$538$290.40Prescription eligible
- $393Prescription eligible$375Prescription eligible
- $434$234.60Prescription eligible$434$234.60Prescription eligible$152$82.20Prescription eligible
- $262Prescription eligible$422Prescription eligible$110$66Prescription eligible
- $158$85.20$508$243.60Prescription eligible$363Prescription eligible
- $458$229Prescription eligible$534$288.60Prescription eligible$310$167.40Prescription eligible
- $584$315.60Prescription eligible$216$103.80Prescription eligible$216$103.80Prescription eligible
- $630Prescription eligible$518$279.60Prescription eligible$98$29Prescription eligible
- $184$88.20Prescription eligible$180$126Prescription eligible$126$67.80Prescription eligible
- $216$116.40Prescription eligible$198$118.80Prescription eligible$96$39Prescription eligible
- $207Prescription eligible$128$115Prescription eligible
- $254$137.40Prescription eligible$363Prescription eligible$96$39Prescription eligible
- $548$262.80Prescription eligible







































































