- $138Prescription eligible$160$144
- $140Prescription eligible$454$245.40Prescription eligible$605$217.80
- $108$333
- $109$98Prescription eligible$333Prescription eligible
- $511Prescription eligible
- $486
- $208$187$78$62Prescription eligible$544$261Prescription eligible
- $478$258Prescription eligible$590$247.80Prescription eligible$122$66Prescription eligible
- $138$74.40Prescription eligible$84$45.60Prescription eligible$114$103Prescription eligible
- $96$86Prescription eligible$228$123Prescription eligible$246$118.20Prescription eligible
- $174$94.20Prescription eligible$399Prescription eligible$452Prescription eligible
- $393$275.10Prescription eligible$427Prescription eligible$512$256Prescription eligible







































































