$138$123Prescription eligible
- $196$104.40Prescription eligible$141$57.60Prescription eligible
- $138$126Prescription eligible$82$46.20Prescription eligible$86$77Prescription eligible
- $98$88Prescription eligible$96$86Prescription eligible$94$85Prescription eligible
- $104$94Prescription eligible$94$85Prescription eligible$170Prescription eligible
- $296$178.80Prescription eligible$249$132.60Prescription eligible$406$218.40Prescription eligible
- $156$137Prescription eligible$110$48Prescription eligible$78$70Prescription eligible
- $88$79Prescription eligible$119$63.60Prescription eligible$98$88Prescription eligible









































