This notice is being posted in accordance with AS 18.23.400. Disclosure and reporting of health care services, prices, and fee information. Effective January 1, 2019 and until further notice, the Arctic Chiropractic Dutch Harbor charges the following undiscounted fees for the listed health care services:

You will be provided an estimate of the anticipated charges for your non-emergency care upon request. Please do not hesitate to ask for information.

The undiscounted prices listed below may be higher or lower than the amount an individual actually pays for the health care services described.

Arctic Chiropractic Dutch Harbor is contracted to provide health care services as an in-network preferred provider with Premera Blue Cross Blue Shield of Alaska.

Billing Code	Description	Fee
Evaluation/Management
99201	New Patient Exam, Problem Focused Exam	$225
99202	New Patient Exam, Expanded Problem Focused Exam	$250
99211	Established Patient Exam, Minimal Exam	$75
99212	Established Patient Exam, Problem Focused Exam	$150
Medicine
Billing Code	Description	Fee
97140	Manual Therapy Per Unit	$80
98940	Chiropractic Adjustment 1-2 Regions	$75
97032	Electrical Muscle Stimulation Per Unit	$70
97110	Therapeutic Procedure/Exercise 15 min/1 unit	$90
97530	Therapeutic Activities Per Unit	$90
97032	Electrical Muscle Stimultion Per Unit	$70

You may also find a copy of this fee schedule on our website at https://arcticchiropractic.com/.

The State of Alaska Department of Health and Social Services website address is http://dhss.alaska.gov/Pages/default.aspx