$488$263.40Prescription eligible
- $475$256.80Prescription eligible$258$123.60Prescription eligible
- $648$310.80Prescription eligible$295Prescription eligible$219$118.20Prescription eligible
- $166$89.40Prescription eligible$238$128.40Prescription eligible$270$97.20Prescription eligible
- $267$144Prescription eligible$228$182Prescription eligible$205$143.50
- $367$183.50$194$105$185$100.20
- $185$100.20$185$100.20$89$48Prescription eligible
- $211$101.40$202$121.20$228$123
- $181$87$668$360.60$668$360.60
- $158$75.60Prescription eligible$163$78Prescription eligible$158$85.20Prescription eligible
- $163$88.20Prescription eligible$158$85.20$137$57.60Prescription eligible
- $156$84Prescription eligible$145$78.60Prescription eligible$663$358.20Prescription eligible
- $663$318Prescription eligible$267$160.20Prescription eligible$218$174Prescription eligible







































































