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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
69910-00 labyrinthectomy mstdc $1,296.75
69915-00 vstblr nrv sctj translabyrinthine appr $1,092.00
69930-00 cochlear dev impltj +-mstdc $1,435.20
69950-00 vstblr nrv sctj transcrnl $965.25
69955-00 tot facial nrv dcmprn&/rpr $838.50
69960-00 dcmprn int aud canal $916.50
69970-00 rmvl tum temporal b1 $1,033.50
90470-00 immune admin h1n1 im/nasal incl cnsl $3.90
90471-00 imadm prq id subq/im njxs 1 vacc $3.90
90472-00 imadm prq id subq/im njxs ea vacc $3.90
90473-00 imadm intransl/oral 1 vacc $3.90
90474-00 imadm intransl/oral ea vacc $3.90
90633-00 hepatitis a vaccine pediatric 2 dose schedule im $3.90
90636-00 hepatitis a & b vaccine hepa-hepb adult im $3.90
90645-00 hemophilus influenza b vacc hboc conj 4 dose im $3.90
90646-00 hemophilus influenza b vaccine prp-d booster im $3.90
90647-00 hemophilus influenza b vaccine prp-omp 3 dose im $3.90
90648-00 hemophilus influenza b vaccine prp-t 4 dose im $3.90
90649-00 human papilloma virus vaccine quadriv 3 dose im $3.90
90650-00 human papilloma virus bivalent vaccine 3 dose im $3.90
90655-00 influenza virus vacc split prsrv free 6-35 mo im $3.90
90656-00 influenza virus vacc split prsrv fr 3 years + im $3.90
90657-00 influenza virus vaccine split virus 6-35 mo im $3.90
90658-00 influenza virus vaccine split virus 3 years + im $3.90
90660-00 influenza virus vaccine live intranasal $3.90
90669-00 pneumococcal conj vaccine 7 valent im $3.90
90670-00 pneumococcal conj vaccine 13 valent im $3.90
90680-00 rotavirus vaccine pentavalent 3 dose live oral $3.90
90681-00 rotavirus vacc human attenuated 2 dose live oral $3.90
90696-00 dtap-ipv inactivated if admin pts age 4-6 yrs im $3.90
90698-00 dtap-hib-ipv vaccine im $3.90
90700-00 dtap vaccine < 7 yr im $3.90
90701-00 diphtheria tetanus toxoid pertussis vaccine im $3.90
90702-00 diphtheria tetanus toxoid adsorbed < 7 yr im $3.90
90703-00 tetanus toxoid adsorbed intramuscular $3.90
90704-00 mumps virus vaccine live subcutaneous $3.90
90705-00 measles virus vaccine live subcutaneous $3.90
90706-00 rubella virus vaccine live subcutaneous $3.90
90707-00 measles mumps rubella virus vaccine live subq $3.90
90708-00 measles & rubella virus vaccine live subq $3.90
90710-00 measles mumps rubella varicella vacc live subq $3.90
90712-00 poliovirus vaccine any live oral $3.90
90713-00 poliovirus vaccine inactivated subq/im $3.90
90714-00 td toxoids adsorbed prsrv fr 7 yr + im $3.90
90715-00 tdap vaccine 7 yr + im $3.90
90716-00 varicella virus vaccine live subq $3.90
90718-00 tetanus & diphtheria toxoids adsorbed 7 yr + im $3.90
90720-00 dtp-hib vaccine intramuscular $3.90
90721-00 dtap-hib vaccine intramuscular $3.90
90723-00 dtap-hepb-ipv vaccine intramuscular $3.90
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