$119$64.20
- $156$84$198$118.80
- $129$54Prescription eligible$129$61.80Prescription eligible$578$312Prescription eligible
- $378$181.20Prescription eligible$488$263.40Prescription eligible
- $176$52.80Prescription eligible$220Prescription eligible$205Prescription eligible
- $228$182Prescription eligible$125$60Prescription eligible$89$48Prescription eligible
- $181$97.80$202$121.20$181$97.80
- $163$88.20Prescription eligible$163$78Prescription eligible$158$85.20Prescription eligible
- $163$97.80Prescription eligible$158$94.80Prescription eligible$163$78Prescription eligible
- $163$78Prescription eligible$163$88.20Prescription eligible$163$78
- $163$88.20$663$318Prescription eligible$246$221Prescription eligible
- $591$319.20Prescription eligible$217$104.40Prescription eligible$216$116.40Prescription eligible
- $630Prescription eligible$126$67.80Prescription eligible$293$140.40Prescription eligible







































































