$137$57.60Prescription eligible
- $86$46.20Prescription eligible$137$123Prescription eligible
- $98$88Prescription eligible$96$86Prescription eligible$104$94Prescription eligible
- $94$85Prescription eligible$140$126Prescription eligible$86$77Prescription eligible
- $193$104.40Prescription eligible$78$70Prescription eligible$298$178.80Prescription eligible
- $246$132.60Prescription eligible$404$218.40Prescription eligible$118$63.60Prescription eligible
- $88$79Prescription eligible$89$48Prescription eligible$152$137Prescription eligible
- $170Prescription eligible$98Prescription eligible$94$85Prescription eligible









































