Please enter your payment amount and account number below. Once your payment has been confirmed, your receipt will be emailed to you and the charge will appear on your bank or credit card statement once the payment has settled.
if you have questions about your payment, call (888) 987-0381 or email to [email protected] For questions regarding your bill, please contact your heath care provider directly.
Item Amount: $____
+ Additional Fees:
The minimum amount is $1.00.