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Credit Card Payment

Credit Card Payment

Please choose your correct copay and pay at the time of your appointment. 
2Questions
  • 1
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  • 2
    If copay chosen does not match correct copay amount, we reserve the right to charge your card on file the remaining amount due.
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    My Bag
    0
    My Bag
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    Great Product Name
    $20
    Quantity:1
    Size:Small
    RemoveEdit
    ORDER SUMMARY
    Total costUSD
    • Private Pay - 1:1
      Private Pay - 1:1
      $200.00RemoveEdit
      Back
    • No Copay
      No Copay
      $FreeRemoveEdit
      Back
    • Copay
      Copay
      $20.00RemoveEdit
      Back
    • Copay
      Copay
      $25.00RemoveEdit
      Back
    • Copay
      Copay
      $40.00RemoveEdit
      Back
    • Copay
      Copay
      $45.00RemoveEdit
      Back
    • Copay
      Copay
      $50.00RemoveEdit
      Back
    • Missed Appointment
      Missed Appointment
      $25.00RemoveEdit
      Back
      Total cost $0.00
      Credit Card
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      Enter
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