$110$59.40
- $100$54
- $128$69Prescription eligible$92$44.40Prescription eligible$183$99
- $183$99$183$99$183$99
- $165$89.40Prescription eligible$98$29Prescription eligible$178$64.20
- $114$103Prescription eligible$123$58.80Prescription eligible$106$95Prescription eligible
- $96$86Prescription eligible$155$74.40$109$39Prescription eligible
- $146$43.80Prescription eligible$200$84$193$104.40
- $166$79.80$119$64.20$260$109.20Prescription eligible
- $138$74.40$164$58.80Prescription eligible$165$69.60Prescription eligible
- $288$69Prescription eligible$332$79.80Prescription eligible$96$86Prescription eligible
- $165$79.20$144$69$118$19Prescription eligible







































































