$693$291Prescription eligible
- $181$97.80$211$114
- $158$85.20$163$88.20$218$174Prescription eligible
- $642$308.40Prescription eligible$126$67.80Prescription eligible$434$234.60Prescription eligible
- $118$106Prescription eligible$192Prescription eligible
- $496$238.20Prescription eligible$404$193.80Prescription eligible$121$58.20Prescription eligible
- $582$314.40Prescription eligible$168$90.60
- $300Prescription eligible$350Prescription eligible$166$99.60Prescription eligible
- $198$118.80Prescription eligible$338$162
- $106$39Prescription eligible$226$94.80Prescription eligible
- $133$40.20Prescription eligible$163$88.20Prescription eligible
- $144$78Prescription eligible$163Prescription eligible







































































