$96$39Prescription eligible
- $88$39Prescription eligible$94$39Prescription eligible
- $108$43Prescription eligible$120$48Prescription eligible$88$53Prescription eligible
- $110$55$98$59Prescription eligible$88$62Prescription eligible
- $94$66Prescription eligible$86$69Prescription eligible$86$77Prescription eligible
- $96$77Prescription eligible$98$78Prescription eligible$98$78Prescription eligible
- $98$78Prescription eligible$78Prescription eligible$104$83Prescription eligible
- $119$83Prescription eligible$92$83Prescription eligible$104$83Prescription eligible
- $85Prescription eligible$172$86Prescription eligible$88Prescription eligible
- $176$88Prescription eligible$154$92Prescription eligible$104$94
- $118$94Prescription eligible$104$94Prescription eligible$94Prescription eligible
- $106$95Prescription eligible$136$95Prescription eligible$96Prescription eligible
- $96Prescription eligible$107$96Prescription eligible$108$97