$425$229.80Prescription eligible
- $234$98.40Prescription eligible$233$111.60Prescription eligible
- $193$81Prescription eligible$292$157.80$217$117Prescription eligible
- $178$96Prescription eligible$210Prescription eligible$168Prescription eligible
- $216$116.40Prescription eligible$139$83.40Prescription eligible$167$100.20Prescription eligible
- $138$29Prescription eligible$341$163.80Prescription eligible$136$73.20Prescription eligible
- $84$29Prescription eligible$96$29Prescription eligible$304$164.40Prescription eligible
- $326$156.60Prescription eligible$145Prescription eligible$108$97Prescription eligible
- $283$170Prescription eligible$338$162$267$144Prescription eligible
- $285Prescription eligible$391$274Prescription eligible$226$181Prescription eligible
- $217$130Prescription eligible$256$123Prescription eligible$207Prescription eligible
- $119$64.20Prescription eligible$128$61.20Prescription eligible$119$64.20
- $156$75$144$78Prescription eligible$268$144.60







































































