$428$231Prescription eligible
- $479$258.60Prescription eligible$486$233.40Prescription eligible
- $448$214.80Prescription eligible$471$198$670$321.60
- $390$210.60Prescription eligible$347$187.20$594$285Prescription eligible
- $528$285Prescription eligible$563$202.80$684$246Prescription eligible
- $588$317.40Prescription eligible$448$241.80Prescription eligible$448$241.80Prescription eligible
- $444$213$438$236.40Prescription eligible$518$279.60Prescription eligible
- $582$349.20$496$238.20Prescription eligible$328$177Prescription eligible
- $534$288.60Prescription eligible$482$231.60Prescription eligible$388$186Prescription eligible
- $428$231Prescription eligible$412$222.60Prescription eligible$376$180.60Prescription eligible