FSA/HSA Eligible
$1,500.00
$6,899.00
$7,999.00
$5,499.00
$1,924.65
$4,999.00
$1,749.65
$6,999.00
$2,449.65
$8,699.00
$3,044.65
$7,599.00
$2,659.65
$6,699.00
