$348$187.80Prescription eligible
- $205$98.40Prescription eligible$113$61.20Prescription eligible
- $164$88.80Prescription eligible$134$64.20Prescription eligible$280$151.20Prescription eligible
- $250$135Prescription eligible$277$133.20Prescription eligible$140$126Prescription eligible
- $140$67.20Prescription eligible$266$96Prescription eligible$128$69Prescription eligible
- $162$146Prescription eligible$119$64.20Prescription eligible$118$56.40Prescription eligible
- $226$108.60Prescription eligible$198$106.80Prescription eligible$120$28.80Prescription eligible
- $240$129.60Prescription eligible$208$112.20Prescription eligible$348$166.80
- $130$39Prescription eligible$442$238.80Prescription eligible$118$63.60Prescription eligible
- $103$55.80Prescription eligible$107$57.60Prescription eligible$271$130.20Prescription eligible
- $148$79.80Prescription eligible$139$75Prescription eligible$138$66Prescription eligible
- $479$258.60Prescription eligible$143$77.40Prescription eligible$82$44.40
- $120$64.80Prescription eligible$110$59.40Prescription eligible$117$63Prescription eligible








































































