- $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
- $78$62Prescription eligible$513$410
- $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







































































