- $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$390$163.80Prescription eligible$488$234
- $582$314.40Prescription eligible$533$223.80$386$208.20
- $578$346.80$478$201Prescription eligible$362$195.60
- $592$319.80Prescription eligible$496$238.20Prescription eligible$404$218.40Prescription eligible
- $496$267.60Prescription eligible$533$288Prescription eligible$489$264Prescription eligible









































































