- $164$98.40Prescription eligible$148$79.80Prescription eligible$292$157.80
- $218$130.80Prescription eligible$226$135.60Prescription eligible$167$100.20Prescription eligible
- $182$109.20Prescription eligible$174$83.40Prescription eligible$168$100.80Prescription eligible
- $182$109.20Prescription eligible$324$194.40Prescription eligible$139$83.40Prescription eligible
- $132$63.60$368$198.60Prescription eligible$188$112.80Prescription eligible
- $267$144Prescription eligible$336$181.20Prescription eligible$139$83.40Prescription eligible
- $168$80.40$92$49.80Prescription eligible$316$151.80
- $154$83.40Prescription eligible$216$116.40Prescription eligible















































