$178
- $128$54Prescription eligible$108
- $137$123Prescription eligible$163$130Prescription eligible
- $178$160$96$86Prescription eligible
- $292$157.80$338$162$126$63
- $252$136.20Prescription eligible
- $395Prescription eligible$154$139Prescription eligible
- $108Prescription eligible$287$154.80
- $188$90$180
- $138$110$139$111







































































