$367$198Prescription eligible
- $204$97.80Prescription eligible$299$143.40Prescription eligible
- $454$217.80Prescription eligible$332$179.40$144$78Prescription eligible
- $126$67.80Prescription eligible$274$148.20Prescription eligible$163$78Prescription eligible
- $480$259.20$587$211.20$293$123
- $442$238.80Prescription eligible$156$65.40Prescription eligible$118$63.60
- $142$68.40Prescription eligible$139$75$274$148.20Prescription eligible
- $348$166.80$142$68.40Prescription eligible$145$78.60Prescription eligible
- $120$36Prescription eligible$188$67.80Prescription eligible$556$200.40
- $149$71.40$448$214.80$75$36
- $183$99$314$132Prescription eligible$132$71.40Prescription eligible
- $152$82.20$120$36Prescription eligible$142$76.80Prescription eligible
- $110$52.80$82$39.60$461$221.40Prescription eligible







































































