$397$213.60Prescription eligible
- $591$352.80Prescription eligible$582$314.40Prescription eligible
- $563$304.20Prescription eligible$536$288Prescription eligible$230$108Prescription eligible
- $230$108Prescription eligible$114$103Prescription eligible$118$106Prescription eligible
- $114Prescription eligible$98Prescription eligible$94Prescription eligible
- $138$64.20Prescription eligible$647$349.80Prescription eligible$508$243.60Prescription eligible
- $114$103Prescription eligible































