$138$33Prescription eligible
- $108$98Prescription eligible
- $213$100$54
- $416$199.80Prescription eligible$418$200.40Prescription eligible$668$360.60Prescription eligible
- $468$224.40Prescription eligible$466$251.40Prescription eligible
- $395Prescription eligible
- $592$533Prescription eligible$472$255Prescription eligible
- $308$184.80Prescription eligible$368$198.60Prescription eligible$120$64.80
- $294$141Prescription eligible$462$249.60Prescription eligible$316$170.40
- $125Prescription eligible$618$370.80Prescription eligible$434$208.20Prescription eligible
- $544$326.40Prescription eligible$158$85.20Prescription eligible$297$160.20Prescription eligible
- $234$70.20Prescription eligible$118$49.80Prescription eligible$202$97.20Prescription eligible
- $398$214.80Prescription eligible$106$64Prescription eligible$256$138Prescription eligible







































































