$112$54Prescription eligible
- $106$29Prescription eligible$184$166Prescription eligible
- $144$69$290$139.20$138$74.40Prescription eligible
- $259$124.20Prescription eligible$384$184.20Prescription eligible$692$290.40Prescription eligible
- $184$99.60Prescription eligible$95Prescription eligible
- $640$268.80Prescription eligible$88Prescription eligible$324$194.40Prescription eligible
- $165$89.40Prescription eligible$480$259.20Prescription eligible$228$109.20Prescription eligible
- $201Prescription eligible$201Prescription eligible$201Prescription eligible
- $221$106.20Prescription eligible$248$118.80Prescription eligible$230$124.20Prescription eligible
- $426$229.80Prescription eligible$114$54.60Prescription eligible$133$63.60Prescription eligible
- $110$59.40Prescription eligible$592$355.20$452$244.20Prescription eligible
- $408$244.80Prescription eligible$196$94.20Prescription eligible$492$295.20Prescription eligible
- $170Prescription eligible$212$114.60Prescription eligible$106$95Prescription eligible







































































