Insurance Coverage
 
Prior to undergoing treatment, there will be some necessary testing. This will ensure the overall
safety of the procedure and give the physicians an overall view of your general state of health.

You will be screened for cardio arrhythmia, prostatic hyperthrophy, acute angle glaucoma. For the
ladies: If you feel that you may be pregnant, we would want to rule out this possibility before
proceeding.

It should be noted ... If you are currently taking large amounts of psychotropic medications or if
you are suffering from severe depression, panic or anxiety attacks, your chances of success with
this treatment protocol are greatly diminished.
 
Your Diagnosis will be TDD 305.1 (Tobacco Dependency Disorder)
     
Procedure CPT
Charges
     
Level 2 Office Visit 99202 48.00
Counseling / Drug Abuse 99403 65.00
EKG with interpretation 93000 70.00
Pulmonary Lung Function 94010 38.00
Anticholinergic Block with titration 90772 197.00
Total   *418.00
 

Current Special

Groups of two or more will be treated for $70 off the full treatment price for appointments booked and completed by 09/30/2007.  The number of appointment times at this price are limited and will fill up quickly.  This special may be discontinued at any time without prior notice.  The appointment must be booked at least two days in advance and be paid for by Cash or Check only.  This offer cannot be combined with any other offer.

Some insurance companies may pay all of the charges, some may pay only a portion and others
may pay nothing at all. We Do Not Accept Assignment of Insurance nor make any claims as to
what your insurer may pay. Patients will be responsible for payment at the time the services are
rendered. We will provide you with the appropriate documentation to submit to your insurer. This
procedure is not covered by Medicare.
 
The Internal Revenue Service has ruled that smoking cessation procedures administered by
licensed physicians are tax deductible up to $350.00. These deductions do not include over the
counter medications. Check with your accountant for deductions you may be entitled to. The
clinics and its affiliates will assume no responsibility nor make any claims with respect to individual
tax situations.
 

* Prices subject to change without notice and may vary by geographical locations.

 

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