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 Nome 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 Nome 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, Minimal Exam	$175
99202	New Patient Expanded Problem Focused Exam	$225
99211	Existing Patient Minimal Exam	$75
97040	Xray Cervical AP/Lateral	$285
Medicine
Billing Code	Description	Fee
98940	Chiropractic Adjustment 1-2 Regions	$85
98941	Chiropractic Adjustment 3-4 Regions	$125
98943	Extremity Adjustment - i.e. shoulder, wrist, ankle	$60
97014	Muscle Stimulation	$60
97035	Ultrasound 1 unit 15 minutes	$75
97140	Manual Therapy 1 unit 15 Minutes	$90

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