$126$75.60
- Prescription eligiblePrescription eligible$129$77.40Prescription eligible$170
- Prescription eligible$99$59.40Prescription eligible$138$74.40Prescription eligible$397$214.20
- Prescription eligible$384$184.20Prescription eligible$108$64.80Prescription eligible$118$70.80
- Prescription eligible$692$290.40Prescription eligible$106$95Prescription eligible$186$89.40
- Prescription eligible$165$79.20Prescription eligible$144$60.60Prescription eligible$120$72
- Prescription eligible$588$352.80Prescription eligible$195Prescription eligible$195
- Prescription eligible$154$92.40Prescription eligible$446$214.20Prescription eligible$480$259.20
- Prescription eligible$212$127.20Prescription eligible$258$139.20Prescription eligible$262
- Prescription eligible$206$123.60Prescription eligible$323$174.60Prescription eligible$114$103
- Prescription eligible$645$309.60Prescription eligible$369$199.20Prescription eligible$369$199.20
- Prescription eligible$267$144Prescription eligible$582$314.40Prescription eligible$665$399
- Prescription eligible$563$304.20Prescription eligible$138$74.40Prescription eligible$591$319.20







































































