AREA

EMPLOYEE ONLY

EMPLOYEE +
SPOUSE

EMPLOYEE +
CHILD(ren)

EMPLOYEE +
FAMILY

1

$30.36

$59.90

$49.18

$101.24

2

$33.08

$64.86

$53.60

$109.84

3

$36.08

$70.70

$58.44

$110.43

4

$39.32

$77.08

$63.70

$129.24

5

$42.88

$84.04

$69.46

$143.86

6

$46.74

$91.58

$75.70

$150.45