- $298$107.40$314$169.80Prescription eligible
- $264$158.40Prescription eligible$216$116.40Prescription eligible$106$29Prescription eligible
- $336Prescription eligible$288$121.20Prescription eligible$231
- $108$86Prescription eligible$106$39Prescription eligible$191Prescription eligible
- $106Prescription eligible$289
- $114Prescription eligible$239$108$39Prescription eligible
- $282Prescription eligible$220Prescription eligible
- $298$178.80Prescription eligible$146$87.60Prescription eligible
- $126$50Prescription eligible$108$29Prescription eligible$108Prescription eligible























































