$298$160.80Prescription eligible
- $210$100.80Prescription eligible$277$133.20Prescription eligible
- $432$207.60Prescription eligible$94$51Prescription eligible$78$42Prescription eligible
- $280$151.20Prescription eligible$140$67.20Prescription eligible$326$156.60Prescription eligible
- $164$88.80Prescription eligible$258$139.20Prescription eligible$480$259.20
- $118$63.60$587$211.20$266$143.40Prescription eligible
- $208$112.20$134$64.20$442$238.80Prescription eligible
- $134$64.20Prescription eligible$388$209.40Prescription eligible$118$63.60
- $178$96Prescription eligible$118$56.40Prescription eligible$496$267.60
- $139$75$250$135Prescription eligible$138$74.40Prescription eligible
- $122$66Prescription eligible$348$166.80$120$36Prescription eligible
- $486$233.40Prescription eligible$108$51.60Prescription eligible$428$231Prescription eligible
- $128$61.20Prescription eligible$188$90Prescription eligible$236$113.40Prescription eligible