Pay Your Bill

Welcome to the Suburban Imaging Online Payment Center. You may pay your bill here by using your credit card. All credit cards accepted.

Please fill out the payment form below. All your information will be kept secure and confidential. All payments are made via secure server.

If you have questions or need more information, you may contact our billing department at 952.837.9700, Monday-Friday from 7:30am to 4:00pm CST.

If you would like to setup a payment plan, including automatic withdrawal using your credit card, contact us at 952.837.9710.

Please have a copy of your statement as it contains the information needed to complete the form.

First Name of Card Holder *:

Last Name of Card Holder *:

Billing Address *:

City *:

State *:

Zip Code *:

Patient Name is the same as Card Holder:

Patient First Name *:

Patient Last Name *:

Provider (Located on your statement) *:

Account Number *:

Email Address:

Yes, I would like to receive an email confirmation sent to my email address:

Amount of Payment *:

Credit Card Number (No dashes or spaces) *:

Expiration Date Month *:

Expiration Date Year *:

Card Identification Code *:

Comments Related to Your Payment:

Please confirm the information listed above is correct before submitting your payment.