$496$238.20
- $418$225.60$428$231Prescription eligible
- $442$212.40Prescription eligible$479$258.60Prescription eligible$486$233.40Prescription eligible
- $578$346.80$448$214.80Prescription eligible$448$241.80
- $476$256.80$471$226.20$670$281.40
- $636$381.60$347$187.20$594$356.40Prescription eligible
- $508$274.20Prescription eligible$563$236.40$418$250.80Prescription eligible
- $684$410.40Prescription eligible$428$231Prescription eligible$546$327.60Prescription eligible
- $480$288$448$268.80Prescription eligible$468$280.80Prescription eligible
- $520$280.80Prescription eligible$398$214.80Prescription eligible$448$241.80Prescription eligible
- $382$206.40$444$213$358$214.80Prescription eligible
- $390$234Prescription eligible$448$268.80Prescription eligible$438$262.80Prescription eligible
- $476$256.80Prescription eligible$582$314.40$398$214.80Prescription eligible