$314$150.60Prescription eligible
- $211$114Prescription eligible$238$128.40Prescription eligible
- $284$136.20Prescription eligible$284$153.60Prescription eligible$598$322.80Prescription eligible
- $494$267Prescription eligible$252$151.20Prescription eligible$502$301.20Prescription eligible
- $528$316.80Prescription eligible$284$136.20Prescription eligible$558$267.60Prescription eligible
- $494$267Prescription eligible$364$218.40Prescription eligible$364$218.40Prescription eligible
- $560$302.40Prescription eligible