$348$187.80Prescription eligible
- $205$98.40Prescription eligible$277$133.20Prescription eligible
- $332$179.40$113$61.20Prescription eligible$100$54Prescription eligible
- $280$151.20Prescription eligible$140$67.20Prescription eligible$164$88.80Prescription eligible
- $480$259.20$587$211.20$266$143.40Prescription eligible
- $442$238.80Prescription eligible$134$64.20Prescription eligible$118$63.60
- $118$56.40Prescription eligible$139$75$250$135Prescription eligible
- $122$66Prescription eligible$148$70.80Prescription eligible$348$166.80
- $108$51.60Prescription eligible$128$69Prescription eligible$120$28.80Prescription eligible
- $188$79.20Prescription eligible$215$116.40Prescription eligible$556$200.40
- $149$71.40$448$214.80$175$73.80Prescription eligible
- $361$151.80$75$40.80$208$112.20Prescription eligible
- $282$135.60$183$99$476$228.60








































































