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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
21336-00 open tx nasal septal fracture +-stabilization $249.60
21337-00 closed tx nasal septal fracture +-stabilization $48.75
21338-00 open tx nasoethmoid fx w/o external fixation $643.50
21339-00 open tx nasoethmoid fx w/external fixation $804.38
21340-00 percutaneous tx nasoethmoid complex fracture $468.00
21343-00 open tx depressed frontal sinus fracture $154.05
21344-00 open tx complicated frontal sinus fracture $787.80
21345-00 closed tx nasomaxillary complex fracture $263.25
21346-00 optx nasomax cplx fx left ii type w/wirg&fixj $643.50
21347-00 optx nasomax cplx fx left ii type req mlt opn $653.25
21348-00 optx nasomax cplx fx left ii type w/b1 grfg $389.03
21355-00 percutaneous tx malar area fracture $48.75
21356-00 open tx depressed zygomatic arch fracture $260.33
21360-00 open tx depressed malar fracture $302.25
21365-00 open tx comp fx malar w/internal fx&mult surg $633.75
21366-00 open tx comp fracture malar area w/bone graft $611.33
21385-00 open tx orbital floor blowout fx transantral $341.25
21386-00 open tx orbital floor blowout fx periorbital $594.75
21387-00 open tx orbital floor blowout fx combined appr $585.00
21390-00 optx orb floor blwt fx pri/bital appr w/allplstc $594.75
21395-00 optx orb floor blwt fx pri/bital appr w/b1 grf $770.25
21400-00 clsd tx fx orbit except blowout w/o manipulation $19.50
21401-00 closed tx fx orbit except blowout w/manipulation $146.25
21406-00 open tx fx orbit except blowout w/o implant $195.00
21407-00 open tx fx orbit except blowout w/implant $292.50
21408-00 open tx fx orbit except blowout w/bone graft $468.00
21421-00 closed tx palatal/maxillary fx w/fixation/splint $292.50
21422-00 open treatment palatal/maxillary fracture $487.50
21423-00 open tx palatal/maxillary fx comp multiple appr $565.50
21431-00 closed tx craniofacial separation $341.25
21432-00 open tx craniofacial sep w/wiring&/int fixj $390.00
21433-00 open tx craniofacial sep complicated mlt appr $487.50
21435-00 open tx craniofacial sep comp w/int&/xtrnl fixj $663.00
21436-00 optx cranfcl sep left iii typ comp int fixj w/b1 $1,159.28
21440-00 cltx mandibular/maxillary alveolar ridge fx spx $160.88
21445-00 optx mandibular/maxillary alveolar ridge fx spx $253.50
21450-00 closed tx mandibular fracture w/o manipulation $126.75
21451-00 closed tx mandibular fracture w/manipulation $195.00
21452-00 percutaneous tx mandibular fx w/external fixj $126.75
21453-00 closed tx mandibular fx w/interdental fixation $195.00
21454-00 open tx mandibular fx w/external fixation $390.00
21461-00 open tx mandibular fx w/o interdental fixation $487.50
21462-00 open tx mandibular fx w/interdental fixation $711.75
21465-00 open tx mandibular condylar fx $468.00
21470-00 optx comp mandibular fx mlt appr w/int fixation $487.50
21480-00 closed tx temporomandibular dislocation 1st/sbsq $58.50
21485-00 closed tx temporomandibular dislc comp 1st/sbsq $175.50
21490-00 open treatment temporomandibular dislocation $243.75
21495-00 open treatment hyoid fracture $195.00
21497-00 interdental wiring other than fracture $217.43
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