$88$29Prescription eligible
- $86$29Prescription eligible$78$29Prescription eligible
- $94$29Prescription eligible$108$43Prescription eligible$108$43Prescription eligible
- $88$44Prescription eligible$120$48Prescription eligible$98$49Prescription eligible
- $144$58Prescription eligible$75$60$106$64Prescription eligible
- $74$67$168$67Prescription eligible$74$67
- $78$70$141$71$89$71
- $80$72$93$74$74Prescription eligible
- $150$75Prescription eligible$83$75$109$76Prescription eligible
- $136$82Prescription eligible$118$83Prescription eligible$84Prescription eligible
- $120$84Prescription eligible$84Prescription eligible$86Prescription eligible
- $86Prescription eligible$108$86Prescription eligible$108$86Prescription eligible
- $96$86$108$86Prescription eligible$114$91Prescription eligible