$119$64.20
- $156$84$106$95Prescription eligible
- $195Prescription eligible
- $168$90.60$238$128.40Prescription eligible$89$48Prescription eligible
- $137$66Prescription eligible$516$247.80Prescription eligible$126$67.80Prescription eligible
- $170Prescription eligible$342$143.40Prescription eligible$329$79.20Prescription eligible
- $217$91.20Prescription eligible$96$29Prescription eligible$257$138.60
- $305$165
- $138Prescription eligible$581$279Prescription eligible
- $365Prescription eligible$196Prescription eligible$496$267.60Prescription eligible
- $141$67.80Prescription eligible$425$255Prescription eligible$346$186.60Prescription eligible
- $248$148.80Prescription eligible$188$112.80Prescription eligible$88$52.80Prescription eligible
- $166$99.60Prescription eligible$132$79.20Prescription eligible$198$118.80Prescription eligible







































































