$106$95Prescription eligible
- $114$103Prescription eligible$184$173Prescription eligible
- $645$310.80Prescription eligible$108$97Prescription eligible$191Prescription eligible
- $98$88Prescription eligible$100Prescription eligible$230$108Prescription eligible
- $196$94.20Prescription eligible$160Prescription eligible$114$54Prescription eligible
- $106Prescription eligible$393$275.10Prescription eligible$422Prescription eligible
- $290$153.60Prescription eligible$191Prescription eligible$191Prescription eligible
- $375Prescription eligible$375Prescription eligible$106Prescription eligible
- $191Prescription eligible$108Prescription eligible$96$86Prescription eligible
- $191Prescription eligible$191
- $191Prescription eligible$286Prescription eligible$108Prescription eligible
- $220Prescription eligible$104Prescription eligible$248$197Prescription eligible
- $191Prescription eligible$110$58.20Prescription eligible$259$124.20Prescription eligible







































































