- $90
- $78$124$171$120
- $126$74
- $94$135$106
- $228
- $133
- $115Prescription eligible$86$116
- $135Prescription eligible$115Prescription eligible$96
- $106Prescription eligible$115$180
- $171$120Prescription eligible$198$171$120
- $228$218
- Prescription eligible$82$175








































































