$134$64.20Prescription eligible
- $181$87$363Prescription eligible
- $422$202.80Prescription eligible$322$258Prescription eligible$422Prescription eligible
- $267$128.40Prescription eligible$156$75Prescription eligible$191Prescription eligible
- $488$292.80Prescription eligible$382$229.20Prescription eligible$382$229.20Prescription eligible
- $191Prescription eligible$452Prescription eligible$363Prescription eligible
- $163$130Prescription eligible$351$210.60$192$103.80
- $404$193.80Prescription eligible$248$104.40Prescription eligible$160$96Prescription eligible
- $238$128.40$341$184.20$426$204.60Prescription eligible
- $288$259Prescription eligible$422Prescription eligible$194Prescription eligible
- $371$178.20Prescription eligible$382$229.20Prescription eligible$420Prescription eligible
- $244Prescription eligible$274$131.40Prescription eligible$191Prescription eligible
- $393Prescription eligible



































































