$248$133.80
- $196$105.60Prescription eligible$195Prescription eligible
- $563$304.20Prescription eligible$166$99.60Prescription eligible$141$59.40Prescription eligible
- $822$444$158$94.80$126$67.80Prescription eligible
- $262Prescription eligible$163$88.20Prescription eligible$74$40.20Prescription eligible
- $94$85Prescription eligible$248$118.80Prescription eligible$104$94Prescription eligible
- $137$123Prescription eligible$339Prescription eligible$184$99.60Prescription eligible
- $156$75Prescription eligible$404$193.80Prescription eligible$668$320.40Prescription eligible
- $554$299.40Prescription eligible$266$143.40Prescription eligible$138$82.80Prescription eligible
- $186$100.20Prescription eligible$148$79.80Prescription eligible$254$137.40
- $82$44.40$156$65.40Prescription eligible$311$168Prescription eligible
- $226$108.60Prescription eligible$287$120.60
- $160Prescription eligible$160Prescription eligible







































































