$147$79.20
- Prescription eligiblePrescription eligible$134$64.20Prescription eligible$134$64.20
- Prescription eligible$138$66Prescription eligible$249$134.40Prescription eligible$126$75.60
- Prescription eligible$129$77.40Prescription eligible$170Prescription eligible$99$59.40
- Prescription eligible$138$74.40Prescription eligible$397$214.20Prescription eligible$221$119.40
- Prescription eligible$384$184.20Prescription eligible$108$64.80Prescription eligible$118$70.80
- Prescription eligible$692$290.40Prescription eligible$175$94.80Prescription eligible$106$95
- Prescription eligible$249$119.40Prescription eligible$186$89.40Prescription eligible$165$79.20
- Prescription eligible$144$69Prescription eligible$147$79.20Prescription eligible$144$60.60
- Prescription eligible$129$69.60Prescription eligible$120$72Prescription eligible$588$352.80
- Prescription eligible$389Prescription eligible$356Prescription eligible$195
- Prescription eligible$195Prescription eligible$154$92.40Prescription eligible$137$82.20
- Prescription eligible$418$250.80Prescription eligible$446$214.20Prescription eligible$488$292.80







































































