$96$77Prescription eligible
- $78$47Prescription eligible$106Prescription eligible
- $96Prescription eligible$274$66$324$175.20Prescription eligible
- $106$74Prescription eligible$84$29Prescription eligible$191Prescription eligible
- $94$29Prescription eligible$106Prescription eligible
- $88$31.80$96$34.80
- $193Prescription eligible$118$63.60$328$177Prescription eligible
- $156$65.40$160$86.40Prescription eligible$180$75.60
- $146$70.20$144$78$98Prescription eligible
- $118$63.60$98$78Prescription eligible$472$255Prescription eligible
- $124$59.40$118$63.60$98$39Prescription eligible
- $444$240$94$66Prescription eligible