Oral Surgeon Fee Schedule - Arkansas · 2019-10-01 · 00100 Anesthesia $0.00 00102 Anesthesia...

Procedure

Code Mod 1 Mod 2 Mod 3 Mod 4 Provider Program

Medicaid

Maximum

Allowed

Amount

00100 Anesthesia $0.00











Arkansas Medicaid Oral Surgery Fee Schedule

Provider Type: 79

Run Date 9/30/19

This fee schedule does not address the various coverage limitations routinely applied by Arkansas

Medicaid before final payment is determined (e.g., beneficiary and provider eligibility, benefit limits,

billing instructions, frequency of services, third party liability, age restrictions, prior authorization,

co-payments/coinsurance where applicable). Procedure codes and/or fee schedule amounts listed do

not guarantee payment, coverage or amount allowed.

Although every effort is made to ensure the accuracy of this information, discrepancies may occur. This

fee schedule may be changed or updated at any time to correct such discrepancies. The reimbursement

rates reflected in this fee schedule are in effect as of the date of this report. The reimbursement rate

applied to a claim depends on the claim’s date of service because Arkansas Medicaid’s reimbursement

rates are date-of-service effective. This fee schedule reflects only procedure codes that are currently

payable. Any procedure code reflecting a Medicaid maximum of $0.00 is manually priced with the

exception of anesthesia. The anesthesia procedure codes will also reflect a Medicaid maximum of

$0.00 since the reimbursement rate is determined when the claim is processed. The payment for

anesthesiology services is calculated using the base rate ($23.96 for an physician or $19.17 for a

CRNA) times the base units.

Please note that Arkansas Medicaid will reimburse the lesser of the amount billed or the Medicaid

maximum. For a full explanation of the procedure codes and modifiers listed here, refer to your

Arkansas Medicaid provider manual and provider notices.

Current Dental Terminology (including procedure codes, nomenclature, descriptors and other data

contained therein) is copyright © 2015 American Dental Association. All rights reserved. Applicable

FARS/DFARS apply.




10060 Surgeon $55.60

10061 Surgeon $167.20

10120 Surgeon $63.73

10121 Surgeon $155.02

10140 Surgeon $67.14

10160 Surgeon $58.48

10180 Surgeon $141.57

11000 Surgeon $65.27

11001 Surgeon $30.00

11042 Surgeon $76.21

11043 Surgeon $164.23

11044 Surgeon $230.77

11102 Surgeon $108.10

11103 Surgeon $58.41

11104 Surgeon $135.94

11105 Surgeon $66.96

11106 Surgeon $164.45

11107 Surgeon $79.02

11200 Surgeon $55.00

11201 Surgeon $16.50

11305 Surgeon $55.00

11306 Surgeon $62.70

11307 Surgeon $86.90

11308 Surgeon $130.90

11310 Surgeon $79.26

11311 Surgeon $101.18

11312 Surgeon $116.56

11313 Surgeon $190.58

11420 Surgeon $62.94

11421 Surgeon $83.14

11422 Surgeon $94.94

11423 Surgeon $116.18

11424 Surgeon $131.92

11426 Surgeon $265.10

11440 Surgeon $80.30

11441 Surgeon $101.20

11442 Surgeon $116.60

11443 Surgeon $189.20

11444 Surgeon $210.10

11446 Surgeon $436.00

11620 Surgeon $105.60

11621 Surgeon $127.60

11622 Surgeon $192.50

11623 Surgeon $210.10

11624 Surgeon $268.40

11626 Surgeon $388.30

11640 Surgeon $130.90

11641 Surgeon $195.80

11642 Surgeon $257.40

11643 Surgeon $315.70

11644 Surgeon $370.70

11646 Surgeon $356.40

11960 Surgeon $711.39

11970 Surgeon $669.52

11971 Surgeon $191.13

12001 Surgeon $86.54

12002 Surgeon $95.20

12004 Surgeon $113.56

12005 Surgeon $141.10

12006 Surgeon $184.63

12007 Surgeon $201.94

12011 Surgeon $92.05

12013 Surgeon $104.38

12014 Surgeon $123.79

12015 Surgeon $156.57

12016 Surgeon $189.88

12017 Surgeon $251.24

12018 Surgeon $307.11

12020 Surgeon $125.88

12021 Surgeon $87.33

12031 Surgeon $105.43

12032 Surgeon $120.11

12034 Surgeon $143.19

12035 Surgeon $164.96

12036 Surgeon $213.74

12037 Surgeon $305.79

12041 Surgeon $117.49

12042 Surgeon $132.18

12044 Surgeon $151.85

12045 Surgeon $178.07

12046 Surgeon $225.81

12047 Surgeon $257.54

12051 Surgeon $121.69

12052 Surgeon $136.38

12053 Surgeon $152.64

12054 Surgeon $179.12

12055 Surgeon $298.10

12056 Surgeon $304.70

12057 Surgeon $355.30

13120 Surgeon $156.05

13121 Surgeon $210.10

13131 Surgeon $203.50

13132 Surgeon $374.00

13151 Surgeon $304.70

13152 Surgeon $421.30

13160 Surgeon $432.20

14020 Surgeon $454.30

14021 Surgeon $547.80

14040 Surgeon $566.50

14041 Surgeon $834.90

14060 Surgeon $798.60

14061 Surgeon $1,052.70

15004 Surgeon $395.04

15004 Assistant Surgeon $79.01

15005 Surgeon $118.09


15040 Surgeon $322.96

15050 Surgeon $210.33

15100 Surgeon $511.50

15101 Surgeon $193.49


15115 Surgeon $958.44


15116 Surgeon $209.14

15120 Surgeon $667.70

15121 Surgeon $310.63

15135 Surgeon $1,025.78

15136 Surgeon $122.83

15155 Surgeon $848.42

15156 Surgeon $221.47

15157 Surgeon $245.18

15220 Surgeon $409.39

15221 Surgeon $120.76

15240 Surgeon $667.70

15241 Surgeon $186.50

15260 Surgeon $693.00

15261 Surgeon $219.14


15275 Surgeon $1,187.20


15276 Surgeon $737.60


15277 Surgeon $1,187.20


15278 Surgeon $737.60

15570 Surgeon $447.68

15572 Surgeon $482.90

15574 Surgeon $689.70

15576 Surgeon $707.75

15600 Surgeon $192.50

15610 Surgeon $261.00

15620 Surgeon $337.70

15630 Surgeon $374.00

15740 Surgeon $544.19

15750 Surgeon $604.51

15760 Surgeon $456.86

15770 Surgeon $536.80


15777 Surgeon $1,646.40

15840 Surgeon $1,017.50

15841 Surgeon $1,108.05

15842 Surgeon $1,847.10

15845 Surgeon $1,017.50

15850 Surgeon $100.24

15851 Surgeon $107.82

15852 Surgeon $102.00

15860 Surgeon $146.52

16000 Surgeon $42.48

16020 Surgeon $40.65

16025 Surgeon $80.30

16030 Surgeon $100.18

16035 Surgeon $203.25

17000 Surgeon $44.00

17003 Surgeon $10.88

17004 Surgeon $196.52

17107 Surgeon $542.21

17108 Surgeon $952.06

17110 Surgeon $49.50

17250 Surgeon $27.54

17270 Surgeon $105.60

17271 Surgeon $127.60

17272 Surgeon $179.97

17273 Surgeon $206.54

17274 Surgeon $254.57

17276 Surgeon $353.00

17280 Surgeon $130.54

17281 Surgeon $178.00

17282 Surgeon $234.00

17283 Surgeon $287.00

17284 Surgeon $337.00

17286 Surgeon $356.40

17311 Surgeon $765.90


17312 Surgeon $325.33


17315 Surgeon $123.30


17340 Surgeon $49.50

17999 Surgeon $0.00

20200 Surgeon $108.90

20205 Surgeon $156.20

20206 Surgeon $77.10

20220 Surgeon $116.60

20520 Surgeon $121.69

20525 Surgeon $201.94

20551 Surgeon $70.14

20552 Surgeon $70.14

20553 Surgeon $70.14

20605 Surgeon $58.30

20606 Surgeon $99.61


20612 Surgeon $63.12

20615 Surgeon $119.85

20670 Surgeon $156.20

20680 Surgeon $309.10

20690 Surgeon $316.11

20692 Surgeon $528.76

20693 Surgeon $343.31

20694 Surgeon $250.98

20900 Surgeon $270.65

20902 Surgeon $392.08

20910 Surgeon $290.40

20912 Surgeon $327.30

20920 Surgeon $274.06

20922 Surgeon $377.91

20924 Surgeon $508.20

20926 Surgeon $330.56

20932 Surgeon $820.37

20933 Surgeon $752.64

20934 Surgeon $819.94

20962 Surgeon $2,852.64

20969 Surgeon $3,663.12

20970 Surgeon $3,588.81

20999 Surgeon $0.00

21010 Surgeon $509.31

21015 Surgeon $511.07

21025 Surgeon $432.99

21026 Surgeon $246.00

21029 Surgeon $416.99

21030 Surgeon $295.83

21031 Surgeon $184.89

21032 Surgeon $203.50

21034 Surgeon $679.78

21040 Surgeon $239.80

21044 Surgeon $1,013.61

21045 Surgeon $1,391.73

21046 Surgeon $1,007.82

21047 Surgeon $1,243.79

21048 Surgeon $1,037.11

21049 Surgeon $1,178.20

21050 Surgeon $953.70

21060 Surgeon $1,029.93

21070 Surgeon $635.80

21079 Surgeon $2,105.85

21080 Surgeon $2,364.22

21081 Surgeon $2,155.41

21082 Surgeon $1,965.20

21083 Surgeon $1,483.16

21084 Surgeon $2,123.61

21085 Surgeon $1,060.70

21086 Surgeon $2,350.06

21087 Surgeon $2,348.92

21088 Surgeon $0.00

21089 Surgeon $0.00

21100 Surgeon $272.80

21110 Surgeon $389.40

21116 Surgeon $123.26

21120 Surgeon $360.80

21121 Surgeon $568.40

21122 Surgeon $625.74

21123 Surgeon $817.56

21125 Surgeon $1,040.88

21127 Surgeon $1,180.00

21137 Surgeon $1,055.45

21138 Surgeon $1,180.00

21139 Surgeon $1,237.86

21141 Surgeon $1,224.59


21142 Surgeon $1,270.59


21143 Surgeon $1,320.14


21145 Surgeon $1,440.47

21146 Surgeon $1,490.03

21147 Surgeon $1,546.66

21150 Surgeon $1,858.11

21151 Surgeon $2,081.08

21154 Surgeon $2,229.73

21155 Surgeon $2,527.03

21159 Surgeon $3,121.09

21160 Surgeon $3,417.50

21172 Surgeon $2,042.15

21175 Surgeon $2,452.70

21179 Surgeon $1,635.14

21180 Surgeon $1,858.11

21181 Surgeon $714.92

21182 Surgeon $2,378.38

21183 Surgeon $2,601.35

21184 Surgeon $2,824.33

21188 Surgeon $1,635.14


21193 Surgeon $1,235.20

21194 Surgeon $1,974.38

21195 Surgeon $1,238.74

21196 Surgeon $1,366.16

21198 Surgeon $1,235.20


21199 Surgeon $1,135.71

21206 Surgeon $953.70

21208 Surgeon $1,180.00

21209 Surgeon $762.89

21210 Surgeon $985.63

21215 Surgeon $1,027.59

21230 Surgeon $891.00

21235 Surgeon $421.19

21240 Surgeon $763.44

21242 Surgeon $1,235.20

21243 Surgeon $1,447.56

21244 Surgeon $1,121.95

21245 Surgeon $983.92

21246 Surgeon $888.35

21247 Surgeon $2,084.62

21248 Surgeon $1,084.47

21249 Surgeon $1,631.27

21255 Surgeon $1,539.57

21256 Surgeon $1,490.03

21260 Surgeon $1,454.20

21261 Surgeon $2,017.38

21263 Surgeon $2,501.84

21267 Surgeon $1,419.24

21268 Surgeon $1,705.92

21270 Surgeon $849.42

21275 Surgeon $852.96

21280 Surgeon $554.25

21282 Surgeon $353.93

21295 Surgeon $105.17

21296 Surgeon $322.07

21299 Surgeon $0.00

21310 Surgeon $103.04

21315 Surgeon $108.90

21320 Surgeon $277.00

21325 Surgeon $345.40

21330 Surgeon $471.90

21335 Surgeon $957.00

21336 Surgeon $285.08

21337 Surgeon $178.60

21338 Surgeon $327.83

21339 Surgeon $410.96

21340 Surgeon $635.80

21343 Surgeon $621.82

21344 Surgeon $1,182.12

21345 Surgeon $635.80

21346 Surgeon $891.00

21347 Surgeon $1,110.12

21348 Surgeon $1,203.35

21355 Surgeon $175.98

21356 Surgeon $492.47

21360 Surgeon $609.40

21365 Surgeon $1,197.90

21366 Surgeon $1,289.20

21385 Surgeon $834.90

21386 Surgeon $834.90

21387 Surgeon $1,069.44

21390 Surgeon $834.90

21395 Surgeon $980.10

21400 Surgeon $225.54

21401 Surgeon $414.37

21406 Surgeon $621.03

21407 Surgeon $763.40

21408 Surgeon $943.89

21421 Surgeon $407.00

21422 Surgeon $635.80

21423 Surgeon $852.96

21431 Surgeon $385.00

21432 Surgeon $635.80

21433 Surgeon $1,180.70

21435 Surgeon $1,399.20

21436 Surgeon $1,773.17

21440 Surgeon $254.10

21445 Surgeon $482.90

21450 Surgeon $254.10

21451 Surgeon $458.69

21452 Surgeon $170.47

21453 Surgeon $510.36

21454 Surgeon $618.23

21461 Surgeon $711.70

21462 Surgeon $974.00

21465 Surgeon $1,222.71

21470 Surgeon $1,410.38

21480 Surgeon $48.78

21485 Surgeon $189.35

21490 Surgeon $515.87

21499 Surgeon $0.00

21501 Surgeon $187.52

21550 Surgeon $98.35

21555 Surgeon $201.15

21557 Surgeon $745.80

29800 Surgeon $336.22

29804 Surgeon $466.30

29999 Surgeon $0.00

30000 Surgeon $76.32

30020 Surgeon $123.20

30100 Surgeon $71.50

30110 Surgeon $208.06

30115 Surgeon $319.00

30117 Surgeon $304.70

30118 Surgeon $488.07

30120 Surgeon $530.11

30124 Surgeon $144.77

30125 Surgeon $356.94

30130 Surgeon $297.00

30140 Surgeon $290.40

30150 Surgeon $508.20

30160 Surgeon $763.40

30200 Surgeon $40.65

30210 Surgeon $56.91

30220 Surgeon $130.24

30300 Surgeon $64.26

30310 Surgeon $179.97

30320 Surgeon $381.70

30400 Surgeon $613.80

30410 Surgeon $1,234.20

30420 Surgeon $1,650.00

30430 Surgeon $372.93

30435 Surgeon $927.29

30450 Surgeon $861.26

30462 Surgeon $1,567.89

30520 Surgeon $706.35

30540 Surgeon $569.80

30545 Surgeon $1,039.71

30560 Surgeon $68.71

30580 Surgeon $522.50

30600 Surgeon $493.75

30620 Surgeon $746.57

30630 Surgeon $710.00

30801 Surgeon $65.57

30802 Surgeon $119.90

30901 Surgeon $67.14

30903 Surgeon $97.90

30905 Surgeon $195.80

30906 Surgeon $140.57

30915 Surgeon $530.20

30920 Surgeon $913.83

30930 Surgeon $111.13

30999 Surgeon $0.00

31000 Surgeon $64.52

31002 Surgeon $108.90

31020 Surgeon $360.00

31030 Surgeon $647.00

31050 Surgeon $388.30

31051 Surgeon $389.98

31070 Surgeon $427.90

31075 Surgeon $974.00

31080 Surgeon $1,205.00

31081 Surgeon $908.60

31084 Surgeon $851.40

31085 Surgeon $851.40

31086 Surgeon $1,103.30

31087 Surgeon $1,103.30

31090 Surgeon $1,122.00

31225 Surgeon $1,325.50

31230 Surgeon $1,488.30

31231 Surgeon $116.60

31233 Surgeon $192.50

31235 Surgeon $307.00

31237 Surgeon $168.11

31238 Surgeon $185.42

31239 Surgeon $461.84

31240 Surgeon $151.80

31241 Surgeon $533.06

31276 Surgeon $620.79

31287 Surgeon $201.94

31288 Surgeon $235.77

31290 Surgeon $1,415.82

31291 Surgeon $1,454.19

31292 Surgeon $735.90

31293 Surgeon $801.99

31294 Surgeon $945.71

31295 Surgeon $225.40


31296 Surgeon $269.88


31297 Surgeon $220.60


31298 Surgeon $4,406.10


31299 Surgeon $0.00

31500 Surgeon $89.17

31502 Surgeon $104.90

31505 Surgeon $43.01

31510 Surgeon $93.10

31511 Surgeon $108.58

31512 Surgeon $117.23

31513 Surgeon $193.69

31515 Surgeon $101.20

31530 Surgeon $301.19

31531 Surgeon $403.00

31535 Surgeon $307.00

31536 Surgeon $407.38

31575 Surgeon $76.58

31576 Surgeon $197.22

31577 Surgeon $243.84

31578 Surgeon $279.28

31600 Surgeon $324.04

31601 Surgeon $370.70

31603 Surgeon $204.30

31605 Surgeon $347.00

31820 Surgeon $273.01

31825 Surgeon $392.86

31830 Surgeon $274.06

36000 Surgeon $29.00

36400 Surgeon $14.16

36405 Surgeon $26.40

36406 Surgeon $16.50

36410 Surgeon $19.80

36591 Surgeon $19.80

36592 Surgeon $24.48

36600 Surgeon $39.00

36620 Surgeon $99.66

36625 Surgeon $175.42

38300 Surgeon $101.49

38500 Surgeon $210.10

38505 Surgeon $100.52

38510 Surgeon $265.10

38520 Surgeon $265.10

38525 Surgeon $265.10

38531 Surgeon $496.34

38542 Surgeon $302.39

38700 Surgeon $514.55

38720 Surgeon $980.10

38724 Surgeon $814.32

38740 Surgeon $578.00

38745 Surgeon $744.70

40490 Surgeon $72.60

40500 Surgeon $447.59

40510 Surgeon $443.30

40520 Surgeon $427.90

40525 Surgeon $743.25

40527 Surgeon $888.35

40530 Surgeon $298.71

40650 Surgeon $355.34

40652 Surgeon $416.92

40654 Surgeon $523.81

40700 Surgeon $853.60

40701 Surgeon $1,361.80

40702 Surgeon $682.00

40720 Surgeon $980.10

40761 Surgeon $1,081.30

40799 Surgeon $0.00

40800 Surgeon $65.30

40801 Surgeon $124.05

40804 Surgeon $72.38

40806 Surgeon $26.40

40808 Surgeon $60.58

40810 Surgeon $83.93

40812 Surgeon $127.60

40814 Surgeon $422.53

40816 Surgeon $445.26

40818 Surgeon $254.10

40819 Surgeon $126.67

40820 Surgeon $70.02

40830 Surgeon $87.60

40831 Surgeon $141.90

40840 Surgeon $508.20

40842 Surgeon $508.20

40843 Surgeon $763.40

40844 Surgeon $826.10

40845 Surgeon $953.70

40899 Surgeon $0.00

41000 Surgeon $73.17

41005 Surgeon $69.30

41006 Surgeon $152.11

41007 Surgeon $168.63

41008 Surgeon $150.27

41009 Surgeon $190.40

41010 Surgeon $71.50

41015 Surgeon $172.31

41016 Surgeon $212.95

41017 Surgeon $183.32

41018 Surgeon $252.56

41100 Surgeon $86.28

41105 Surgeon $119.90

41108 Surgeon $66.87

41110 Surgeon $210.39

41112 Surgeon $337.44

41113 Surgeon $347.00

41114 Surgeon $438.90

41115 Surgeon $105.17

41116 Surgeon $143.98

41120 Surgeon $547.80

41130 Surgeon $558.61

41135 Surgeon $1,452.00

41140 Surgeon $1,195.12

41145 Surgeon $1,597.20

41150 Surgeon $1,221.00

41153 Surgeon $2,031.54

41155 Surgeon $1,459.22

41250 Surgeon $101.20

41251 Surgeon $145.20

41252 Surgeon $191.40

41510 Surgeon $254.10


41512 Surgeon $742.66

41520 Surgeon $289.00


41530 Surgeon $2,562.26

41599 Surgeon $0.00

41800 Surgeon $65.04

41805 Surgeon $68.71

41806 Surgeon $129.29

41820 Surgeon $347.00

41821 Surgeon $347.00

41822 Surgeon $314.13

41823 Surgeon $347.00

41825 Surgeon $190.58

41826 Surgeon $279.74

41827 Surgeon $426.61

41828 Surgeon $347.00

41830 Surgeon $409.13

41850 Surgeon $46.00

41870 Surgeon $462.00

41872 Surgeon $330.45

41872 Surgeon $343.00

41874 Surgeon $377.07

41874 Surgeon $343.00

41899 Surgeon $0.00

42000 Surgeon $70.55

42100 Surgeon $74.48

42104 Surgeon $213.89

42106 Surgeon $270.42

42107 Surgeon $462.00

42120 Surgeon $508.20

42140 Surgeon $163.36

42145 Surgeon $784.68

42160 Surgeon $105.17

42180 Surgeon $132.44

42182 Surgeon $193.28

42200 Surgeon $1,188.00

42205 Surgeon $914.30

42210 Surgeon $1,071.40

42215 Surgeon $744.70

42220 Surgeon $743.00

42225 Surgeon $817.30

42226 Surgeon $544.50

42227 Surgeon $544.50

42235 Surgeon $743.00

42260 Surgeon $586.30

42280 Surgeon $150.78

42281 Surgeon $140.15

42299 Surgeon $0.00

42300 Surgeon $98.09

42305 Surgeon $266.98

42310 Surgeon $97.90

42320 Surgeon $264.00

42330 Surgeon $112.20

42335 Surgeon $246.40

42340 Surgeon $435.94

42400 Surgeon $60.32

42405 Surgeon $163.90

42408 Surgeon $224.50

42409 Surgeon $352.59

42410 Surgeon $508.20

42415 Surgeon $813.01

42420 Surgeon $1,016.40

42425 Surgeon $654.08

42426 Surgeon $1,415.70

42440 Surgeon $613.80

42450 Surgeon $236.50

42500 Surgeon $304.70

42505 Surgeon $572.00

42507 Surgeon $578.00

42509 Surgeon $826.10

42510 Surgeon $731.50

42550 Surgeon $185.16

42600 Surgeon $471.83

42650 Surgeon $48.40

42660 Surgeon $56.10

42665 Surgeon $141.62

42699 Surgeon $0.00

42700 Surgeon $90.74

42720 Surgeon $238.40

42725 Surgeon $472.59

42800 Surgeon $80.78

42804 Surgeon $80.78

42806 Surgeon $163.90

42808 Surgeon $254.10

42810 Surgeon $203.50

42815 Surgeon $511.50

42900 Surgeon $317.90

42950 Surgeon $763.40

42953 Surgeon $763.40

42960 Surgeon $116.60

42961 Surgeon $244.17

42962 Surgeon $358.77

42970 Surgeon $211.12

42971 Surgeon $281.14

42972 Surgeon $335.17

42999 Surgeon $0.00

43191 Surgeon $177.43


43192 Surgeon $211.39


43193 Surgeon $251.66


43194 Surgeon $227.82


43195 Surgeon $252.15


43196 Surgeon $275.38


43197 Surgeon $257.87


43198 Surgeon $287.69


43200 Surgeon $195.80

43201 Surgeon $274.34

43202 Surgeon $225.50

43204 Surgeon $403.30

43205 Surgeon $357.84


43206 Surgeon $0.00

43211 Surgeon $341.52


43212 Surgeon $267.83


43213 Surgeon $1,726.26


43214 Surgeon $274.42


43215 Surgeon $226.59

43216 Surgeon $248.00

43217 Surgeon $248.98

43220 Surgeon $225.54

43226 Surgeon $250.60

43227 Surgeon $363.00

43229 Surgeon $1,015.55


43233 Surgeon $325.62


64400 Surgeon $65.83

64402 Surgeon $94.94

64405 Surgeon $76.05

64716 Surgeon $578.00

64722 Surgeon $317.90

64727 Surgeon $289.00

64732 Surgeon $427.90

64734 Surgeon $427.90

64736 Surgeon $410.76

64738 Surgeon $443.30

64740 Surgeon $610.77

64742 Surgeon $684.79

64744 Surgeon $443.30

64774 Surgeon $261.80

64788 Surgeon $272.80

64790 Surgeon $834.90

64792 Surgeon $763.40

64795 Surgeon $261.56

64840 Surgeon $635.80

64864 Surgeon $953.70

64872 Surgeon $127.60

64874 Surgeon $191.40

64885 Surgeon $1,169.30

64886 Surgeon $1,287.00

64901 Surgeon $925.00

64902 Surgeon $1,017.50

64905 Surgeon $1,017.50

64907 Surgeon $1,017.50

64999 Surgeon $0.00

67599 Surgeon $0.00

67700 Surgeon $118.80

67710 Surgeon $119.33

67715 Surgeon $75.90

67800 Surgeon $128.77

67801 Surgeon $152.64

67805 Surgeon $164.17

67808 Surgeon $195.80

67810 Surgeon $113.04

67820 Surgeon $50.09

67825 Surgeon $148.18

67830 Surgeon $188.56

67835 Surgeon $297.93

67875 Surgeon $347.00

67880 Surgeon $288.23

67882 Surgeon $383.95

67900 Surgeon $351.80

67901 Surgeon $427.90

67902 Surgeon $573.10

67903 Surgeon $759.00

67904 Surgeon $763.23

67906 Surgeon $573.10

67908 Surgeon $427.90

67909 Surgeon $343.82

67911 Surgeon $427.90

67914 Surgeon $566.00

67915 Surgeon $221.61

67916 Surgeon $566.50

67917 Surgeon $584.10

67921 Surgeon $276.16

67922 Surgeon $216.36

67923 Surgeon $427.75

67924 Surgeon $360.35

67930 Surgeon $381.70

67935 Surgeon $635.80

67938 Surgeon $135.32

67950 Surgeon $549.30

67961 Surgeon $385.00

67966 Surgeon $454.30

67971 Surgeon $678.70

67973 Surgeon $871.20

67974 Surgeon $889.90

67975 Surgeon $405.72

67999 Surgeon $0.00

68400 Surgeon $173.35

68420 Surgeon $195.91

68440 Surgeon $112.25

68530 Surgeon $290.06

68700 Surgeon $531.51

68705 Surgeon $155.26

68720 Surgeon $834.90

68745 Surgeon $530.20

68750 Surgeon $530.20

68760 Surgeon $139.78

68761 Surgeon $125.88

68770 Surgeon $428.80

68840 Surgeon $139.52

68850 Surgeon $197.22

68899 Surgeon $0.00

69000 Surgeon $68.98

69005 Surgeon $104.38

69100 Surgeon $51.40

69110 Surgeon $175.45

69200 Surgeon $43.53

69205 Surgeon $145.70

69210 Surgeon $35.15

69300 Surgeon $460.90

69399 Surgeon $0.00

70030 26 $11.66

70030 TC $16.94

70030 $28.60

70100 26 $16.00

70100 TC $19.20

70100 $35.20

70110 26 $19.00

70110 TC $28.56

70110 $47.56

70140 26 $17.00

70140 TC $23.70

70140 $40.70

70150 26 $18.00

70150 TC $21.60

70150 $39.60

70160 26 $13.00

70160 TC $24.30

70160 $37.30

70170 26 $20.05

70170 $38.03

70210 26 $18.00

70210 TC $17.20

70210 $35.20

70220 26 $16.50

70220 TC $33.00

70220 $49.50

70250 26 $19.00

70250 TC $26.10

70250 $45.10

70260 26 $22.38

70260 TC $35.92

70260 $58.30

70300 26 $7.38

70300 TC $13.52

70300 $20.90

70310 26 $7.70

70310 TC $16.50

70310 $24.20

70320 26 $13.20

70320 TC $20.90

70320 $34.10

70328 26 $15.00

70328 TC $15.80

70328 $30.80

70330 26 $16.32

70330 TC $27.68

70330 $44.00

70332 26 $36.37

70332 $79.20

70336 26 $119.00

70336 TC $343.00

70336 $462.00

70350 26 $9.00

70350 TC $22.00

70350 $31.00

70355 26 $10.45

70355 TC $24.20

70355 $35.20

70360 26 $11.00

70360 TC $10.45

70360 $20.90

70380 26 $11.00

70380 TC $16.50

70380 $27.50

70390 26 $25.18

70390 $64.26

70480 26 $96.00

70480 TC $208.70

70480 $304.70

70486 26 $92.00

70486 TC $206.10

70486 $298.10

76000 26 $18.00

76000 $43.01

76100 26 $37.81

76100 TC $53.49

76100 $91.30

76140 26 $6.60

76140 $6.60

76499 26 $0.00

76499 TC $0.00

76499 $0.00

92511 $63.80

95831 $24.20

95851 $24.25

95868 26 $93.58

95868 TC $7.62

95868 $101.20

95937 26 $52.97

95937 TC $13.24

95937 $66.21

95999 $0.00

96365 $90.58

96366 $28.93

96367 $45.53

96368 $27.03

96374 $71.61

96375 $31.30

96379 $0.00

99151 $86.32

99152 $57.12

99153 $11.82

99155 $88.47

99156 $76.89

99157 $58.16

99201 $29.70

99202 $45.10

99203 $64.90

99204 $88.00

99205 $137.50

99211 $14.30

99212 $27.50

99213 $36.30

99214 $70.05

99215 $106.00

99217 $46.73

99218 $52.80

99219 $75.90

99220 $116.60

99221 $64.90

99222 $92.40

99223 $141.90

99231 $34.50

99232 $50.60

99233 $68.20

99234 $68.71

99235 $92.86

99236 $116.08

99238 $52.80

99241 UA UB $42.36

99241 $53.50

99242 UA UB $66.97

99242 $72.60

99243 UA UB $86.90

99243 $101.20

99244 U1 UA $122.09

99244 U1 $122.09

99244 $119.90

99245 U1 UA $164.45

99245 $123.20

99251 $53.00

99252 $72.60

99253 $98.56

99254 $119.90

99255 $123.20

99281 $22.00

99282 $35.00

99283 $53.90

99284 $71.50

99285 $83.75

99288 $53.09

99341 $56.32

99342 $71.50

99343 $93.50

99347 $38.93

99348 $56.99

99349 $83.47

99354 $106.00

99355 $55.64

99356 $106.00

99357 $55.00

99415 $9.18

99416 $0.75

D0120 EP Child $26.60

D0120 Adult $26.60

D0120 Child $26.60

D0140 EP Child $34.20

D0140 Adult $34.20

D0140 Child $34.20

D0210 Adult $86.45

D0210 Child $86.45

D0220 Adult $18.05

D0220 Child $18.05

D0230 Adult $14.25

D0230 Child $14.25

D0240 Child $24.70

D0250 Child $53.20

D0272 Child $24.70

D0272 Adult $24.70

D0330 Adult $62.70

D0330 Child $62.70

D0340 Child $67.45

D0350 Child $33.25

D0470 Adult $47.50

D0470 Child $47.50

D1110 Adult $48.45

D1110 Child $48.45

D1120 Child $36.10

D1206 Child $19.95

D1208 Adult $19.95

D1208 Child $19.95

D1320 Child $25.00

D1320 Adult $25.00

D1351 Child $28.50

D1510 Child $171.95

D1516 Child $256.50

D1517 Child $256.50

D1526 Child $266.00

D1527 Child $266.00

D1575 Child $171.95

D2140 Adult $65.55

D2140 Child $65.55

D2150 Adult $80.75

D2150 Child $80.75

D2160 Adult $94.05

D2160 Child $94.05

D2161 Adult $114.95

D2161 Child $114.95

D2330 Adult $76.95

D2330 Child $76.95

D2331 Adult $95.95

D2331 Child $95.95

D2332 Adult $114.95

D2332 Child $114.95

D2335 Child $144.40

D2335 Adult $144.40

D2710 Child $371.45

D2752 Child $610.85

D2920 Adult $43.70

D2920 Child $43.70

D2930 Child $140.60

D2931 Child $158.65

D2931 Adult $158.65

D3220 Child $86.45

D3221 Child $92.15

D3310 Child $404.70

D3320 Child $474.05

D3330 Child $599.45

D3410 Child $380.00

D4341 Child $142.50

D4341 Adult $142.50

D4346 Adult $48.45

D4346 Child $48.45

D4355 Adult $93.10

D4910 Child $66.50

D4910 Adult $66.50

D5110 Child $807.50

D5120 Child $807.50

D5211 Child $570.00

D5212 Child $570.00

D5410 Adult $41.80

D5411 Adult $41.80

D5611 Adult $76.95

D5611 Child $76.95

D5612 Adult $76.95

D5612 Child $76.95

D5621 Child $127.30

D5622 Child $127.30

D5640 Adult $75.05

D5640 Child $75.05

D5650 Adult $97.85

D5650 Child $97.85

D5730 Adult $163.40

D5731 Adult $163.40

D5750 Child $259.35

D6930 Adult $64.60

D6930 Child $64.60

D7111 Child $47.50

D7140 Adult $72.20

D7140 Child $72.20

D7210 Adult $138.70

D7210 Child $138.70

D7220 Adult $180.50

D7220 Child $180.50

D7230 Adult $234.65

D7230 Child $234.65

D7240 Adult $268.85

D7240 Child $268.85

D7241 Child $306.85

D7241 Adult $306.85

D7250 Adult $158.65

D7250 Child $158.65

D7270 Child $211.85

D7280 Child $149.15

D7285 Child $119.70

D7285 Adult $119.70

D7286 Child $110.20

D7286 Adult $110.20

D7310 Adult $135.85

D7472 Adult $249.85

D7473 Adult $249.85

D7510 Adult $87.40

D7510 Child $87.40

D7630 Child $680.00

D7640 Child $488.00

D7740 Child $720.00

D7960 Child $189.05

D8070 Child $3,838.00

D8080 Child $3,924.45

D8090 Child $4,174.30

D8210 Child $624.15

D8220 Child $825.55

D8999 Child $0.00

D9110 Adult $43.70

D9110 Child $43.70

D9222 Child $95.95

D9223 Child $95.95

D9230 Child $26.60

D9248 Child $96.74

D9920 Child $20.00

D9920 Adult $20.00

D9999 Adult $0.00

D9999 Child $0.00

Q3014 $2.54

T1502 $1.60

Oral Surgeon Fee Schedule - Arkansas · 2019-10-01 · 00100 Anesthesia $0.00 00102 Anesthesia...

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Transcript of Oral Surgeon Fee Schedule - Arkansas · 2019-10-01 · 00100 Anesthesia $0.00 00102 Anesthesia...