$210$100.80Prescription eligible
- $238$128.40Prescription eligible$496$238.20Prescription eligible
- $88$26.40Prescription eligible$442$212.40Prescription eligible$208$112.20Prescription eligible
- $120$36Prescription eligible$486$262.20Prescription eligible$120$28.80Prescription eligible
- $114$68.40Prescription eligible$141$42.60$234$126.60Prescription eligible
- $139$49.80Prescription eligible$138$74.40Prescription eligible$184.95Prescription eligible
- $138$74.40Prescription eligible$138$82.80Prescription eligible$201$120.60Prescription eligible
- $68$32.40$210$126Prescription eligible$274$148.20
- $212$114.60Prescription eligible$109$52.20Prescription eligible$108$64.80Prescription eligible
- $194$116.40Prescription eligible$455Prescription eligible$110$33
- $124$74.40Prescription eligible$594$356.40Prescription eligible$476$256.80
- $508$274.20Prescription eligible$187$90Prescription eligible$418$250.80Prescription eligible
- $184.95Prescription eligible$188$101.40Prescription eligible$184.95Prescription eligible