- $94$85Prescription eligible$190Prescription eligible
- $160$76.80Prescription eligible$198$118.80Prescription eligible$238$114Prescription eligible
- $168Prescription eligible$216$116.40Prescription eligible$233$97.80Prescription eligible
- $145Prescription eligible$149Prescription eligible$190Prescription eligible
- $165Prescription eligible
- $309Prescription eligible
- $210$96Prescription eligible$144$78Prescription eligible$212Prescription eligible









































































