$322$174Prescription eligible
- $106$95Prescription eligible$216$116.40Prescription eligible
- $191Prescription eligible$350Prescription eligible$144$86.40Prescription eligible
- $288$121.20Prescription eligible$231$191Prescription eligible
- $108$97Prescription eligible$106$29Prescription eligible$106Prescription eligible
- $298$107.40$126$113Prescription eligible
- $239$108$29Prescription eligible$282Prescription eligible
- $108Prescription eligible$108$29Prescription eligible
- $289















































