- $480$259.20$428$231Prescription eligible$528$285Prescription eligible
- $486$262.20Prescription eligible$448$214.80Prescription eligible$475$228
- $680$204$347$187.20$461$221.40Prescription eligible
- $605$217.80$588$352.80Prescription eligible$563$304.20Prescription eligible
- $358$193.20Prescription eligible$582$349.20$578$346.80
- $592$319.80Prescription eligible$489$264Prescription eligible$396$213.60Prescription eligible
- $428$231Prescription eligible$533$288Prescription eligible$496$267.60Prescription eligible
- $492$236.40Prescription eligible$385$208.20Prescription eligible$415$224.40Prescription eligible

















































