$348$187.80Prescription eligible
- $205$98.40Prescription eligible$277$133.20Prescription eligible
- $432$207.60Prescription 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$208$112.20$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$486$233.40Prescription eligible
- $108$51.60Prescription eligible$128$69Prescription eligible$120$28.80Prescription eligible
- $188$79.20Prescription eligible$215$116.40Prescription eligible$556$200.40
- $436$235.20Prescription eligible$149$71.40$448$214.80
- $175$73.80Prescription eligible$361$151.80$75$40.80







































































