$425$204Prescription eligible
- $195Prescription eligible$84Prescription eligible
- $205Prescription eligible$156$56.40Prescription eligible$426$178.80Prescription eligible
- $532$319.20Prescription eligible$540$291.60Prescription eligible$96$86Prescription eligible
- $262Prescription eligible$697$334.80Prescription eligible$78Prescription eligible
- $165$115.50$262Prescription eligible$213Prescription eligible
- $128$69Prescription eligible$96Prescription eligible
- $74$67Prescription eligible$191Prescription eligible
- $89$31.80Prescription eligible$138$66Prescription eligible$91$49.20
- $249Prescription eligible$104$94Prescription eligible$113$57
- $123$44.40Prescription eligible$166$49.80Prescription eligible$238$114Prescription eligible
- $404$193.80Prescription eligible$279$133.80Prescription eligible$163$49.20Prescription eligible
- $427$116$104Prescription eligible$184$99.60Prescription eligible







































































