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MyChart - Pay as Guest

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You can find the guarantor name and account number on your statement.</span> </div> <div> <span class="header">What is a visit account?</span> <span>A visit account is how your charges are grouped together to bill insurance, and usually represents your billing activity for a single visit. You may have multiple visit accounts, each with their own balance.</span> </div> <div id="divCSPhone" class="guestPaySidebarHeader hidden"> <span class="header">Need help?</span> <span id="csPhoneNumber"></span> </div> <div id="divMyChartSignInPromptSidebar" class="hidden"> <span class="header">Sign in to MyChart</span> <span>Want to use a saved credit card or bank account? Log in to your MyChart account!</span> <form action="/UCI/Billing/GuestPay/Verify" autocomplete="off" method="post"><input name="__RequestVerificationToken" type="hidden" value="7SL9cHD8zcdtHHodC07ZaR616UrwygHHp8lcZuV0klllsUPBNtYMNIUIN_BUcBRpaKEcVuD0Jq6W7ywwpY__Xf7rBTk1" /><input id="SignInSidebar-id" name="guarantorID" type="hidden" value="" /><input id="SignInSidebar-context" name="context" type="hidden" value="" /><input id="SignInSidebar-relay" name="relaystate" type="hidden" value="" /> <div><input class="button autowidth" type="submit" title="Leave this page and sign in to your MyChart account before paying." value="Sign in" /></div> </form> </div> <div id="divMyChartSignUpPromptSidebar" class="hidden"> <span class="header">Sign up for MyChart</span> <span>Want to save your credit card or bank account for next time? You can also learn more about your bill, sign up for a payment plan, and review your payment history. 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