$298$160.80Prescription eligible
- $210$100.80Prescription eligible$277$133.20Prescription eligible
- $432$207.60Prescription eligible$332$179.40$78$42Prescription eligible
- $496$267.60Prescription eligible$280$151.20Prescription 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
- $134$64.20$208$112.20$428$231Prescription eligible
- $442$238.80Prescription eligible$358$193.20Prescription eligible$118$63.60
- $178$96Prescription eligible$118$56.40Prescription eligible$139$75
- $208$112.20Prescription eligible$138$74.40Prescription eligible$122$66Prescription eligible
- $348$166.80$216$116.40Prescription eligible$120$36Prescription eligible
- $486$233.40Prescription eligible$108$58.20Prescription eligible$428$231Prescription eligible
- $140$67.20Prescription eligible$128$61.20Prescription eligible$188$90Prescription eligible