$286$137.40Prescription eligible
- $114$91Prescription eligible$262$236Prescription eligible
- $422Prescription eligible$178Prescription eligible$207Prescription eligible
- $688$412.80Prescription eligible$98$69Prescription eligible$132$71.40Prescription eligible
- $65Prescription eligible$108$58.20Prescription eligible$75Prescription eligible
- $393$275.10Prescription eligible$106Prescription eligible
- $114$91Prescription eligible$106$29Prescription eligible$578
- $422Prescription eligible$98$78Prescription eligible$246$197Prescription eligible
- $124$59.40Prescription eligible$106$57Prescription eligible$160Prescription eligible
- $94$29Prescription eligible$114$80Prescription eligible$128$54Prescription eligible





















































