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	Product	Price	Quantity	Total
×	Therapy Copay 40$	$40.00	Quantity	$40.00
×	Therapy Copay 20$	$20.00	Quantity	$20.00
×	Semi-Sliding Scale Fee	$90.00	Quantity	$90.00
×	Sliding Therapy Session Fee $60	$60.00	Quantity	$60.00

Order Summary

Subtotal	$210.00
Total	$210.00