- Prescription eligible$331$159Prescription eligible$248$148.80Prescription eligible$311$186.60
- Prescription eligible$313$169.20Prescription eligible$502$301.20Prescription eligible$598$358.80
- Prescription eligible$494$296.40$592$355.20Prescription eligible$415$174.60
- Prescription eligible$415$174.60Prescription eligible$406$219Prescription eligible$426$178.80
- Prescription eligible$343$164.40Prescription eligible$366$219.60Prescription eligible$539$226.20
- Prescription eligible$560$336Prescription eligible$364$218.40Prescription eligible$373$178.80





































