$134$64.20Prescription eligible
- $693$291Prescription eligible$589$318Prescription eligible
- $195Prescription eligible$441$211.80Prescription eligible$114$103Prescription eligible
- $108$97Prescription eligible$413$198Prescription eligible$228$182Prescription eligible
- $194$105$185$100.20$202$97.20
- $663$358.20Prescription eligible$237$127.80Prescription eligible$267$128.40Prescription eligible
- $363Prescription eligible$457$228.50Prescription eligible$178Prescription eligible
- $293$140.40Prescription eligible$533$288Prescription eligible$104$94Prescription eligible
- $126$50$245$88.20Prescription eligible$200$108Prescription eligible
- $258$108.60Prescription eligible$196$82.20Prescription eligible$121$51Prescription eligible
- $126$60.60Prescription eligible$119$71.40Prescription eligible$163$78Prescription eligible
- $225$121.80Prescription eligible$249$199Prescription eligible$217$174Prescription eligible
- $246$118.20Prescription eligible$630Prescription eligible$393Prescription eligible







































































