$119$64.20
- $156$84$134$56.40Prescription eligible
- $248$118.80Prescription eligible$183$76.80Prescription eligible$156$75Prescription eligible
- $142$85.20Prescription eligible$126$67.80Prescription eligible$195Prescription eligible
- $195Prescription eligible$114$103Prescription eligible$98$41.40Prescription eligible
- $220Prescription eligible$413$223.20Prescription eligible$141$59.40Prescription eligible
- $163$88.20Prescription eligible$158$75.60Prescription eligible$126$67.80Prescription eligible
- $274$148.20Prescription eligible$246$118.20Prescription eligible$104$94Prescription eligible
- $86$51.60Prescription eligible$196$82.20Prescription eligible$86Prescription eligible
- $267$128.40Prescription eligible$225$121.80Prescription eligible$219$105Prescription eligible
- $348$166.80Prescription eligible$163$88.20Prescription eligible$272$114Prescription eligible
- $194$105$152$73.20Prescription eligible
- $98$29Prescription eligible$78Prescription eligible$160Prescription eligible







































































