Cart

	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

Order Summary

Subtotal	$150.00
Total	$150.00