$589$318Prescription eligible
- $114$39Prescription eligible$202$121.20
- $163$88.20Prescription eligible$163$88.20Prescription eligible$106$29Prescription eligible
- $108$64.80Prescription eligible$196$94.20Prescription eligible$128$69
- $132$63.60$118$106Prescription eligible$125$113Prescription eligible
- $179$54Prescription eligible$111$60$257$108Prescription eligible
- $595$357$159$76.20$475$199.80
- $207$176$73.80Prescription eligible$215Prescription eligible
- $406$195Prescription eligible$395Prescription eligible$375Prescription eligible
- $126$75.60Prescription eligible$298$149Prescription eligible$488$292.80Prescription eligible
- $105Prescription eligible$144$86.40Prescription eligible$144$86.40Prescription eligible
- $393Prescription eligible$526$263Prescription eligible$341$163.80
- $207$106$29Prescription eligible







































































