$195Prescription eligible
- $114$103Prescription eligible$194$105
- $202$97.20$163$88.20Prescription eligible$158$85.20Prescription eligible
- $163$88.20Prescription eligible$163$88.20Prescription eligible$163$88.20Prescription eligible
- $158$85.20$158$75.60Prescription eligible$163$88.20Prescription eligible
- $163$88.20$163$88.20$663$358.20Prescription eligible
- $137$73.80Prescription eligible$185$78Prescription eligible$108$64.80Prescription eligible
- $288$155.40Prescription eligible$154$83.40Prescription eligible$630Prescription eligible
- $144$78Prescription eligible$160Prescription eligible$283$170Prescription eligible
- $217$130Prescription eligible$207Prescription eligible$134$64.20Prescription eligible
- $248$133.80$232$125.40Prescription eligible$183$76.80Prescription eligible
- $333Prescription eligible$486$185$100.20
- $98Prescription eligible$116$62.40$168$50.40Prescription eligible







































































