Cart

	Product	Price	Quantity	Total
×	Semi-Sliding Scale Fee	$90.00	Quantity	$90.00
×	Therapy Copay for 50$	$50.00	Quantity	$50.00
×	Therapy Copay 20$	$20.00	Quantity	$20.00

Order Summary

Subtotal	$160.00
Total	$160.00