$158$126Prescription eligible
$188$169Prescription eligible
$152$137Prescription eligible
$152$137Prescription eligible
$174$157Prescription eligible
$152$137Prescription eligible
$113$102Prescription eligible
$124$99Prescription eligible
$134$94Prescription eligible
$228$182Prescription eligible
$98$78Prescription eligible
$108$86Prescription eligible
$108$97Prescription eligible
$98$78Prescription eligible