$221$119.40Prescription eligible
- $230$207Prescription eligible$156$84
- $106$95Prescription eligible
- $195Prescription eligible$166$89.40$240$129.60Prescription eligible
- $270$145.80Prescription eligible$91$49.20Prescription eligible$519$249Prescription eligible
- $128$69Prescription eligible$376$300.80Prescription eligible$170Prescription eligible
- $88$29Prescription eligible$82$44.40Prescription eligible$452Prescription eligible
- $582$314.40Prescription eligible$280$134.40Prescription eligible$365Prescription eligible
- $196Prescription eligible$313$169.20Prescription eligible$499$269.40Prescription eligible
- $343$164.40Prescription eligible$146$78.60Prescription eligible$184$99.60Prescription eligible
- $165$89.40Prescription eligible$128$69Prescription eligible$239$129Prescription eligible
- $258$139.20$141$59.40Prescription eligible
- $257$138.60$141$59.40Prescription eligible







































































