$234$56.40Prescription eligible
- $278$150Prescription eligible$248$104.40Prescription eligible
- $183$99Prescription eligible$118$63.60$198$83.40Prescription eligible
- $162$87.60Prescription eligible$120$57.60Prescription eligible$186$100.20Prescription eligible
- $218$104.40Prescription eligible$184$77.40Prescription eligible$244$73.20Prescription eligible
- $222$106.80Prescription eligible$152$82.20Prescription eligible$195$93.60Prescription eligible
- $178$96Prescription eligible$127$68.40Prescription eligible$219$118.20Prescription eligible
- $178$106.80Prescription eligible$218$117.60Prescription eligible$74$44.40Prescription eligible
- $132$79.20Prescription eligible$106$57Prescription eligible$208$112.20Prescription eligible
- $169$70.80Prescription eligible


















































