$96$77Prescription eligible
- $78Prescription eligible$106Prescription eligible
- $96Prescription eligible$324$259Prescription eligible$106$39Prescription eligible
- $104$83Prescription eligible$94$29Prescription eligible$106Prescription eligible
- $88$53$328$262Prescription eligible$180$126
- $164$148$98$78Prescription eligible$118$106
- $94Prescription eligible$98Prescription eligible$472$378Prescription eligible
- $444$355$124$99$118$106