$184$166Prescription eligible
- $108Prescription eligible$645$309.60Prescription eligible
- $100Prescription eligible$230$110.40Prescription eligible$196$94.20Prescription eligible
- $160Prescription eligible$114$54.60Prescription eligible$106Prescription eligible
- $393$275.10Prescription eligible$422Prescription eligible$290$139.20Prescription eligible
- $191Prescription eligible$191Prescription eligible$375Prescription eligible
- $375Prescription eligible$108$97Prescription eligible$207Prescription eligible
- $98$88Prescription eligible$114$103Prescription eligible$96$86Prescription eligible
- $106$95Prescription eligible$106Prescription eligible$191Prescription eligible
- $104Prescription eligible$248$198Prescription eligible$191Prescription eligible
- $220Prescription eligible$259$124.20Prescription eligible$332$159.60Prescription eligible
- $238$100.20Prescription eligible$139Prescription eligible$399Prescription eligible
- $422Prescription eligible$295$159.60Prescription eligible$191Prescription eligible







































































