$118$63.60Prescription eligible
- $144$78Prescription eligible$163$68.40Prescription eligible
- $158$85.20Prescription eligible$199$71.40Prescription eligible$144$86.40Prescription eligible
- $143$77.40Prescription eligible$126$67.80Prescription eligible$120$64.80Prescription eligible
- $141$76.20Prescription eligible$141$67.80Prescription eligible$176$73.80Prescription eligible
- $142$76.80Prescription eligible$120$64.80Prescription eligible$141$76.20Prescription eligible
- $125$67.80Prescription eligible$163$88.20Prescription eligible$119$64.20Prescription eligible
- $110$66Prescription eligible$110$59.40Prescription eligible$121$65.40Prescription eligible
- $139$66.60Prescription eligible$121$58.20Prescription eligible$163$68.40Prescription eligible
- $119$64.20Prescription eligible


















































