- $480$259.20$479$258.60Prescription eligible$471$198
- $670$281.40$347$187.20$461$221.40Prescription eligible
- $605$217.80$684$287.40$588$317.40Prescription eligible
- $558$301.20Prescription eligible$518$279.60Prescription eligible$582$314.40
- $444$213$578$312$482$260.40Prescription eligible
- $388$209.40Prescription eligible$428$205.20Prescription eligible$588$282Prescription eligible
- $534$288.60Prescription eligible$376$180.60Prescription eligible$496$267.60Prescription eligible
- $492$265.80Prescription eligible$492$265.80Prescription eligible$412$222.60Prescription eligible

















































