$480$259.20
- $486$233.40Prescription eligible$471$226.20
- $670$281.40$347$187.20$528$285Prescription eligible
- $563$202.80$684$205.20Prescription eligible$588$317.40Prescription eligible
- $622$298.80Prescription eligible$444$240$518$279.60Prescription eligible
- $582$349.20$496$238.20Prescription eligible$534$288.60Prescription eligible
- $482$231.60Prescription eligible$388$209.40Prescription eligible$428$231Prescription eligible
- $532$319.20Prescription eligible$492$295.20Prescription eligible$412$222.60Prescription eligible
- $376$180.60Prescription eligible











































