$298$160.80Prescription eligible
- $210$100.80Prescription eligible$277$133.20Prescription eligible
- $432$207.60Prescription eligible$260$140.40Prescription eligible$332$179.40
- $94$51Prescription eligible$78$42Prescription eligible$496$267.60
- $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$418$225.60Prescription eligible$118$63.60
- $178$96Prescription eligible$118$56.40Prescription eligible$139$75
- $208$112.20Prescription eligible$138$74.40Prescription eligible$122$66Prescription eligible
- $148$79.80Prescription eligible$348$166.80$120$36Prescription eligible
- $486$233.40Prescription eligible$428$231Prescription eligible$128$61.20Prescription eligible