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Listas para Publicar en el Portal-1 (2) - Triple-S Salud

Listas para Publicar en el Portal-1 (2) - Triple-S Salud

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Procedure &<br />

Place of Service<br />

Tarifas<br />

Servicios de <strong>Salud</strong><br />

Description Fee<br />

67906-00 rpr blpos suprior rectus fscal sling $585.00<br />

67908-00 rpr blpos conjunctivo-tarso-musc-levator rescj $451.43<br />

67909-00 rdctj >corrj ptosis $312.00<br />

67911-00 corrj lid retrcj $376.35<br />

67912-00 corrj lagophthalmos impltj upr ey<strong>el</strong>id lid load $345.74<br />

67914-00 rpr ectropion sutr $48.75<br />

67915-00 rpr ectropion thermocaut $48.75<br />

67916-00 rpr ectropion exc tarsal wedge $292.50<br />

67917-00 rpr ectropion x10sv $390.00<br />

67921-00 rpr <strong>en</strong>tropion sutr $48.75<br />

67922-00 rpr <strong>en</strong>tropion thermocaut $48.75<br />

67923-00 rpr <strong>en</strong>tropion exc tarsal wedge $292.50<br />

67924-00 rpr <strong>en</strong>tropion x10sv $390.00<br />

67930-00 sutr rec<strong>en</strong>t wnd ey<strong>el</strong>id prtl thkns $58.50<br />

67935-00 sutr rec<strong>en</strong>t wnd ey<strong>el</strong>id full thkns $107.25<br />

67938-00 rmvl embedded fb ey<strong>el</strong>id $52.65<br />

67950-00 canthoplasty $401.70<br />

67961-00 exc&rpr ey<strong>el</strong>id < one-4th lid mrgn $390.00<br />

67966-00 exc&rpr ey<strong>el</strong>id > one-4th lid mrgn $487.50<br />

67971-00 rcnstj ey<strong>el</strong>id full thkns < 2-3rd 1 stg $487.50<br />

67973-00 rcnstj ey<strong>el</strong>id full thkns tot lwr 1 stg $731.25<br />

67974-00 rcnstj ey<strong>el</strong>id full thkns tot upr 1 stg $828.75<br />

67975-00 rcnstj ey<strong>el</strong>id full thkns 2nd stg $78.00<br />

68020-00 inc cjnc drg cst $48.75<br />

68040-00 expression cjncl follicles $19.50<br />

68100-00 bx cjnc $48.75<br />

68110-00 exc les cjnc up 1 cm $48.75<br />

68115-00 exc les cjnc > 1 cm $125.78<br />

68130-00 exc les cjnc w/adj scl $214.50<br />

68135-00 dstrj les cjnc $19.50<br />

68200-00 scjncl njx $19.50<br />

68320-00 cjp cjncl grf/x10sv reargmt $487.50<br />

68325-00 cjp buccal muc memb grf $585.00<br />

68326-00 cjp rcnstj cul-de-sac cjncl grf/reargmt $370.50<br />

68328-00 cjp rcnstj cul-de-sac buccal muc memb grf $477.75<br />

68330-00 rpr symblepharon cjp w/o grf $263.25<br />

68335-00 rpr symblepharon fr grf cjnc/buccal muc memb $438.75<br />

68340-00 rpr symblepharon div $165.75<br />

68360-00 cjncl flap bridge/prtl spx $273.00<br />

68362-00 cjncl flap tot $360.75<br />

68400-00 inc drg lacrimal glnd $97.50<br />

68420-00 inc drg lacrimal sac $73.13<br />

68440-00 snip inc lacrimal punctum $19.50<br />

68500-00 exc lacrimal glnd xcp tum tot $487.50<br />

68505-00 exc lacrimal glnd xcp tum prtl $429.00<br />

68510-00 bx lacrimal glnd $195.00<br />

68520-00 exc lacrimal sac $487.50<br />

68525-00 bx lacrimal sac $195.00<br />

68530-00 rmvl fb/dacryolith lacrimal psages $492.38<br />

68540-00 exc lacrimal glnd tum frnt appr $585.00<br />

101

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