$134$56.40Prescription eligible
- $127$76.20Prescription eligible$378$226.80Prescription eligible
- $144$78Prescription eligible$204$110.40Prescription eligible$328$157.20Prescription eligible
- $259$108.60$178$64.20$152$73.20
- $132$71.40$91$33$335$160.80
- $404$193.80
- $108$97Prescription eligible$158$85.20Prescription eligible$340$183.60Prescription eligible
- $168$40.20Prescription eligible$246$103.20Prescription eligible$187$45Prescription eligible
- $393Prescription eligible$218$117.60$231
- $98$29Prescription eligible$118$106Prescription eligible$280$151.20Prescription eligible
- $418$225.60Prescription eligible$363Prescription eligible$488$244Prescription eligible
- $698$334.80Prescription eligible$427$172$155Prescription eligible
- $170Prescription eligible$342$143.40Prescription eligible$328$157.20Prescription eligible







































































