- $309Prescription eligible$274$148.20Prescription eligible
- $246$118.20Prescription eligible$495$237.60Prescription eligible$304$164.40Prescription eligible
- $106$29Prescription eligible$126$60.60Prescription eligible$470$253.80Prescription eligible
- $105Prescription eligible$406$195Prescription eligible$183$87.60Prescription eligible
- $180$97.20Prescription eligible$204$97.80Prescription eligible$152$73.20Prescription eligible
- $82Prescription eligible$84Prescription eligible$106$29Prescription eligible
- $272$147Prescription eligible$218$117.60Prescription eligible$192$103.80
- $156$75Prescription eligible$322$258Prescription eligible$141$51Prescription eligible
- $335Prescription eligible$170Prescription eligible$488$292.80Prescription eligible
- $244Prescription eligible$244$220Prescription eligible$186$100.20Prescription eligible
- $132$79.20Prescription eligible$144$86.40Prescription eligible$88$29Prescription eligible
- $94$29Prescription eligible$138$29Prescription eligible$150Prescription eligible







































































