- $496$267.60Prescription eligible$480$259.20$442$238.80Prescription eligible
- $479$258.60Prescription eligible$448$214.80$476$228.60
- $471$198$670$281.40$636$305.40
- $347$187.20$461$221.40Prescription eligible$605$217.80
- $684$287.40$588$317.40Prescription eligible$368$220.80Prescription eligible
- $558$301.20Prescription eligible$404$218.40$448$241.80Prescription eligible
- $518$279.60Prescription eligible$582$314.40$502$241.20Prescription eligible
- $444$213$488$263.40$578$312Prescription eligible
- $521$219$665$319.20Prescription eligible$386$208.20
- $578$312$362$195.60$412$222.60Prescription eligible
- $534$288.60Prescription eligible$482$260.40Prescription eligible$482$260.40Prescription eligible
- $388$209.40Prescription eligible$428$205.20Prescription eligible$588$282Prescription eligible









































































