Non-discountable
$63.87
$22.35
$1,189.02
$416.16
$56.19
$103.66
$36.28
$251.39
$87.99
$813.48
$284.72
$125.19
$43.82
$645.85
$226.05
$303.32
$106.16
$25,513.01
$8,929.55
$73.60
$3,620.81
$1,267.28
