- $351$189.60
- $178
- $305$146.40Prescription eligible$128$54Prescription eligible$138$33Prescription eligible
- $160$80$140Prescription eligible$239
- $454$245.40Prescription eligible$605$217.80$475$199.80
- $108$191$272Prescription eligible
- $333$191Prescription eligible
- $215
- $109$98Prescription eligible$213$333Prescription eligible
- $218$511Prescription eligible
- $274$164.40Prescription eligible$333$486







































































