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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 $2,414.00 $2,478.00 $50.08 $2,479.00 $2,544.00 $51.46 $2,545.00 $2,609.00 $52.62 $2,610.00 $2,674.00 $55.62 $2,675.00 $2,739.00 $63.23 $2,740.00 $2,804.00 $71.08 2 $3,262.00 $3,349.00 $67.62 $3,350.00 $3,437.00 $69.46 $3,438.00 $3,525.00 $71.08 $3,526.00 $3,614.00 $75.00 $3,615.00 $3,702.00 $85.38 $3,703.00 $3,790.00 $96.23 3 $4,110.00 $4,220.00 $85.15 $4,221.00 $4,331.00 $87.46 $4,332.00 $4,442.00 $89.77 $4,443.00 $4,553.00 $94.62 $4,554.00 $4,664.00 $107.54 $4,665.00 $4,775.00 $121.15 4 $4,958.00 $5,091.00 $102.69 $5,092.00 $5,225.00 $105.46 $5,226.00 $5,359.00 $108.23 $5,360.00 $5,493.00 $114.00 $5,494.00 $5,627.00 $129.92 $5,628.00 $5,761.00 $146.31 5 $5,806.00 $5,962.00 $120.46 $5,963.00 $6,119.00 $123.46 $6,120.00 $6,275.00 $126.69 $6,276.00 $6,432.00 $133.62 $6,433.00 $6,589.00 $152.08 $6,590.00 $6,746.00 $171.23 6 $6,654.00 $6,833.00 $138.00 $6,834.00 $7,012.00 $141.69 $7,013.00 $7,192.00 $145.15 $7,193.00 $7,372.00 $153.00 $7,373.00 $7,552.00 $174.23 $7,553.00 $7,732.00 $196.38 7 $7,502.00 $7,703.00 $155.54 $7,704.00 $7,906.00 $159.69 $7,907.00 $8,109.00 $163.85 $8,110.00 $8,312.00 $172.62 $8,313.00 $8,514.00 $196.38 $8,515.00 $8,717.00 $221.31 8 $8,350.00 $8,574.00 $173.08 $8,575.00 $8,800.00 $177.69 $8,801.00 $9,025.00 $182.31 $9,026.00 $9,251.00 $192.23 $9,252.00 $9,477.00 $218.77 $9,478.00 $9,702.00 $246.23 9 $9,198.00 $9,445.00 $190.62 $9,446.00 $9,694.00 $195.69 $9,695.00 $9,942.00 $200.77 $9,943.00 $10,191.00 $211.62 $10,192.00 $10,439.00 $240.92 $10,440.00 $10,688.00 $271.38 10 $10,045.00 $10,316.00 $208.38 $10,317.00 $10,587.00 $213.69 $10,588.00 $10,859.00 $219.23 $10,860.00 $11,130.00 $231.23 $11,131.00 $11,402.00 $263.08 $11,403.00 $11,673.00 $296.31 11 $10,893.00 $11,187.00 $225.92 $11,188.00 $11,481.00 $231.92 $11,482.00 $11,775.00 $237.69 $11,776.00 $12,070.00 $250.62 $12,071.00 $12,364.00 $285.23 $12,365.00 $12,659.00 $321.23 12 $11,741.00 $12,058.00 $243.46 $12,059.00 $12,375.00 $249.92 $12,376.00 $12,692.00 $256.38 $12,693.00 $13,009.00 $270.23 $13,010.00 $13,327.00 $307.62 $13,328.00 $13,644.00 $346.38 13 $12,589.00 $12,928.00 $261.00 $12,929.00 $13,269.00 $267.92 $13,270.00 $13,609.00 $274.85 $13,610.00 $13,949.00 $289.62 $13,950.00 $14,289.00 $329.77 $14,290.00 $14,629.00 $371.31 14 $13,437.00 $13,799.00 $278.54 $13,800.00 $14,162.00 $285.92 $14,163.00 $14,525.00 $293.31 $14,526.00 $14,889.00 $309.23 $14,890.00 $15,252.00 $351.92 $15,253.00 $15,615.00 $396.46 15 $14,285.00 $14,670.00 $296.31 $14,671.00 $15,056.00 $303.92 $15,057.00 $15,442.00 $311.77 $15,443.00 $15,828.00 $328.85 $15,829.00 $16,214.00 $374.08 $16,215.00 $16,600.00 $421.38 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 $2,805.00 $2,870.00 $79.38 $2,871.00 $2,935.00 $88.15 $2,936.00 $3,000.00 $96.92 $3,001.00 $3,065.00 $106.15 $3,066.00 $3,130.00 $115.62 $3,131.00 $3,196.00 $125.31 2 $3,791.00 $3,878.00 $107.31 $3,879.00 $3,966.00 $119.08 $3,967.00 $4,054.00 $131.08 $4,055.00 $4,142.00 $143.31 $4,143.00 $4,230.00 $156.23 $4,231.00 $4,319.00 $169.38 3 $4,776.00 $4,886.00 $135.23 $4,887.00 $4,997.00 $150.00 $4,998.00 $5,108.00 $165.00 $5,109.00 $5,219.00 $180.69 $5,220.00 $5,330.00 $196.85 $5,331.00 $5,442.00 $213.46 4 $5,762.00 $5,895.00 $163.15 $5,896.00 $6,029.00 $180.92 $6,030.00 $6,163.00 $199.15 $6,164.00 $6,297.00 $218.08 $6,298.00 $6,430.00 $237.46 $6,431.00 $6,564.00 $257.54 5 $6,747.00 $6,903.00 $191.08 $6,904.00 $7,060.00 $211.85 $7,061.00 $7,217.00 $233.08 $7,218.00 $7,374.00 $255.23 $7,375.00 $7,530.00 $278.08 $7,531.00 $7,687.00 $301.62 6 $7,733.00 $7,911.00 $219.00 $7,912.00 $8,091.00 $242.77 $8,092.00 $8,271.00 $267.23 $8,272.00 $8,451.00 $292.62 $8,452.00 $8,630.00 $318.69 $8,631.00 $8,810.00 $345.69 7 $8,718.00 $8,920.00 $246.92 $8,921.00 $9,122.00 $273.69 $9,123.00 $9,325.00 $301.38 $9,326.00 $9,528.00 $329.77 $9,529.00 $9,730.00 $359.31 $9,731.00 $9,933.00 $389.77 8 $9,703.00 $9,928.00 $274.85 $9,929.00 $10,154.00 $304.62 $10,155.00 $10,379.00 $335.31 $10,380.00 $10,605.00 $367.15 $10,606.00 $10,830.00 $399.92 $10,831.00 $11,056.00 $433.85 9 $10,689.00 $10,936.00 $302.77 $10,937.00 $11,185.00 $335.54 $11,186.00 $11,433.00 $369.46 $11,434.00 $11,682.00 $404.31 $11,683.00 $11,930.00 $440.54 $11,931.00 $12,179.00 $477.69 10 $11,674.00 $11,945.00 $330.69 $11,946.00 $12,216.00 $366.46 $12,217.00 $12,488.00 $403.38 $12,489.00 $12,759.00 $441.69 $12,760.00 $13,030.00 $481.15 $13,031.00 $13,302.00 $521.77 11 $12,660.00 $12,953.00 $358.62 $12,954.00 $13,247.00 $397.38 $13,248.00 $13,542.00 $437.54 $13,543.00 $13,836.00 $478.85 $13,837.00 $14,130.00 $521.77 $14,131.00 $14,425.00 $565.85 12 $13,645.00 $13,961.00 $386.54 $13,962.00 $14,279.00 $428.31 $14,280.00 $14,596.00 $471.46 $14,597.00 $14,913.00 $516.23 $14,914.00 $15,230.00 $562.38 $15,231.00 $15,548.00 $609.92 13 $14,630.00 $14,970.00 $414.46 $14,971.00 $15,310.00 $459.23 $15,311.00 $15,650.00 $505.62 $15,651.00 $15,990.00 $553.62 $15,991.00 $16,330.00 $603.00 $16,331.00 $16,671.00 $654.00 14 $15,616.00 $15,978.00 $442.38 $15,979.00 $16,341.00 $490.15 $16,342.00 $16,704.00 $539.77 $16,705.00 $17,067.00 $590.77 $17,068.00 $17,430.00 $643.62 $17,431.00 $17,794.00 $698.08 15 $16,601.00 $16,986.00 $470.31 $16,987.00 $17,372.00 $521.08 $17,373.00 $17,758.00 $573.69 $17,759.00 $18,144.00 $628.15 $18,145.00 $18,530.00 $684.23 $18,531.00 $18,917.00 $742.15 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 $3,197.00 $3,261.00 $135.46 $3,262.00 $3,326.00 $145.85 $3,327.00 $3,391.00 $156.46 $3,392.00 $3,457.00 $167.54 $3,458.00 $3,522.00 $178.85 $3,523.00 $3,587.00 $190.38 2 $4,320.00 $4,407.00 $183.00 $4,408.00 $4,495.00 $197.08 $4,496.00 $4,583.00 $211.62 $4,584.00 $4,671.00 $226.38 $4,672.00 $4,759.00 $241.62 $4,760.00 $4,847.00 $257.31 3 $5,443.00 $5,553.00 $230.77 $5,554.00 $5,664.00 $248.31 $5,665.00 $5,775.00 $266.54 $5,776.00 $5,886.00 $285.23 $5,887.00 $5,997.00 $304.38 $5,998.00 $6,108.00 $324.23 4 $6,565.00 $6,698.00 $278.31 $6,699.00 $6,832.00 $299.54 $6,833.00 $6,966.00 $321.46 $6,967.00 $7,100.00 $344.08 $7,101.00 $7,234.00 $367.15 $7,235.00 $7,368.00 $391.15 5 $7,688.00 $7,844.00 $325.85 $7,845.00 $8,001.00 $350.77 $8,002.00 $8,158.00 $376.62 $8,159.00 $8,315.00 $402.92 $8,316.00 $8,472.00 $430.15 $8,473.00 $8,629.00 $458.08 6 $8,811.00 $8,990.00 $373.38 $8,991.00 $9,170.00 $402.00 $9,171.00 $9,350.00 $431.54 $9,351.00 $9,529.00 $461.77 $9,530.00 $9,709.00 $492.92 $9,710.00 $9,889.00 $524.77 7 $9,934.00 $10,136.00 $420.92 $10,137.00 $10,339.00 $453.23 $10,340.00 $10,541.00 $486.46 $10,542.00 $10,744.00 $520.62 $10,745.00 $10,947.00 $555.69 $10,948.00 $11,149.00 $591.69 8 $11,057.00 $11,282.00 $468.69 $11,283.00 $11,507.00 $504.46 $11,508.00 $11,733.00 $541.62 $11,734.00 $11,959.00 $579.46 $11,960.00 $12,184.00 $618.46 $12,185.00 $12,410.00 $658.62 9 $12,180.00 $12,428.00 $516.23 $12,429.00 $12,676.00 $555.69 $12,677.00 $12,925.00 $596.54 $12,926.00 $13,173.00 $638.31 $13,174.00 $13,422.00 $681.46 $13,423.00 $13,670.00 $725.54 10 $13,303.00 $13,573.00 $563.77 $13,574.00 $13,845.00 $607.15 $13,846.00 $14,116.00 $651.46 $14,117.00 $14,388.00 $697.15 $14,389.00 $14,659.00 $744.23 $14,660.00 $14,931.00 $792.46 11 $14,426.00 $14,719.00 $611.31 $14,720.00 $15,014.00 $658.38 $15,015.00 $15,308.00 $706.62 $15,309.00 $15,602.00 $756.00 $15,603.00 $15,897.00 $807.00 $15,898.00 $16,191.00 $859.38 12 $15,549.00 $15,865.00 $659.08 $15,866.00 $16,182.00 $709.62 $16,183.00 $16,500.00 $761.54 $16,501.00 $16,817.00 $815.08 $16,818.00 $17,134.00 $869.77 $17,135.00 $17,452.00 $926.31 13 $16,672.00 $17,011.00 $706.62 $17,012.00 $17,351.00 $760.85 $17,352.00 $17,691.00 $816.46 $17,692.00 $18,032.00 $873.92 $18,033.00 $18,372.00 $932.77 $18,373.00 $18,712.00 $993.23 14 $17,795.00 $18,157.00 $754.15 $18,158.00 $18,520.00 $812.08 $18,521.00 $18,883.00 $871.62 $18,884.00 $19,246.00 $932.77 $19,247.00 $19,609.00 $995.54 $19,610.00 $19,972.00 $1,060.15 15 $18,918.00 $19,303.00 $801.92 $19,304.00 $19,689.00 $863.31 $19,690.00 $20,075.00 $926.54 $20,076.00 $20,461.00 $991.62 $20,462.00 $20,847.00 $1,058.31 $20,848.00 $21,233.00 $1,127.08 260% Monthly FPL Weekly Copayment Weekly Copayment Weekly Copayment Weekly Copayment 235% Monthly FPL Weekly Copayment Weekly Copayment Family Size 245% Monthly FPL 210% Monthly FPL 220% Monthly FPL 240% Monthly FPL 230% Monthly FPL Weekly Copayment Family Size Weekly Copayment Weekly Copayment 255% Monthly FPL 200% Monthly FPL 225% Monthly FPL 205% Monthly FPL Weekly Copayment Weekly Copayment 195% Monthly FPL Weekly Copayment Weekly Copayment Weekly Copayment 190% Monthly FPL Weekly Copayment 250% Monthly FPL 270% Monthly FPL Family Size 265% Monthly FPL Weekly Copayment Weekly Copayment 275% Monthly FPL 215% Monthly FPL Weekly Copayment