- $314$132Prescription eligible$295$159.60Prescription eligible$242$130.80Prescription eligible
- $305$165Prescription eligible$284$153.60Prescription eligible$598$322.80Prescription eligible
- $552$331.20Prescription eligible$252$136.20Prescription eligible$288$121.20Prescription eligible
- $284$153.60Prescription eligible$558$334.80Prescription eligible$494$296.40Prescription eligible
- $296$159.60Prescription eligible$364$174.60Prescription eligible





























