$222Prescription eligible
- $214Prescription eligible$104Prescription eligible
- $363Prescription eligible$183$165
- $178$207
- $202$98Prescription eligible$98Prescription eligible
- $68Prescription eligible$98Prescription eligible$218
- $118Prescription eligible$133Prescription eligible$235$165
- $490Prescription eligible$108Prescription eligible
- $260$156$165$132$158$142
- $154$139$144$130$144$130
- $148$118$148$133$154$139
- $86$77$194$175$78$70
- $80$72$108$97$51$46