California with Introductory Coupon
$35.00
California without Introductory Coupon
$69.00
Non California with Introductory Coupon
$69.00
Non California without Introductory Coupon
$96.00
Prior Authorization / Medical Attestation
$106.00
$35.00
$69.00
$69.00
$96.00
$106.00