- $244Prescription eligible$148$88.80Prescription eligible
- $166$80.40$123$57.60Prescription eligible$134$64.20Prescription eligible
- $196Prescription eligible$218$196Prescription eligible$249Prescription eligible
- $409Prescription eligible$379Prescription eligible
- $191Prescription eligible
- $134$66Prescription eligible$118Prescription eligible
- $144$85.20Prescription eligible
- $212Prescription eligible$195Prescription eligible$191Prescription eligible
- $156$85.20Prescription eligible$213Prescription eligible$202Prescription eligible
- $178Prescription eligible





























































