$178Prescription eligible
- $191Prescription eligible$139Prescription eligible
- $150Prescription eligible$191Prescription eligible$286Prescription eligible
- $94Prescription eligible$94Prescription eligible
- $213$106$29Prescription eligible$147Prescription eligible
- $98$88Prescription eligible$595$214.20
- $333Prescription eligible$147$88.20$199$71.40Prescription eligible
- $140Prescription eligible
- $118$63.60Prescription eligible$106$39Prescription eligible$96$29Prescription eligible
- $232$116Prescription eligible
- $256$123Prescription eligible$680$204$158$75.60
- $240$144Prescription eligible$248$89.40Prescription eligible$114$48Prescription eligible
- $427$215








































































