$119$64.20
- $363Prescription eligible$126$67.80Prescription eligible
- $274$148.20Prescription eligible$766$367.80Prescription eligible$132$63.60
- $190Prescription eligible$288$155.40Prescription eligible
- $257$108Prescription eligible
- $581$279Prescription eligible$196Prescription eligible$416$174.60Prescription eligible
- $116$62.40Prescription eligible$186$100.20Prescription eligible$198$118.80Prescription eligible
- $393Prescription eligible$217$104$29Prescription eligible
- $156$93.60Prescription eligible$160Prescription eligible
- $351$210.60$163$78Prescription eligible$148$79.80Prescription eligible
- $108$58.20Prescription eligible
- $192$92.40Prescription eligible







































































