Co pay
Payment $1
$1.00
$1.00
Co pay $5
$5.00
$5.00
Co pay $10
$10.00
$10.00
Co pay $15
$15.00
$15.00
Co pay $20
$20.00
$20.00
Co pay $25
$25.00
$25.00
Co pay $30
$30.00
$30.00
Co pay $40
$40.00
$40.00
Co pay $50
$50.00
$50.00