$114$91Prescription eligible
- $118$94Prescription eligible$114$91Prescription eligible
- $588$317.40Prescription eligible$578$312Prescription eligible$558$301.20Prescription eligible
- $534$288.60Prescription eligible$216$116.40Prescription eligible$216$103.80Prescription eligible
- $628$339Prescription eligible$98$78Prescription eligible$648$349.80Prescription eligible
- $502$241.20Prescription eligible$314$188.40Prescription eligible$124$59.40Prescription eligible
- $94Prescription eligible$114$80Prescription eligible

































