$367$198Prescription eligible
- $228$96Prescription eligible$305$146.40Prescription eligible
- $454$245.40Prescription eligible$144$78Prescription eligible$129$69.60Prescription eligible
- $274$164.40Prescription eligible$480$259.20$305$128.40
- $441$264.60Prescription eligible$158$85.20Prescription eligible$142$68.40Prescription eligible
- $139$75$351$189.60$152$63.60Prescription eligible
- $144$86.40Prescription eligible$127$38.40Prescription eligible$199$83.40Prescription eligible
- $556$200.40$436$235.20Prescription eligible$149$62.40Prescription eligible
- $79$37.80$321$135Prescription eligible$141$76.20Prescription eligible
- $404$218.40Prescription eligible$475$228$155$84
- $117$63Prescription eligible$82$34.20$461$221.40Prescription eligible
- $636$267$120$64.80Prescription eligible$680$204
- $237$114$143$77.40Prescription eligible$193$104.40Prescription eligible







































































