- $140Prescription eligible$605$217.80
- $333$215$908$490.20Prescription eligible
- $422$253.20Prescription eligible$228$136.80Prescription eligible
- $424$229.20Prescription eligible$89$48Prescription eligible$114$91Prescription eligible
- $118$94Prescription eligible$128$76.80Prescription eligible$118$63.60Prescription eligible
- $394$189Prescription eligible$176
- $298$107.40$108$58.20Prescription eligible$204$110.40
- $98Prescription eligible$138$74.40Prescription eligible$148$79.80Prescription eligible
- $158$85.20Prescription eligible$578$277.20Prescription eligible$258$154.80Prescription eligible
- $278$133.20Prescription eligible$232$125.40Prescription eligible$201Prescription eligible
- $226$181Prescription eligible$244$220Prescription eligible$479Prescription eligible
- $198$94.80Prescription eligible$213Prescription eligible$452Prescription eligible







































































