$119$64.20
- $134$64.20Prescription eligible$589$318Prescription eligible
- $258$123.60Prescription eligible$246$197Prescription eligible$219$105Prescription eligible
- $218$130.80Prescription eligible$478$258Prescription eligible$412$172.80Prescription eligible
- $166$99.60Prescription eligible$120$64.80$125$60Prescription eligible
- $194$105$194$105$185$100.20
- $211$114$202$121.20$163$88.20Prescription eligible
- $163$78Prescription eligible$163$88.20Prescription eligible$163$88.20
- $137$57.60Prescription eligible$145$78.60Prescription eligible$145$78.60Prescription eligible
- $517$248.40Prescription eligible$267$160.20Prescription eligible$218$174Prescription eligible
- $266$239Prescription eligible$363Prescription eligible$293$158.40Prescription eligible
- $125$60Prescription eligible$267$144Prescription eligible$175$94.80Prescription eligible
- $258$108.60Prescription eligible$121$51Prescription eligible$308$147.60Prescription eligible







































































