$367$220.20Prescription eligible
- $228$96Prescription eligible$305$146.40Prescription eligible
- $144$78Prescription eligible$129$69.60Prescription eligible$274$164.40Prescription eligible
- $163$68.40Prescription eligible$480$259.20$595$214.20
- $305$128.40$441$264.60Prescription eligible$158$85.20Prescription eligible
- $142$68.40Prescription eligible$139$75$351$168.60
- $152$73.20Prescription eligible$144$86.40Prescription eligible$127$38.40Prescription eligible
- $199$71.40Prescription eligible$556$200.40$149$62.40
- $79$37.80$183$99$321$135Prescription eligible
- $141$76.20Prescription eligible$404$121.20Prescription eligible$475$228
- $155$84$117$63Prescription eligible$82$34.20
- $461$221.40Prescription eligible$636$267$120$64.80Prescription eligible
- $680$204$237$127.80$193$104.40Prescription eligible







































































