$418$225.60
- $479$258.60Prescription eligible$486$262.20Prescription eligible
- $448$214.80Prescription eligible$471$226.20$670$281.40
- $347$187.20$594$356.40Prescription eligible$508$274.20Prescription eligible
- $563$236.40$684$410.40Prescription eligible$546$294.60Prescription eligible
- $480$288$448$268.80Prescription eligible$448$241.80Prescription eligible
- $444$213$358$214.80Prescription eligible$438$262.80Prescription eligible
- $476$256.80Prescription eligible$582$314.40$496$238.20Prescription eligible
- $578$243$398$238.80Prescription eligible$328$177Prescription eligible
- $388$209.40Prescription eligible$428$231Prescription eligible$482$231.60Prescription eligible
- $534$256.20Prescription eligible$412$222.60Prescription eligible$376$202.80Prescription eligible