- $190Prescription eligible
- $138Prescription eligible$160$144$140Prescription eligible
- $454$245.40Prescription eligible$605$217.80$108
- $333
- $109$98Prescription eligible$333Prescription eligible
- $511Prescription eligible$300$162Prescription eligible$333
- $486
- $208$187$94$29Prescription eligible$78$62Prescription eligible
- $114$103Prescription eligible$114$103Prescription eligible$379Prescription eligible
- $409Prescription eligible$138$66Prescription eligible$126$60.60Prescription eligible
- $142$76.80Prescription eligible$163$68.40Prescription eligible$498$268.80Prescription eligible







































































