$496$238.20
- $418$225.60$442$212.40Prescription eligible
- $479$258.60Prescription eligible$486$262.20Prescription eligible$448$214.80Prescription eligible
- $448$214.80Prescription eligible$476$256.80$471$226.20
- $670$281.40$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$294.60Prescription eligible
- $480$288$448$268.80Prescription eligible$468$280.80Prescription eligible
- $520$280.80Prescription eligible$448$241.80Prescription eligible$382$229.20
- $444$213$358$193.20Prescription eligible$390$234Prescription eligible
- $448$268.80Prescription eligible$476$256.80Prescription eligible$582$314.40
- $398$238.80Prescription eligible$502$271.20Prescription eligible$358$214.80Prescription eligible
- $448$241.80Prescription eligible$472$226.80Prescription eligible$488$263.40