ANESTHESIA DEPOSIT AND FEES

To submit payment for the deposit please use the links below. The entire fee for the anesthesia services rendered is determined by the length of the surgery being performed. The final bill will be available as soon as the surgery is compete. Dr. Yancey currently accepts medicaid and fee-for-service only. This bill is provided to help patients submit this to their private insurance if they choose to do so.

 

Once the deposit is received your appointment will be confirmed. Full payment is required on the day of anesthesia. After submitting the deposit please sign electronically the financial agreement below. 

 

Please don't hesitate to email Dr. Yancey at moutaindenlaanesthesia@gmail.com with any payment questions. Thank You.

PEDIATRIC PATIENTS (13 years old and younger)

 

 

 

ADULT PATIENTS (14 years old and older)

PEDIATRIC FEES

1. $950 fee for every case which is 2 hours or less

2. $600/hr billed in 15 minute increments for cases 2 hours or longer

PEDIATRIC DEPOSIT

There is a mandatory $300 deposit in order to hold the appointment. 

ADULT FEES

1. $600 for every case which is 1 hour or less

2. $600/hr billed in 15 minute increments for cases 1 hour or longer

ADULT DEPOSIT

There is a mandatory $500 deposit in order to hold the appointment.

Please sign the financial agreement below. Thank you

Please sign the financial agreement below. Thank you

Custom Payment

You can submit the remainder of your payment using the following button:

Mountain dental anesthesia fees are separate from the dental/surgery fees. Mountain dental anesthesia accepts all major credit cards and cash. Ask about a cash discount. 

    Both of these forms can be signed electronically above

      Adult Financial Agreement

    Pediatric Financial Agreement

Here is a sample bill for the statement of anesthesia services. Please use this bill to verify your insurance coverage regarding anesthesia services.