$119$64.20
- $156$75$268$144.60
- $134$64.20Prescription eligible$134$64.20Prescription eligible$134$64.20Prescription eligible
- $248$89.40$129$54Prescription eligible$129$61.80Prescription eligible
- $196$105.60Prescription eligible$438$184.20Prescription eligible$693$291Prescription eligible
- $106$95Prescription eligible$114$103Prescription eligible$114$103Prescription eligible
- $98$41.40Prescription eligible$176$52.80Prescription eligible$108$97Prescription eligible
- $478$258Prescription eligible$413$198Prescription eligible$412$172.80Prescription eligible
- $270$97.20Prescription eligible$141$59.40Prescription eligible$125$60Prescription eligible
- $194$105$194$105$185$100.20
- $185$100.20$185$100.20$185$100.20
- $89$48Prescription eligible$163$78Prescription eligible$181$97.80
- $211$101.40$202$97.20$228$123







































































