$270$129.60Prescription eligible
- $249$134.40$582$279.60Prescription eligible
- $591$319.20Prescription eligible$114$103Prescription eligible$645$309.60Prescription eligible
- $311$149.40Prescription eligible$228$109.20Prescription eligible$675$364.80Prescription eligible
- $480$259.20Prescription eligible$248$118.80Prescription eligible$248$118.80Prescription eligible
- $160Prescription eligible$769$369Prescription eligible$114$54.60Prescription eligible
- $592$355.20$106Prescription eligible$224$94.20Prescription eligible
- $393Prescription eligible$422Prescription eligible$178Prescription eligible
- $215Prescription eligible$191Prescription eligible$406$219Prescription eligible
- $343$164.40Prescription eligible$375Prescription eligible$395Prescription eligible
- $440$220Prescription eligible$108$97Prescription eligible$478$229.20Prescription eligible
- $183$99$183$99$183$99
- $230$124.20$822$444$166$79.80







































































