$234$84Prescription eligible
- $278$133.20Prescription eligible$248$118.80Prescription eligible
- $138$58.20Prescription eligible$183$99Prescription eligible$118$52.80
- $160$67.20Prescription eligible$228$123Prescription eligible$198$47.40Prescription eligible
- $210$63Prescription eligible$162$87.60Prescription eligible$120$57.60Prescription eligible
- $186$100.20Prescription eligible$220$66Prescription eligible$192$103.80Prescription eligible
- $195$70.20Prescription eligible$218$104.40Prescription eligible$211$52.80Prescription eligible
- $244$87.60Prescription eligible$234$126.60Prescription eligible$222$66.60Prescription eligible
- $152$82.20Prescription eligible$84$40.80Prescription eligible$238$100.20Prescription eligible
- $178$85.20Prescription eligible$178$96Prescription eligible$199$107.40Prescription eligible
- $89$48Prescription eligible$316$151.80Prescription eligible$132$71.40Prescription eligible
- $88$47.40Prescription eligible$88$47.40Prescription eligible$88$47.40Prescription eligible
- $208$112.20Prescription eligible




































































