- $496$267.60$480$259.20$428$231Prescription eligible
- $441$238.20Prescription eligible$528$285Prescription eligible$486$262.20Prescription eligible
- $448$214.80Prescription eligible$476$285.60$475$228
- $680$204$636$267$347$187.20
- $461$221.40Prescription eligible$605$217.80$588$352.80Prescription eligible
- $563$304.20Prescription eligible$404$193.80$358$193.20Prescription eligible
- $448$241.80Prescription eligible$582$349.20$508$243.60Prescription eligible
- $472$255Prescription eligible$488$234$582$314.40Prescription eligible
- $533$223.80$386$208.20$578$346.80
- $478$201Prescription eligible$362$195.60$533$288Prescription eligible
- $489$264Prescription eligible$495$237.60Prescription eligible$396$213.60Prescription eligible
- $397$190.80Prescription eligible$428$231Prescription eligible$592$319.80Prescription eligible









































































