- $393Prescription eligible$184$99.60Prescription eligible
- $379Prescription eligible$113$61.20Prescription eligible$262$236Prescription eligible
- $239$114.60Prescription eligible$134$64.20Prescription eligible$138$74.40Prescription eligible
- $194$105Prescription eligible$175$94.80Prescription eligible$147$79.20Prescription eligible
- $409Prescription eligible$550$264Prescription eligible$160Prescription eligible
- $108Prescription eligible$214$107Prescription eligible$249$134.40
- $230$124.20Prescription eligible$186$89.40Prescription eligible$195Prescription eligible
- $114$103Prescription eligible$108$97Prescription eligible$183$99
- $206$99$166$89.40Prescription eligible$156$84Prescription eligible
- $165$89.40Prescription eligible$165$89.40Prescription eligible$156$84
- $166$79.80Prescription eligible$165$89.40Prescription eligible$165$89.40
- $165$89.40$666$319.80Prescription eligible$144$78Prescription eligible







































































