$73$39.60
- $74$40.20
- $164$88.80Prescription eligible$205$98.40Prescription eligible$295$159.60Prescription eligible
- $141$59.40$93$50.40$134$72.60
- $91$38.40$371$178.20$285Prescription eligible
- $154$37.20Prescription eligible$168$40.20Prescription eligible$248$104.40Prescription eligible
- $278$150Prescription eligible$248$89.40Prescription eligible$187$67.20Prescription eligible
- $148$62.40Prescription eligible$234$98.40Prescription eligible$118$56.40Prescription eligible
- $163$78Prescription eligible$393Prescription eligible$117$49.20Prescription eligible
- $335$160.80$322$115.80$218$117.60
- $98$29Prescription eligible$280$168Prescription eligible$418$225.60Prescription eligible
- $427$198Prescription eligible$198Prescription eligible
- $205Prescription eligible$170Prescription eligible$205Prescription eligible







































































