$134$56.40Prescription eligible
- $127$76.20Prescription eligible$465$279Prescription eligible$378$226.80Prescription eligible
- $328$157.20Prescription eligible$259$108.60$178$64.20
- $152$73.20Prescription eligible$132$71.40$91$33
- $262Prescription eligible
- $404$193.80$108$97Prescription eligible$158$85.20Prescription eligible
- $340$183.60Prescription eligible
- $168$40.20Prescription eligible$246$103.20Prescription eligible$234$140.40Prescription eligible
- $104$94Prescription eligible$393Prescription eligible$117$56.40Prescription eligible
- $218$117.60$231$252$136.20
- $125$113Prescription eligible$280$151.20Prescription eligible$98$29Prescription eligible







































































