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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
24152-00 radical resection tumor radial head/neck $975.00
24155-00 resection elbow joint arthrectomy $682.50
24160-00 implant removal elbow joint $253.50
24164-00 implant removal radial head $185.25
24200-00 rmvl foreign body upper arm/elbow subcutaneous $19.50
24201-00 removal foreign body upper arm/elbow deep $284.77
24220-00 injection elbow arthrography $29.25
24300-00 manipulation elbow under anesthesia $248.33
24301-00 muscle/tendon transfer upper arm/elbow single $526.50
24305-00 tendon lengthening upper arm/elbow ea tendon $292.50
24310-00 tenotomy open elbow to shoulder each tendon $195.00
24320-00 tenoplasty elbow to shoulder single $487.50
24330-00 flexor-plasty elbow $292.50
24331-00 flexor-plasty elbow w/extensor advancement $453.38
24332-00 tenolysis triceps $341.35
24340-00 tenodesis biceps tendon elbow spx $438.75
24342-00 rinsj rptd biceps/triceps tdn dstl +-tdn grf $594.75
24343-00 repair lateral collateral ligament elbow $449.28
24344-00 rcnstj lat coltrl ligm elbow w/tendon graft $686.21
24345-00 repair medial collateral ligament elbow $449.28
24346-00 rcnstj medial coltrl ligm elbw w/tdn grf $703.80
24357-00 tenotomy elbow lateral/medial percutaneous $253.50
24358-00 tnot elbow lateral/medial debride open $320.00
24359-00 tnot elbow lateral/medial debride open tdn rpr $372.94
24360-00 arthroplasty elbow w/membrane $780.00
24361-00 arthroplasty elbow w/distal humrl prostc rplcmt $1,316.25
24362-00 arthrp elbow w/implt&fsca lata ligament rcnstj $1,316.25
24363-00 arthrp elbow w/distal hum&prox ur prostc rplcmt $1,413.75
24365-00 arthroplasty radial head $429.00
24366-00 arthroplasty radial head w/implant $539.61
24400-00 osteotomy humerus +-internal fixation $487.50
24410-00 mlt osteot w/relignmt imed rod humeral shaft $487.50
24420-00 osteoplasty humerus $975.00
24430-00 repair non/malunion humerus w/o graft $741.00
24435-00 repair non/malunion humerus w/iliac/oth agrft $867.75
24470-00 hemiepiphyseal arrest $429.00
24495-00 decompression fasct f/arm w/brach art expl $390.00
24498-00 prophylactic tx +-methylmethacrylate humrl shft $476.78
24500-00 clsd tx humeral shaft fracture w/o manipulation $78.00
24505-00 cltx humeral shft fx w/manipulation +-skel tracj $333.19
24515-00 optx humeral shft fx w/plate/screws +-cerclage $631.80
24516-00 tx humeral shaft fx w/insj imed implt +-cerclage $645.84
24530-00 cltx sprcndylr/transcndylr humeral fx+-mnpj $58.50
24535-00 cltx sprcndylr/transcndylr humeral fx w/mnpj $426.93
24538-00 prq skel fixj sprcndylr/transcndylr humeral fx $547.56
24545-00 open tx humeral supracondylar fracture w/o xtn $566.87
24546-00 open tx humeral supracondylar fracture w/xtn $805.55
24560-00 cltx humeral epicondylar fx medial/lat w/o mnpj $68.25
24565-00 cltx humeral epicondylar fx medial/lat w/mnpj $350.69
24566-00 prq skel fixj humrl epcndylr fx medial/lat mnpj $402.68
17