$165$79.20
- $175$94.80Prescription eligible$138$74.40Prescription eligible
- $344$144.60$147$70.80Prescription eligible$144$60.60Prescription eligible
- $129$69.60Prescription eligible$214Prescription eligible$166$89.40
- $323$174.60Prescription eligible$233Prescription eligible
- $165$89.40Prescription eligible$198Prescription eligible
- $188Prescription eligible$332$139.20Prescription eligible$176$105.60
- $115Prescription eligible$82Prescription eligible$86Prescription eligible
- $84Prescription eligible$78Prescription eligible
- $129$31.20Prescription eligible$205$143.50
- $202Prescription eligible$163$82Prescription eligible$108Prescription eligible
- $82$44.40Prescription eligible$82$39.60Prescription eligible$110$59.40Prescription eligible







































































