$367$198Prescription eligible
- $228$96Prescription eligible$305$128.40Prescription eligible
- $144$78Prescription eligible$129$69.60Prescription eligible$274$164.40Prescription eligible
- $163$68.40Prescription eligible$480$259.20$595$214.20
- $305$128.40$441$264.60Prescription eligible$158$85.20Prescription eligible
- $142$68.40Prescription eligible$139$75$351$168.60
- $152$73.20Prescription eligible$144$86.40Prescription eligible$127$38.40Prescription eligible
- $199$71.40Prescription eligible$556$200.40$436$235.20Prescription eligible
- $149$62.40$79$37.80$183$99
- $321$135Prescription eligible$141$76.20Prescription eligible$404$121.20Prescription eligible
- $475$228$155$84$117$63Prescription eligible
- $82$34.20$461$221.40Prescription eligible$636$267
- $120$64.80Prescription eligible$680$204$237$99.60








































































