intensive outpatient/partial hospitalization liability tables...allegheny intensive...

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Ada

ms

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,740 $2,262 $2,784 $3,306 $3,828 $4,350 $4,3502 $2,359 $3,067 $3,775 $4,483 $5,190 $5,898 $5,8983 $2,978 $3,872 $4,766 $5,659 $6,553 $7,446 $7,4464 $3,598 $4,677 $5,756 $6,836 $7,915 $8,994 $8,9945 $4,217 $5,482 $6,747 $8,012 $9,277 $10,542 $10,5426 $4,836 $6,287 $7,738 $9,189 $10,639 $12,090 $12,0907 $5,455 $7,092 $8,728 $10,365 $12,002 $13,638 $13,6388 $6,074 $7,897 $9,719 $11,541 $13,364 $15,186 $15,1869 $6,694 $8,702 $10,710 $12,718 $14,726 $16,734 $16,734

10 $7,313 $9,507 $11,701 $13,894 $16,088 $18,282 $18,282

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Alle

ghen

y

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,811 $2,354 $2,897 $3,441 $3,984 $4,527 $4,5272 $2,455 $3,192 $3,928 $4,665 $5,402 $6,138 $6,1383 $3,100 $4,030 $4,959 $5,889 $6,819 $7,749 $7,7494 $3,744 $4,867 $5,991 $7,114 $8,237 $9,360 $9,3605 $4,388 $5,705 $7,022 $8,338 $9,655 $10,971 $10,9716 $5,033 $6,543 $8,053 $9,562 $11,072 $12,582 $12,5827 $5,677 $7,380 $9,084 $10,787 $12,490 $14,193 $14,1938 $6,322 $8,218 $10,115 $12,011 $13,908 $15,804 $15,8049 $6,966 $9,056 $11,146 $13,236 $15,325 $17,415 $17,415

10 $7,610 $9,894 $12,177 $14,460 $16,743 $19,026 $19,026

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Arm

stro

ng

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Bea

ver

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Bed

ford

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Ber

ks

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Bla

ir

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Bra

dfor

d

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Buc

ks

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,600 $3,380 $4,160 $4,940 $5,720 $6,500 $6,5002 $3,525 $4,583 $5,640 $6,698 $7,755 $8,813 $8,8133 $4,450 $5,785 $7,121 $8,456 $9,791 $11,126 $11,1264 $5,376 $6,988 $8,601 $10,214 $11,826 $13,439 $13,4395 $6,301 $8,191 $10,081 $11,971 $13,862 $15,752 $15,7526 $7,226 $9,394 $11,562 $13,729 $15,897 $18,065 $18,0657 $8,151 $10,597 $13,042 $15,487 $17,933 $20,378 $20,3788 $9,076 $11,799 $14,522 $17,245 $19,968 $22,691 $22,6919 $10,002 $13,002 $16,003 $19,003 $22,003 $25,004 $25,004

10 $10,927 $14,205 $17,483 $20,761 $24,039 $27,317 $27,317

Client Liability: 0% 10% 20% 30% 40% 50% 100%

But

ler

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,841 $2,394 $2,946 $3,498 $4,051 $4,603 $4,6032 $2,496 $3,245 $3,994 $4,743 $5,492 $6,241 $6,2413 $3,152 $4,097 $5,043 $5,988 $6,934 $7,879 $7,8794 $3,807 $4,949 $6,091 $7,233 $8,375 $9,517 $9,5175 $4,462 $5,801 $7,139 $8,478 $9,816 $11,155 $11,1556 $5,117 $6,652 $8,188 $9,723 $11,258 $12,793 $12,7937 $5,772 $7,504 $9,236 $10,968 $12,699 $14,431 $14,4318 $6,428 $8,356 $10,284 $12,213 $14,141 $16,069 $16,0699 $7,083 $9,208 $11,333 $13,457 $15,582 $17,707 $17,707

10 $7,738 $10,059 $12,381 $14,702 $17,024 $19,345 $19,345

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cam

bria

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,558 $2,025 $2,493 $2,960 $3,428 $3,895 $3,8952 $2,112 $2,746 $3,380 $4,013 $4,647 $5,281 $5,2813 $2,667 $3,467 $4,267 $5,067 $5,867 $6,667 $6,6674 $3,221 $4,188 $5,154 $6,120 $7,087 $8,053 $8,0535 $3,776 $4,908 $6,041 $7,174 $8,306 $9,439 $9,4396 $4,330 $5,629 $6,928 $8,227 $9,526 $10,825 $10,8257 $4,884 $6,350 $7,815 $9,280 $10,746 $12,211 $12,2118 $5,439 $7,070 $8,702 $10,334 $11,965 $13,597 $13,5979 $5,993 $7,791 $9,589 $11,387 $13,185 $14,983 $14,983

10 $6,548 $8,512 $10,476 $12,440 $14,405 $16,369 $16,369

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cam

eron

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Car

bon

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cen

tre

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,953 $2,538 $3,124 $3,710 $4,296 $4,881 $4,8812 $2,647 $3,442 $4,236 $5,030 $5,824 $6,618 $6,6183 $3,342 $4,345 $5,347 $6,350 $7,353 $8,355 $8,3554 $4,037 $5,248 $6,459 $7,670 $8,881 $10,092 $10,0925 $4,732 $6,151 $7,571 $8,990 $10,410 $11,829 $11,8296 $5,427 $7,054 $8,682 $10,310 $11,938 $13,566 $13,5667 $6,121 $7,958 $9,794 $11,631 $13,467 $15,303 $15,3038 $6,816 $8,861 $10,906 $12,951 $14,995 $17,040 $17,0409 $7,511 $9,764 $12,017 $14,271 $16,524 $18,777 $18,777

10 $8,206 $10,667 $13,129 $15,591 $18,053 $20,514 $20,514

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Che

ster

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,630 $3,419 $4,209 $4,998 $5,787 $6,576 $6,5762 $3,566 $4,636 $5,706 $6,776 $7,846 $8,916 $8,9163 $4,502 $5,853 $7,204 $8,554 $9,905 $11,256 $11,2564 $5,438 $7,070 $8,701 $10,333 $11,964 $13,596 $13,5965 $6,374 $8,287 $10,199 $12,111 $14,024 $15,936 $15,9366 $7,310 $9,503 $11,697 $13,890 $16,083 $18,276 $18,2767 $8,246 $10,720 $13,194 $15,668 $18,142 $20,616 $20,6168 $9,182 $11,937 $14,692 $17,446 $20,201 $22,956 $22,9569 $10,118 $13,154 $16,189 $19,225 $22,260 $25,296 $25,296

10 $11,054 $14,371 $17,687 $21,003 $24,320 $27,636 $27,636

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cla

rion

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cle

arfie

ld

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Clin

ton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Col

umbi

a

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cra

wfo

rd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Cum

berla

nd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Dau

phin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,831 $2,380 $2,930 $3,479 $4,028 $4,578 $4,5782 $2,483 $3,228 $3,972 $4,717 $5,462 $6,207 $6,2073 $3,134 $4,075 $5,015 $5,955 $6,895 $7,836 $7,8364 $3,786 $4,922 $6,057 $7,193 $8,329 $9,465 $9,4655 $4,438 $5,769 $7,100 $8,431 $9,763 $11,094 $11,0946 $5,089 $6,616 $8,143 $9,669 $11,196 $12,723 $12,7237 $5,741 $7,463 $9,185 $10,907 $12,630 $14,352 $14,3528 $6,392 $8,310 $10,228 $12,145 $14,063 $15,981 $15,9819 $7,044 $9,157 $11,270 $13,383 $15,497 $17,610 $17,610

10 $7,696 $10,004 $12,313 $14,621 $16,930 $19,239 $19,239

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Del

awar

e

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,357 $3,064 $3,771 $4,479 $5,186 $5,893 $5,8932 $3,196 $4,155 $5,114 $6,072 $7,031 $7,990 $7,9903 $4,035 $5,245 $6,456 $7,666 $8,877 $10,087 $10,0874 $4,874 $6,336 $7,798 $9,260 $10,722 $12,184 $12,1845 $5,712 $7,426 $9,140 $10,854 $12,567 $14,281 $14,2816 $6,551 $8,517 $10,482 $12,447 $14,413 $16,378 $16,3787 $7,390 $9,607 $11,824 $14,041 $16,258 $18,475 $18,4758 $8,229 $10,697 $13,166 $15,635 $18,103 $20,572 $20,5729 $9,068 $11,788 $14,508 $17,228 $19,949 $22,669 $22,669

10 $9,906 $12,878 $15,850 $18,822 $21,794 $24,766 $24,766

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Elk

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Erie

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Faye

tte

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Fore

st

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Fran

klin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Fulto

n

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,578 $2,052 $2,525 $2,999 $3,472 $3,946 $3,9462 $2,140 $2,782 $3,424 $4,066 $4,708 $5,350 $5,3503 $2,701 $3,512 $4,322 $5,133 $5,943 $6,754 $6,7544 $3,263 $4,242 $5,221 $6,200 $7,179 $8,158 $8,1585 $3,825 $4,972 $6,119 $7,267 $8,414 $9,562 $9,5626 $4,386 $5,702 $7,018 $8,334 $9,650 $10,966 $10,9667 $4,948 $6,432 $7,916 $9,401 $10,885 $12,370 $12,3708 $5,509 $7,162 $8,815 $10,468 $12,121 $13,774 $13,7749 $6,071 $7,892 $9,714 $11,535 $13,356 $15,178 $15,178

10 $6,633 $8,622 $10,612 $12,602 $14,592 $16,582 $16,582

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Gre

ene

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Hun

tingd

on

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,548 $2,012 $2,477 $2,941 $3,405 $3,870 $3,8702 $2,099 $2,728 $3,358 $3,987 $4,617 $5,247 $5,2473 $2,649 $3,444 $4,239 $5,034 $5,829 $6,624 $6,6244 $3,200 $4,160 $5,120 $6,080 $7,041 $8,001 $8,0015 $3,751 $4,876 $6,002 $7,127 $8,252 $9,378 $9,3786 $4,302 $5,592 $6,883 $8,174 $9,464 $10,755 $10,7557 $4,853 $6,308 $7,764 $9,220 $10,676 $12,132 $12,1328 $5,403 $7,024 $8,646 $10,267 $11,888 $13,509 $13,5099 $5,954 $7,741 $9,527 $11,313 $13,099 $14,886 $14,886

10 $6,505 $8,457 $10,408 $12,360 $14,311 $16,263 $16,263

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Indi

ana

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Jeffe

rson

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,568 $2,039 $2,509 $2,979 $3,450 $3,920 $3,9202 $2,126 $2,764 $3,402 $4,040 $4,677 $5,315 $5,3153 $2,684 $3,489 $4,295 $5,100 $5,905 $6,710 $6,7104 $3,242 $4,215 $5,187 $6,160 $7,133 $8,105 $8,1055 $3,800 $4,940 $6,080 $7,220 $8,360 $9,500 $9,5006 $4,358 $5,666 $6,973 $8,280 $9,588 $10,895 $10,8957 $4,916 $6,391 $7,866 $9,341 $10,815 $12,290 $12,2908 $5,474 $7,116 $8,759 $10,401 $12,043 $13,685 $13,6859 $6,032 $7,842 $9,651 $11,461 $13,271 $15,080 $15,080

10 $6,590 $8,567 $10,544 $12,521 $14,498 $16,475 $16,475

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Juni

ata

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,548 $2,012 $2,477 $2,941 $3,405 $3,870 $3,8702 $2,099 $2,728 $3,358 $3,987 $4,617 $5,247 $5,2473 $2,649 $3,444 $4,239 $5,034 $5,829 $6,624 $6,6244 $3,200 $4,160 $5,120 $6,080 $7,041 $8,001 $8,0015 $3,751 $4,876 $6,002 $7,127 $8,252 $9,378 $9,3786 $4,302 $5,592 $6,883 $8,174 $9,464 $10,755 $10,7557 $4,853 $6,308 $7,764 $9,220 $10,676 $12,132 $12,1328 $5,403 $7,024 $8,646 $10,267 $11,888 $13,509 $13,5099 $5,954 $7,741 $9,527 $11,313 $13,099 $14,886 $14,886

10 $6,505 $8,457 $10,408 $12,360 $14,311 $16,263 $16,263

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Lack

awan

na

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,730 $2,249 $2,768 $3,287 $3,806 $4,325 $4,3252 $2,346 $3,049 $3,753 $4,457 $5,160 $5,864 $5,8643 $2,961 $3,849 $4,738 $5,626 $6,515 $7,403 $7,4034 $3,577 $4,650 $5,723 $6,796 $7,869 $8,942 $8,9425 $4,192 $5,450 $6,708 $7,965 $9,223 $10,481 $10,4816 $4,808 $6,250 $7,693 $9,135 $10,577 $12,020 $12,0207 $5,424 $7,051 $8,678 $10,305 $11,932 $13,559 $13,5598 $6,039 $7,851 $9,663 $11,474 $13,286 $15,098 $15,0989 $6,655 $8,651 $10,648 $12,644 $14,640 $16,637 $16,637

10 $7,270 $9,451 $11,633 $13,814 $15,995 $18,176 $18,176

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Lanc

aste

r

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,791 $2,328 $2,865 $3,402 $3,939 $4,477 $4,4772 $2,428 $3,156 $3,885 $4,613 $5,341 $6,070 $6,0703 $3,065 $3,985 $4,904 $5,824 $6,743 $7,663 $7,6634 $3,702 $4,813 $5,924 $7,034 $8,145 $9,256 $9,2565 $4,339 $5,641 $6,943 $8,245 $9,547 $10,849 $10,8496 $4,977 $6,470 $7,963 $9,456 $10,949 $12,442 $12,4427 $5,614 $7,298 $8,982 $10,666 $12,350 $14,035 $14,0358 $6,251 $8,126 $10,002 $11,877 $13,752 $15,628 $15,6289 $6,888 $8,955 $11,021 $13,088 $15,154 $17,221 $17,221

10 $7,525 $9,783 $12,041 $14,298 $16,556 $18,814 $18,814

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Law

renc

e

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,700 $2,209 $2,719 $3,229 $3,739 $4,249 $4,2492 $2,304 $2,996 $3,687 $4,378 $5,070 $5,761 $5,7613 $2,909 $3,782 $4,655 $5,527 $6,400 $7,273 $7,2734 $3,514 $4,568 $5,622 $6,677 $7,731 $8,785 $8,7855 $4,119 $5,354 $6,590 $7,826 $9,061 $10,297 $10,2976 $4,724 $6,141 $7,558 $8,975 $10,392 $11,809 $11,8097 $5,328 $6,927 $8,525 $10,124 $11,722 $13,321 $13,3218 $5,933 $7,713 $9,493 $11,273 $13,053 $14,833 $14,8339 $6,538 $8,499 $10,461 $12,422 $14,384 $16,345 $16,345

10 $7,143 $9,286 $11,428 $13,571 $15,714 $17,857 $17,857

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Leba

non

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Lehi

gh

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,942 $2,525 $3,108 $3,691 $4,273 $4,856 $4,8562 $2,634 $3,424 $4,214 $5,004 $5,794 $6,584 $6,5843 $3,325 $4,322 $5,320 $6,317 $7,315 $8,312 $8,3124 $4,016 $5,221 $6,426 $7,630 $8,835 $10,040 $10,0405 $4,707 $6,119 $7,532 $8,944 $10,356 $11,768 $11,7686 $5,398 $7,018 $8,637 $10,257 $11,876 $13,496 $13,4967 $6,090 $7,916 $9,743 $11,570 $13,397 $15,224 $15,2248 $6,781 $8,815 $10,849 $12,884 $14,918 $16,952 $16,9529 $7,472 $9,714 $11,955 $14,197 $16,438 $18,680 $18,680

10 $8,163 $10,612 $13,061 $15,510 $17,959 $20,408 $20,408

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Luze

rne

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Lyco

min

g

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

McK

ean

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Mer

cer

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Miff

lin

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,538 $1,999 $2,460 $2,922 $3,383 $3,844 $3,8442 $2,085 $2,710 $3,336 $3,961 $4,587 $5,212 $5,2123 $2,632 $3,422 $4,211 $5,001 $5,791 $6,580 $6,5804 $3,179 $4,133 $5,087 $6,041 $6,995 $7,948 $7,9485 $3,727 $4,844 $5,962 $7,080 $8,198 $9,316 $9,3166 $4,274 $5,556 $6,838 $8,120 $9,402 $10,684 $10,6847 $4,821 $6,267 $7,713 $9,160 $10,606 $12,052 $12,0528 $5,368 $6,979 $8,589 $10,199 $11,810 $13,420 $13,4209 $5,915 $7,690 $9,465 $11,239 $13,014 $14,788 $14,788

10 $6,463 $8,401 $10,340 $12,279 $14,218 $16,156 $16,156

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Mon

roe

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,003 $2,604 $3,205 $3,806 $4,407 $5,008 $5,0082 $2,716 $3,531 $4,345 $5,160 $5,975 $6,790 $6,7903 $3,429 $4,457 $5,486 $6,515 $7,543 $8,572 $8,5724 $4,142 $5,384 $6,626 $7,869 $9,111 $10,354 $10,3545 $4,854 $6,311 $7,767 $9,223 $10,679 $12,136 $12,1366 $5,567 $7,237 $8,907 $10,577 $12,248 $13,918 $13,9187 $6,280 $8,164 $10,048 $11,932 $13,816 $15,700 $15,7008 $6,993 $9,091 $11,188 $13,286 $15,384 $17,482 $17,4829 $7,706 $10,017 $12,329 $14,640 $16,952 $19,264 $19,264

10 $8,418 $10,944 $13,469 $15,995 $18,520 $21,046 $21,046

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Mon

tgom

ery

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,590 $3,367 $4,144 $4,921 $5,698 $6,475 $6,4752 $3,511 $4,565 $5,618 $6,672 $7,725 $8,779 $8,7793 $4,433 $5,763 $7,093 $8,423 $9,753 $11,083 $11,0834 $5,355 $6,961 $8,567 $10,174 $11,780 $13,387 $13,3875 $6,276 $8,159 $10,042 $11,925 $13,808 $15,691 $15,6916 $7,198 $9,357 $11,517 $13,676 $15,835 $17,995 $17,9957 $8,119 $10,555 $12,991 $15,427 $17,863 $20,299 $20,2998 $9,041 $11,753 $14,466 $17,178 $19,890 $22,603 $22,6039 $9,963 $12,951 $15,940 $18,929 $21,918 $24,907 $24,907

10 $10,884 $14,150 $17,415 $20,680 $23,945 $27,211 $27,211

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Mon

tour

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,740 $2,262 $2,784 $3,306 $3,828 $4,350 $4,3502 $2,359 $3,067 $3,775 $4,483 $5,190 $5,898 $5,8983 $2,978 $3,872 $4,766 $5,659 $6,553 $7,446 $7,4464 $3,598 $4,677 $5,756 $6,836 $7,915 $8,994 $8,9945 $4,217 $5,482 $6,747 $8,012 $9,277 $10,542 $10,5426 $4,836 $6,287 $7,738 $9,189 $10,639 $12,090 $12,0907 $5,455 $7,092 $8,728 $10,365 $12,002 $13,638 $13,6388 $6,074 $7,897 $9,719 $11,541 $13,364 $15,186 $15,1869 $6,694 $8,702 $10,710 $12,718 $14,726 $16,734 $16,734

10 $7,313 $9,507 $11,701 $13,894 $16,088 $18,282 $18,282

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Nor

tham

pton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,983 $2,578 $3,173 $3,767 $4,362 $4,957 $4,9572 $2,688 $3,495 $4,302 $5,108 $5,915 $6,721 $6,7213 $3,394 $4,412 $5,431 $6,449 $7,467 $8,485 $8,4854 $4,100 $5,330 $6,559 $7,789 $9,019 $10,249 $10,2495 $4,805 $6,247 $7,688 $9,130 $10,572 $12,013 $12,0136 $5,511 $7,164 $8,817 $10,471 $12,124 $13,777 $13,7777 $6,216 $8,081 $9,946 $11,811 $13,676 $15,541 $15,5418 $6,922 $8,999 $11,075 $13,152 $15,229 $17,305 $17,3059 $7,628 $9,916 $12,204 $14,493 $16,781 $19,069 $19,069

10 $8,333 $10,833 $13,333 $15,833 $18,333 $20,833 $20,833

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Nor

thum

berla

nd

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Perr

y

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Phila

delp

hia

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,003 $2,604 $3,205 $3,806 $4,407 $5,008 $5,0082 $2,716 $3,531 $4,345 $5,160 $5,975 $6,790 $6,7903 $3,429 $4,457 $5,486 $6,515 $7,543 $8,572 $8,5724 $4,142 $5,384 $6,626 $7,869 $9,111 $10,354 $10,3545 $4,854 $6,311 $7,767 $9,223 $10,679 $12,136 $12,1366 $5,567 $7,237 $8,907 $10,577 $12,248 $13,918 $13,9187 $6,280 $8,164 $10,048 $11,932 $13,816 $15,700 $15,7008 $6,993 $9,091 $11,188 $13,286 $15,384 $17,482 $17,4829 $7,706 $10,017 $12,329 $14,640 $16,952 $19,264 $19,264

10 $8,418 $10,944 $13,469 $15,995 $18,520 $21,046 $21,046

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Pike

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $2,226 $2,893 $3,561 $4,229 $4,896 $5,564 $5,5642 $3,018 $3,923 $4,828 $5,734 $6,639 $7,544 $7,5443 $3,810 $4,953 $6,095 $7,238 $8,381 $9,524 $9,5244 $4,602 $5,982 $7,363 $8,743 $10,124 $11,504 $11,5045 $5,394 $7,012 $8,630 $10,248 $11,866 $13,484 $13,4846 $6,186 $8,041 $9,897 $11,753 $13,608 $15,464 $15,4647 $6,978 $9,071 $11,164 $13,258 $15,351 $17,444 $17,4448 $7,770 $10,101 $12,431 $14,762 $17,093 $19,424 $19,4249 $8,562 $11,130 $13,699 $16,267 $18,836 $21,404 $21,404

10 $9,354 $12,160 $14,966 $17,772 $20,578 $23,384 $23,384

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Potte

r

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,629 $2,117 $2,606 $3,095 $3,583 $4,072 $4,0722 $2,208 $2,871 $3,533 $4,196 $4,858 $5,521 $5,5213 $2,788 $3,624 $4,461 $5,297 $6,134 $6,970 $6,9704 $3,368 $4,378 $5,388 $6,398 $7,409 $8,419 $8,4195 $3,947 $5,131 $6,315 $7,500 $8,684 $9,868 $9,8686 $4,527 $5,885 $7,243 $8,601 $9,959 $11,317 $11,3177 $5,106 $6,638 $8,170 $9,702 $11,234 $12,766 $12,7668 $5,686 $7,392 $9,098 $10,803 $12,509 $14,215 $14,2159 $6,266 $8,145 $10,025 $11,905 $13,784 $15,664 $15,664

10 $6,845 $8,899 $10,952 $13,006 $15,059 $17,113 $17,113

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Schu

ylki

ll

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Snyd

er

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Som

erse

t

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,558 $2,025 $2,493 $2,960 $3,428 $3,895 $3,8952 $2,112 $2,746 $3,380 $4,013 $4,647 $5,281 $5,2813 $2,667 $3,467 $4,267 $5,067 $5,867 $6,667 $6,6674 $3,221 $4,188 $5,154 $6,120 $7,087 $8,053 $8,0535 $3,776 $4,908 $6,041 $7,174 $8,306 $9,439 $9,4396 $4,330 $5,629 $6,928 $8,227 $9,526 $10,825 $10,8257 $4,884 $6,350 $7,815 $9,280 $10,746 $12,211 $12,2118 $5,439 $7,070 $8,702 $10,334 $11,965 $13,597 $13,5979 $5,993 $7,791 $9,589 $11,387 $13,185 $14,983 $14,983

10 $6,548 $8,512 $10,476 $12,440 $14,405 $16,369 $16,369

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Sulli

van

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,598 $2,078 $2,557 $3,037 $3,517 $3,996 $3,9962 $2,167 $2,817 $3,468 $4,118 $4,768 $5,418 $5,4183 $2,736 $3,557 $4,378 $5,198 $6,019 $6,840 $6,8404 $3,305 $4,296 $5,288 $6,279 $7,271 $8,262 $8,2625 $3,874 $5,036 $6,198 $7,360 $8,522 $9,684 $9,6846 $4,442 $5,775 $7,108 $8,441 $9,773 $11,106 $11,1067 $5,011 $6,515 $8,018 $9,521 $11,025 $12,528 $12,5288 $5,580 $7,254 $8,928 $10,602 $12,276 $13,950 $13,9509 $6,149 $7,993 $9,838 $11,683 $13,527 $15,372 $15,372

10 $6,718 $8,733 $10,748 $12,764 $14,779 $16,794 $16,794

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Susq

ueha

nna

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,619 $2,104 $2,590 $3,075 $3,561 $4,047 $4,0472 $2,195 $2,853 $3,511 $4,170 $4,828 $5,487 $5,4873 $2,771 $3,602 $4,433 $5,264 $6,095 $6,927 $6,9274 $3,347 $4,351 $5,355 $6,359 $7,363 $8,367 $8,3675 $3,923 $5,099 $6,276 $7,453 $8,630 $9,807 $9,8076 $4,499 $5,848 $7,198 $8,547 $9,897 $11,247 $11,2477 $5,075 $6,597 $8,119 $9,642 $11,164 $12,687 $12,6878 $5,651 $7,346 $9,041 $10,736 $12,431 $14,127 $14,1279 $6,227 $8,095 $9,963 $11,831 $13,699 $15,567 $15,567

10 $6,803 $8,843 $10,884 $12,925 $14,966 $17,007 $17,007

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Tiog

a

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Uni

on

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,730 $2,249 $2,768 $3,287 $3,806 $4,325 $4,3252 $2,346 $3,049 $3,753 $4,457 $5,160 $5,864 $5,8643 $2,961 $3,849 $4,738 $5,626 $6,515 $7,403 $7,4034 $3,577 $4,650 $5,723 $6,796 $7,869 $8,942 $8,9425 $4,192 $5,450 $6,708 $7,965 $9,223 $10,481 $10,4816 $4,808 $6,250 $7,693 $9,135 $10,577 $12,020 $12,0207 $5,424 $7,051 $8,678 $10,305 $11,932 $13,559 $13,5598 $6,039 $7,851 $9,663 $11,474 $13,286 $15,098 $15,0989 $6,655 $8,651 $10,648 $12,644 $14,640 $16,637 $16,637

10 $7,270 $9,451 $11,633 $13,814 $15,995 $18,176 $18,176

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Vena

ngo

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,588 $2,065 $2,541 $3,018 $3,494 $3,971 $3,9712 $2,154 $2,800 $3,446 $4,092 $4,738 $5,384 $5,3843 $2,719 $3,534 $4,350 $5,166 $5,981 $6,797 $6,7974 $3,284 $4,269 $5,254 $6,239 $7,225 $8,210 $8,2105 $3,849 $5,004 $6,159 $7,313 $8,468 $9,623 $9,6236 $4,414 $5,739 $7,063 $8,387 $9,711 $11,036 $11,0367 $4,980 $6,473 $7,967 $9,461 $10,955 $12,449 $12,4498 $5,545 $7,208 $8,872 $10,535 $12,198 $13,862 $13,8629 $6,110 $7,943 $9,776 $11,609 $13,442 $15,275 $15,275

10 $6,675 $8,678 $10,680 $12,683 $14,685 $16,688 $16,688

Client Liability: 0% 10% 20% 30% 40% 50% 100%

War

ren

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,609 $2,091 $2,574 $3,056 $3,539 $4,021 $4,0212 $2,181 $2,835 $3,490 $4,144 $4,798 $5,452 $5,4523 $2,753 $3,579 $4,405 $5,231 $6,057 $6,883 $6,8834 $3,326 $4,323 $5,321 $6,319 $7,317 $8,314 $8,3145 $3,898 $5,068 $6,237 $7,406 $8,576 $9,745 $9,7456 $4,471 $5,812 $7,153 $8,494 $9,835 $11,176 $11,1767 $5,043 $6,556 $8,069 $9,582 $11,094 $12,607 $12,6078 $5,615 $7,300 $8,985 $10,669 $12,354 $14,038 $14,0389 $6,188 $8,044 $9,900 $11,757 $13,613 $15,469 $15,469

10 $6,760 $8,788 $10,816 $12,844 $14,872 $16,900 $16,900

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Was

hing

ton

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,639 $2,131 $2,622 $3,114 $3,606 $4,097 $4,0972 $2,222 $2,889 $3,555 $4,222 $4,889 $5,555 $5,5553 $2,805 $3,647 $4,488 $5,330 $6,172 $7,013 $7,0134 $3,389 $4,405 $5,422 $6,438 $7,455 $8,471 $8,4715 $3,972 $5,163 $6,355 $7,546 $8,738 $9,929 $9,9296 $4,555 $5,921 $7,288 $8,654 $10,021 $11,387 $11,3877 $5,138 $6,680 $8,221 $9,762 $11,304 $12,845 $12,8458 $5,721 $7,438 $9,154 $10,870 $12,587 $14,303 $14,3039 $6,305 $8,196 $10,087 $11,979 $13,870 $15,761 $15,761

10 $6,888 $8,954 $11,020 $13,087 $15,153 $17,219 $17,219

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Way

ne

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,689 $2,196 $2,703 $3,210 $3,717 $4,224 $4,2242 $2,291 $2,978 $3,665 $4,352 $5,040 $5,727 $5,7273 $2,892 $3,759 $4,627 $5,495 $6,362 $7,230 $7,2304 $3,493 $4,541 $5,589 $6,637 $7,685 $8,733 $8,7335 $4,094 $5,323 $6,551 $7,779 $9,007 $10,236 $10,2366 $4,695 $6,104 $7,513 $8,921 $10,330 $11,739 $11,7397 $5,297 $6,886 $8,475 $10,064 $11,653 $13,242 $13,2428 $5,898 $7,667 $9,437 $11,206 $12,975 $14,745 $14,7459 $6,499 $8,449 $10,399 $12,348 $14,298 $16,248 $16,248

10 $7,100 $9,230 $11,360 $13,491 $15,621 $17,751 $17,751

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Wes

tmor

elan

d

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,669 $2,170 $2,671 $3,172 $3,672 $4,173 $4,1732 $2,263 $2,942 $3,621 $4,300 $4,979 $5,658 $5,6583 $2,857 $3,714 $4,572 $5,429 $6,286 $7,143 $7,1434 $3,451 $4,487 $5,522 $6,557 $7,593 $8,628 $8,6285 $4,045 $5,259 $6,472 $7,686 $8,900 $10,113 $10,1136 $4,639 $6,031 $7,423 $8,815 $10,206 $11,598 $11,5987 $5,233 $6,803 $8,373 $9,943 $11,513 $13,083 $13,0838 $5,827 $7,575 $9,324 $11,072 $12,820 $14,568 $14,5689 $6,421 $8,348 $10,274 $12,200 $14,127 $16,053 $16,053

10 $7,015 $9,120 $11,224 $13,329 $15,434 $17,538 $17,538

Client Liability: 0% 10% 20% 30% 40% 50% 100%

Wyo

min

g

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,679 $2,183 $2,687 $3,191 $3,695 $4,198 $4,1982 $2,277 $2,960 $3,643 $4,326 $5,009 $5,692 $5,6923 $2,875 $3,737 $4,599 $5,462 $6,324 $7,186 $7,1864 $3,472 $4,514 $5,555 $6,597 $7,639 $8,680 $8,6805 $4,070 $5,291 $6,512 $7,733 $8,953 $10,174 $10,1746 $4,667 $6,068 $7,468 $8,868 $10,268 $11,668 $11,6687 $5,265 $6,844 $8,424 $10,003 $11,583 $13,162 $13,1628 $5,863 $7,621 $9,380 $11,139 $12,898 $14,656 $14,6569 $6,460 $8,398 $10,336 $12,274 $14,212 $16,150 $16,150

10 $7,058 $9,175 $11,292 $13,410 $15,527 $17,644 $17,644

Client Liability: 0% 10% 20% 30% 40% 50% 100%

York

Intensive Outpatient/Partial Hospitalization

Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income Monthly Income MonthlyEqual to or Equal to or Equal to or Equal to or Equal to or Equal to or Income

Family Size Less Than Less Than Less Than Less Than Less Than Less Than Greater Than

1 $1,689 $2,196 $2,703 $3,210 $3,717 $4,224 $4,2242 $2,291 $2,978 $3,665 $4,352 $5,040 $5,727 $5,7273 $2,892 $3,759 $4,627 $5,495 $6,362 $7,230 $7,2304 $3,493 $4,541 $5,589 $6,637 $7,685 $8,733 $8,7335 $4,094 $5,323 $6,551 $7,779 $9,007 $10,236 $10,2366 $4,695 $6,104 $7,513 $8,921 $10,330 $11,739 $11,7397 $5,297 $6,886 $8,475 $10,064 $11,653 $13,242 $13,2428 $5,898 $7,667 $9,437 $11,206 $12,975 $14,745 $14,7459 $6,499 $8,449 $10,399 $12,348 $14,298 $16,248 $16,248

10 $7,100 $9,230 $11,360 $13,491 $15,621 $17,751 $17,751

Client Liability: 0% 10% 20% 30% 40% 50% 100%

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