$323$172.80Prescription eligible
- $303$146.40Prescription eligible$143$33Prescription eligible
- $108$138$82.80Prescription eligible$191Prescription eligible
- $98Prescription eligible$191Prescription eligible
- $272Prescription eligible$104$94Prescription eligible
- $321$135Prescription eligible
- $269$147
- $207$117.60Prescription eligible$495Prescription eligible
- $220Prescription eligible$246$74.40Prescription eligible$184$101.40Prescription eligible
- $236$98.40Prescription eligible$313$163.20Prescription eligible$344$162
- $166$90.60$478$258Prescription eligible$175$99.60Prescription eligible
- $369$198.60Prescription eligible$98$88Prescription eligible$119$64.80







































































