$309Prescription eligible
- $495Prescription eligible$452Prescription eligible
- $286$137.40Prescription eligible$178$85.20Prescription eligible$194Prescription eligible
- $178Prescription eligible$258$154.80Prescription eligible$304$145.80Prescription eligible
- $268$128.40Prescription eligible$554$299.40Prescription eligible$472$255Prescription eligible
- $328$138Prescription eligible$375Prescription eligible$434$234.60Prescription eligible
- $109Prescription eligible$176
- $588$317.40Prescription eligible$822$444
- $158$85.20$238$128.40Prescription eligible$236$127.20Prescription eligible
- $298$160.80Prescription eligible$172$72Prescription eligible$242$130.80Prescription eligible
- $598$358.80Prescription eligible$136$65.40Prescription eligible$216$116.40Prescription eligible
- $216$103.80Prescription eligible$246$132.60Prescription eligible$132$71.40Prescription eligible
- $118$63.60Prescription eligible$494$296.40Prescription eligible$74$40.20







































































