FSA/HSA Eligible

$12.04

$4.21

$15.60

$5.46

$79.35

$27.77

$15.60

$5.46

$17.51

$6.13

$39.40

$13.79

$36.39

$17.51

$6.13

$47.06

$16.47

$41.59

$14.56

$17.78

$6.22

$66.22

$23.18