$96$77Prescription eligible
- $78Prescription eligible$106Prescription eligible
- $96Prescription eligible$324$175.20Prescription eligible$106$53Prescription eligible
- $84$29Prescription eligible$94$29Prescription eligible$106Prescription eligible
- $88$31.80$96$51.60
- $205Prescription eligible$328$157.20Prescription eligible$180$75.60
- $144$78$98Prescription eligible$118$63.60
- $98$78Prescription eligible$98Prescription eligible$94$47Prescription eligible
- $472$226.80Prescription eligible$124$59.40$118$63.60
- $444$213$440$264Prescription eligible