$471$198
- $246$132.60Prescription eligible$254$137.40
- $207$239
- $298$107.40$105Prescription eligible$128$61.20Prescription eligible
- $178Prescription eligible$94$39.60$158$85.20
- $176$84.60Prescription eligible$498$268.80Prescription eligible$262$236Prescription eligible
- $422Prescription eligible$284$136.20Prescription eligible$194Prescription eligible
- $178Prescription eligible$191Prescription eligible$258$154.80Prescription eligible
- $588$317.40Prescription eligible$466$251.40Prescription eligible$346$186.60Prescription eligible
- $406$219Prescription eligible$440Prescription eligible$111$46.80Prescription eligible
- $207Prescription eligible$178Prescription eligible$207Prescription eligible
- $109$58.80Prescription eligible$191Prescription eligible$236$127.20Prescription eligible







































































