Credit Card Information
Credit Card Information
When using insurance, your co-pay is determined by your insurance provider. For Self-Pay and Out-of-Network, the maximum is $95. Credit card and ACH processing fees may apply.
This does not include the cost of medication, which will be determined by your pharmacy and/or insurance provider.
* Lab tests, procedures, or requests beyond the standard treatment plan may result in additional charges.
Please provide your credit card information.
Your credit card will be charged based on the services received.
Charges quoted do not include additional items like Lab tests, Imaging or Medication.
* Notice of the amount to be processed will be sent to the email you provided.
