$134$64.20Prescription eligible
- $134$64.20Prescription eligible$248$133.80
- $170Prescription eligible$138$74.40Prescription eligible$218$117.60Prescription eligible
- $232$125.40Prescription eligible$578$312Prescription eligible$378$181.20Prescription eligible
- $438$184.20Prescription eligible$693$291Prescription eligible$393
- $441$211.80Prescription eligible
- $488$263.40Prescription eligible$258$123.60Prescription eligible$246$197Prescription eligible
- $322$174Prescription eligible$114$103Prescription eligible$367$198Prescription eligible
- $260$140.40Prescription eligible$582$314.40Prescription eligible$588$317.40Prescription eligible
- $248$133.80Prescription eligible$79$47.40Prescription eligible$219$118.20Prescription eligible
- $205Prescription eligible$166$89.40Prescription eligible$322$174Prescription eligible
- $270$97.20Prescription eligible$228$182Prescription eligible$194$105
- $185$100.20$185$100.20$185$100.20







































































