$98$68.60
- $104$72.80$90$63
- $78$54.60$124$86.80$171$84
- $154$107.80$126$88.20$74$51.80
- $94$65.80$135$94.50$106$74.20
- $82$57.40$228$159.60$178$124.60
- $89$62.30$97$67.90$133$93.10
- $175$122.50$115$80.50Prescription eligible$86$60.20
- $116$81.20$135$94.50Prescription eligible$115$80.50
- Prescription eligible$96$67.20$106$74.20Prescription eligible$115$80.50
- $180$126$171$84Prescription eligible$198$138.60
- $171$84$228$159.60$218$152.60
- $82$57.40Prescription eligible$82$57.40$175$122.50








































































