$178Prescription eligible
- $191Prescription eligible
- $190Prescription eligible$352$190.20
- $178
- $303$145.20Prescription eligible$141$59.40Prescription eligible$143$34.20Prescription eligible
- $165$132$140Prescription eligible$452$244.20Prescription eligible
- $609$219$197Prescription eligible$191
- $333$215$333Prescription eligible
- $511Prescription eligible$333Prescription eligible
- $184$99.60$217$104.40
- $206$99$184$99.60$230$124.20
- $186$89.40$267$144$675$364.80







































































