$195Prescription eligible
- $441$211.80Prescription eligible$367$198Prescription eligible
- $260$140.40Prescription eligible$582$314.40Prescription eligible$133$79.80Prescription eligible
- $588$317.40Prescription eligible$308$166.20Prescription eligible$198$106.80Prescription eligible
- $413$198Prescription eligible$322$174Prescription eligible$125$60Prescription eligible
- $678$366$163$88.20Prescription eligible$163$78Prescription eligible
- $158$75.60Prescription eligible$158$85.20Prescription eligible$163$78Prescription eligible
- $517$248.40Prescription eligible$591$283.80Prescription eligible$217$104.40Prescription eligible
- $246$118.20Prescription eligible$109$58.80Prescription eligible$98Prescription eligible
- $237$114Prescription eligible$218$130.80Prescription eligible$245$103.20Prescription eligible
- $226$108.60Prescription eligible$158$94.80Prescription eligible$108$64.80Prescription eligible
- $351$189.60Prescription eligible$364$174.60Prescription eligible$95Prescription eligible
- $95Prescription eligible$551$264.60Prescription eligible$592$284.40Prescription eligible







































































