$204$110.40Prescription eligible
- $219$118.20Prescription eligible$458$229Prescription eligible
- $88Prescription eligible$132$63.60Prescription eligible$106$95Prescription eligible
- $114$103Prescription eligible$96$86Prescription eligible$96$86Prescription eligible
- $124$39Prescription eligible$170Prescription eligible$124$39Prescription eligible
- $86$39Prescription eligible$178Prescription eligible$145$61.20Prescription eligible
- $296$124.20Prescription eligible$222$106.80Prescription eligible$85Prescription eligible
- $158$75.60Prescription eligible$137$73.80Prescription eligible$196$94.20Prescription eligible
- $202Prescription eligible$98$52.80Prescription eligible$104$94Prescription eligible
- $106$95Prescription eligible$108$51.60Prescription eligible$124Prescription eligible
- $288$138Prescription eligible$75Prescription eligible$134$72.60Prescription eligible
- $170Prescription eligible$170Prescription eligible$108Prescription eligible
- $98Prescription eligible$96Prescription eligible$84Prescription eligible







































































