Listas para Publicar en el Portal-1 (2) - Triple-S Salud
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 />
91065-00 brth hydrog<strong>en</strong> tst $22.43<br />
91065-26 brth hydrog<strong>en</strong> tst $5.38<br />
91065-TC brth hydrog<strong>en</strong> tst $8.97<br />
91110-00 gi trc img intral esoph thru ile phys i&r $681.07<br />
91117-00 colon motility stdy min 6 hr cont record w/i&r $86.25<br />
91122-00 anrct mano $58.50<br />
92002-00 oph medical xm&eval intrm new pt $24.38<br />
92012-00 oph medical xm&eval intrm est pt $19.50<br />
92015-00 deter refractive state $14.63<br />
92018-00 oph xm&eval anes +-mnpj globe compl $34.22<br />
92019-00 oph xm&eval anes +-mnpj globe lmtd $28.96<br />
92020-00 gonioscopy spx $7.02<br />
92060-00 s<strong>en</strong>simotr xm w/mlt meas oc devij w/i&r spx $20.18<br />
92060-26 s<strong>en</strong>simotr xm w/mlt meas oc devij w/i&r spx $4.85<br />
92060-TC s<strong>en</strong>simotr xm w/mlt meas oc devij w/i&r spx $8.07<br />
92065-00 orthoptic&/pleoptic trainj $3.51<br />
92065-26 orthoptic&/pleoptic trainj $0.84<br />
92065-TC orthoptic&/pleoptic trainj $1.40<br />
92081-00 vis fld xm uni/bi i&r lmtd xm $15.80<br />
92081-26 vis fld xm uni/bi i&r lmtd xm $3.79<br />
92081-TC vis fld xm uni/bi i&r lmtd xm $6.32<br />
92082-00 vis fld xm uni/bi i&r intrm xm $20.18<br />
92082-26 vis fld xm uni/bi i&r intrm xm $4.85<br />
92082-TC vis fld xm uni/bi i&r intrm xm $8.07<br />
92083-00 vis fld xm uni/bi i&r extnd xm $24.57<br />
92083-26 vis fld xm uni/bi i&r extnd xm $5.90<br />
92083-TC vis fld xm uni/bi i&r extnd xm $9.83<br />
92100-00 srl tnmtry spx mlt meas io press $10.53<br />
92120-00 tngrphy i&r rec ind<strong>en</strong>taj tnmtr sucj $6.14<br />
92130-00 tngrphy water provocation $13.16<br />
92133-00 computerized ophthalmic imaging optic nerve $13.85<br />
92133-26 computerized ophthalmic imaging optic nerve $5.55<br />
92133-TC computerized ophthalmic imaging optic nerve $8.31<br />
92134-00 computerized ophthalmic imaging retina $27.72<br />
92134-26 computerized ophthalmic imaging retina $11.09<br />
92134-TC computerized ophthalmic imaging retina $16.63<br />
92136-00 oph bmtry prtl coher intrfrmtry io l<strong>en</strong>s pwr cal $17.55<br />
92136-26 oph bmtry prtl coher intrfrmtry io l<strong>en</strong>s pwr cal $8.42<br />
92136-TC oph bmtry prtl coher intrfrmtry io l<strong>en</strong>s pwr cal $14.04<br />
92140-00 provocative tsts glc i&r w/o tngrphy $39.00<br />
92225-00 opscpy extnd rta drawing i&r 1st $18.87<br />
92226-00 opscpy extnd rta drawing i&r sbsq $14.92<br />
92230-00 fluorescein angioscopy i&r $40.80<br />
92235-00 fluorescein angrph i&r $40.80<br />
92235-26 fluorescein angrph i&r $19.59<br />
92235-TC fluorescein angrph i&r $32.64<br />
92240-00 indocya9-gre<strong>en</strong> angrph i&r $41.24<br />
92240-26 indocya9-gre<strong>en</strong> angrph i&r $19.79<br />
92240-TC indocya9-gre<strong>en</strong> angrph i&r $32.99<br />
92250-00 fundus phtgrphy i&r $11.41<br />
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