54 $6,665.00 $6,981.00 $118.38 $6,982.00 $7,298.00 $129.69 $7,299.00 $7,615.00 $141.46 $7,616.00 $7,933.00 $153.69 13 $6,465.00 $6,805.00 $0.00 $6,806.00 $7,145.00 $115.38 $7,146.00 $7,485.00 $126.92 $7,486.00 $7,825.00 $139.15 $7,826.00 $8,165.00 $151.62 $8,166.00 $8,506.00 $165.00 14 $6,901.00 $7,263.00 $0.00 $7,264.00 $7,626.00 $123.23 $7,627.00 $7,989.00 $135.46 $7,990.00 $8,352.00 $148.38 $8,353.00 $8,715.00 $162.00 $8,716.00 $9,079.00 $176.08 15 $7,336.00 $7,721.00 $0.00 $7,722.00 $8,107.00 $130.85 $8,108.00 $8,493.00 $144.00 $8,494.00 $8,879.00 $157.85 $8,880.00 $9,265.00 $172.15 $9,266.00 $9,652.00 $187.15 Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End 1 $1,632.00 $1,696.00 $34.15 $1,697.00 $1,761.00 $35.54 $1,762.00 $1,826.00 $36.92 $1,827.00 $1,892.00 $38.31 $1,893.00 $1,957.00 $39.46 $1,958.00 $2,022.00 $40.85 2 $2,205.00 $2,292.00 $46.38 $2,293.00 $2,380.00 $48.00 $2,381.00 $2,468.00 $49.85 $2,469.00 $2,556.00 $51.69 $2,557.00 $2,644.00 $53.31 $2,645.00 $2,732.00 $55.15 3 $2,778.00 $2,888.00 $58.38 $2,889.00 $2,999.00 $60.46 $3,000.00 $3,110.00 $62.77 $3,111.00 $3,221.00 $65.08 $3,222.00 $3,332.00 $67.38 $3,333.00 $3,443.00 $69.46 4 $3,350.00 $3,483.00 $70.38 $3,484.00 $3,617.00 $72.92 $3,618.00 $3,751.00 $75.69 $3,752.00 $3,885.00 $78.46 $3,886.00 $4,019.00 $81.23 $4,020.00 $4,153.00 $83.77 5 $3,923.00 $4,079.00 $82.38 $4,080.00 $4,236.00 $85.62 $4,237.00 $4,393.00 $88.62 $4,394.00 $4,550.00 $91.85 $4,551.00 $4,707.00 $95.08 $4,708.00 $4,864.00 $98.31 6 $4,496.00 $4,675.00 $94.38 $4,676.00 $4,855.00 $98.08 $4,856.00 $5,035.00 $101.77 $5,036.00 $5,214.00 $105.23 $5,215.00 $5,394.00 $108.92 $5,395.00 $5,574.00 $112.62 7 $5,069.00 $5,271.00 $106.38 $5,272.00 $5,474.00 $110.54 $5,475.00 $5,676.00 $114.69 $5,677.00 $5,879.00 $118.62 $5,880.00 $6,082.00 $122.77 $6,083.00 $6,284.00 $126.92 8 $5,642.00 $5,867.00 $118.38 $5,868.00 $6,092.00 $123.00 $6,093.00 $6,318.00 $127.62 $6,319.00 $6,544.00 $132.23 $6,545.00 $6,769.00 $136.62 $6,770.00 $6,995.00 $141.23 9 $6,215.00 $6,463.00 $130.62 $6,464.00 $6,711.00 $135.46 $6,712.00 $6,960.00 $140.54 $6,961.00 $7,208.00 $145.62 $7,209.00 $7,457.00 $150.46 $7,458.00 $7,705.00 $155.54 10 $6,788.00 $7,058.00 $142.62 $7,059.00 $7,330.00 $147.92 $7,331.00 $7,601.00 $153.46 $7,602.00 $7,873.00 $159.00 $7,874.00 $8,144.00 $164.54 $8,145.00 $8,416.00 $169.85 11 $7,361.00 $7,654.00 $154.62 $7,655.00 $7,949.00 $160.62 $7,950.00 $8,243.00 $166.38 $8,244.00 $8,537.00 $172.38 $8,538.00 $8,832.00 $178.38 $8,833.00 $9,126.00 $184.38 12 $7,934.00 $8,250.00 $166.62 $8,251.00 $8,567.00 $173.08 $8,568.00 $8,885.00 $179.31 $8,886.00 $9,202.00 $185.77 $9,203.00 $9,519.00 $192.23 $9,520.00 $9,837.00 $198.69 13 $8,507.00 $8,846.00 $178.62 $8,847.00 $9,186.00 $185.54 $9,187.00 $9,526.00 $192.46 $9,527.00 $9,867.00 $199.15 $9,868.00 $10,207.00 $206.08 $10,208.00 $10,547.00 $213.00 14 $9,080.00 $9,442.00 $190.62 $9,443.00 $9,805.00 $198.00 $9,806.00 $10,168.00 $205.38 $10,169.00 $10,531.00 $212.54 $10,532.00 $10,894.00 $219.92 $10,895.00 $11,257.00 $227.31 15 $9,653.00 $10,038.00 $202.62 $10,039.00 $10,424.00 $210.46 $10,425.00 $10,810.00 $218.31 $10,811.00 $11,196.00 $226.15 $11,197.00 $11,582.00 $233.77 $11,583.00 $11,968.00 $241.62 Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End Lower End Higher End 1 $2,023.00 $2,087.00 $42.23 $2,088.00 $2,152.00 $43.38 $2,153.00 $2,218.00 $44.77 $2,219.00 $2,283.00 $46.15 $2,284.00 $2,348.00 $47.31 $2,349.00 $2,413.00 $48.69 2 $2,733.00 $2,820.00 $57.00 $2,821.00 $2,909.00 $58.85 $2,910.00 $2,997.00 $60.46 $2,998.00 $3,085.00 $62.31 $3,086.00 $3,173.00 $64.15 $3,174.00 $3,261.00 $65.77 3 $3,444.00 $3,554.00 $71.77 $3,555.00 $3,665.00 $74.08 $3,666.00 $3,776.00 $76.15 $3,777.00 $3,887.00 $78.46 $3,888.00 $3,998.00 $80.77 $3,999.00 $4,109.00 $83.08 4 $4,154.00 $4,287.00 $86.54 $4,288.00 $4,421.00 $89.31 $4,422.00 $4,555.00 $92.08 $4,556.00 $4,689.00 $94.62 $4,690.00 $4,823.00 $97.38 $4,824.00 $4,957.00 $100.15 5 $4,865.00 $5,020.00 $101.31 $5,021.00 $5,177.00 $104.54 $5,178.00 $5,334.00 $107.77 $5,335.00 $5,491.00 $110.77 $5,492.00 $5,648.00 $114.00 $5,649.00 $5,805.00 $117.23 6 $5,575.00 $5,754.00 $116.08 $5,755.00 $5,934.00 $119.77 $5,935.00 $6,113.00 $123.46 $6,114.00 $6,293.00 $127.15 $6,294.00 $6,473.00 $130.62 $6,474.00 $6,653.00 $134.31 7 $6,285.00 $6,487.00 $131.08 $6,488.00 $6,690.00 $135.00 $6,691.00 $6,893.00 $139.15 $6,894.00 $7,095.00 $143.31 $7,096.00 $7,298.00 $147.46 $7,299.00 $7,501.00 $151.38 8 $6,996.00 $7,220.00 $145.85 $7,221.00 $7,446.00 $150.46 $7,447.00 $7,672.00 $154.85 $7,673.00 $7,897.00 $159.46 $7,898.00 $8,123.00 $164.08 $8,124.00 $8,349.00 $168.69 9 $7,706.00 $7,954.00 $160.62 $7,955.00 $8,202.00 $165.69 $8,203.00 $8,451.00 $170.54 $8,452.00 $8,699.00 $175.62 $8,700.00 $8,948.00 $180.69 $8,949.00 $9,197.00 $185.77 10 $8,417.00 $8,687.00 $175.38 $8,688.00 $8,959.00 $180.92 $8,960.00 $9,230.00 $186.46 $9,231.00 $9,502.00 $191.77 $9,503.00 $9,773.00 $197.31 $9,774.00 $10,044.00 $202.85 11 $9,127.00 $9,420.00 $190.15 $9,421.00 $9,715.00 $196.15 $9,716.00 $10,009.00 $202.15 $10,010.00 $10,304.00 $208.15 $10,305.00 $10,598.00 $213.92 $10,599.00 $10,892.00 $219.92 12 $9,838.00 $10,154.00 $204.92 $10,155.00 $10,471.00 $211.38 $10,472.00 $10,788.00 $217.85 $10,789.00 $11,106.00 $224.31 $11,107.00 $11,423.00 $230.77 $11,424.00 $11,740.00 $237.00 13 $10,548.00 $10,887.00 $219.92 $10,888.00 $11,227.00 $226.62 $11,228.00 $11,568.00 $233.54 $11,569.00 $11,908.00 $240.46 $11,909.00 $12,248.00 $247.38 $12,249.00 $12,588.00 $254.08 14 $11,258.00 $11,620.00 $234.69 $11,621.00 $11,984.00 $242.08 $11,985.00 $12,347.00 $249.23 $12,348.00 $12,710.00 $256.62 $12,711.00 $13,073.00 $264.00 $13,074.00 $13,436.00 $271.38 15 $11,969.00 $12,354.00 $249.46 $12,355.00 $12,740.00 $257.31 $12,741.00 $13,126.00 $265.15 $13,127.00 $13,512.00 $272.77 $13,513.00 $13,898.00 $280.62 $13,899.00 $14,284.00 $288.46 Weekly Copayment Weekly Copayment 145% Monthly FPL 185% Monthly FPL Family Size Weekly Copayment Weekly Copayment 130% Monthly FPL 160% Monthly FPL Weekly Copayment Weekly Copayment 135% Monthly FPL 140% Monthly FPL 150% Monthly FPL Weekly Copayment 175% Monthly FPL Weekly Copayment 100% Monthly FPL Weekly Copayment Weekly Copayment Family Size 115% Monthly FPL 170% Monthly FPL Weekly Copayment 105% Monthly FPL 125% Monthly FPL Weekly Copayment Family Size 110% Monthly FPL Weekly Copayment Weekly Copayment 155% Monthly FPL 120% Monthly FPL 165% Monthly FPL Weekly Copayment Weekly Copayment Weekly Copayment Weekly Copayment 180% Monthly FPL