- $471$198$527$263.50Prescription eligible
- $223Prescription eligible$207$178Prescription eligible
- $176$84.60Prescription eligible$213Prescription eligible$213Prescription eligible
- $406$219Prescription eligible$375Prescription eligible$111$46.80Prescription eligible
- $236$127.20Prescription eligible$588$317.40Prescription eligible$128$76.80Prescription eligible
- $202$121.20$158$85.20$158$85.20
- $118$56.40Prescription eligible$98$69Prescription eligible$106$63.60Prescription eligible
- $188$101.40Prescription eligible$160Prescription eligible$128$69
- $138$82.80Prescription eligible$114Prescription eligible
- $106$29Prescription eligible$179$64.20Prescription eligible
- $215Prescription eligible$336Prescription eligible
- $106$29Prescription eligible$268$128.40Prescription eligible$254$106.80Prescription eligible







































































