$165$89.40
- $341$184.20Prescription eligible$138$74.40Prescription eligible
- $270$129.60Prescription eligible$138$66Prescription eligible$692$249Prescription eligible
- $591$319.20Prescription eligible$195Prescription eligible$446$214.20Prescription eligible
- $165$89.40Prescription eligible$222Prescription eligible$230$124.20Prescription eligible
- $227$109.20Prescription eligible$249$199Prescription eligible$217$174Prescription eligible
- $248$118.80Prescription eligible$630Prescription eligible$393Prescription eligible
- $363Prescription eligible$178Prescription eligible$160Prescription eligible
- $227Prescription eligible$227Prescription eligible$160Prescription eligible
- $110$59.40Prescription eligible$457Prescription eligible$511$255.50Prescription eligible
- $452$244.20Prescription eligible$114$103Prescription eligible$188$90Prescription eligible
- $147$70.80Prescription eligible$499$239.40Prescription eligible$230$207Prescription eligible
- $365Prescription eligible$207$111.60Prescription eligible$422Prescription eligible







































































