$228$96Prescription eligible
- $191Prescription eligible$98$88Prescription eligible
- $108Prescription eligible$441$238.20Prescription eligible$125$113Prescription eligible
- $104$94Prescription eligible$141$59.40$321$135Prescription eligible
- $194$105$106$39Prescription eligible$309Prescription eligible
- $114$103Prescription eligible$302$163.20Prescription eligible$303$163.80Prescription eligible
- $230$124.20$533$223.80
- $124$67.20Prescription eligible$180Prescription eligible$156$75
- $271$135.50$163$78Prescription eligible
- $160$86.40$260$93.60$478$258Prescription eligible
- $166$99.60Prescription eligible$228$109.20Prescription eligible$300$144Prescription eligible
- $470$253.80Prescription eligible$125Prescription eligible$618$296.40Prescription eligible
- $434$234.60Prescription eligible$100$54$425$178.80Prescription eligible







































































