$465$279Prescription eligible
- $144$78Prescription eligible$204$110.40Prescription eligible
- $328$157.20Prescription eligible$259$108.60Prescription eligible$168$100.80
- $178$64.20$152$73.20Prescription eligible$132$71.40
- $91$33$335$160.80$262Prescription eligible
- $404$193.80$108$97Prescription eligible
- $340$183.60Prescription eligible$168$40.20Prescription eligible
- $246$103.20Prescription eligible$220$118.80Prescription eligible$104$94Prescription eligible
- $166$99.60Prescription eligible$393Prescription eligible$218$117.60
- $231$292$175.20Prescription eligible$98$29Prescription eligible
- $118$106Prescription eligible$125$113Prescription eligible$280$151.20Prescription eligible
- $418$225.60Prescription eligible$363Prescription eligible$488$244Prescription eligible







































































