- $496$267.60Prescription eligible$480$259.20$442$238.80Prescription eligible
- $479$258.60Prescription eligible$448$214.80$448$268.80
- $476$228.60$471$198$670$281.40
- $636$305.40$347$187.20$594$356.40Prescription eligible
- $461$221.40Prescription eligible$563$202.80$684$410.40Prescription eligible
- $588$317.40Prescription eligible$628$339Prescription eligible$458$219.60
- $448$241.80Prescription eligible$438$236.40Prescription eligible$518$279.60Prescription eligible
- $582$349.20$502$271.20Prescription eligible$456$219Prescription eligible
- $444$240$472$255Prescription eligible$490$264.60Prescription eligible
- $488$292.80$578$312Prescription eligible$521$219
- $665$319.20Prescription eligible$386$208.20$578$312
- $362$195.60$588$317.40Prescription eligible$492$295.20Prescription eligible









































































