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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
11920-00 tattooing incl micropigmentation 6.0 cm/< $80.76
11921-00 tattooing incl micropigmentation 6.1-20.0 cm $97.40
11922-00 tattooing incl micropigmentation ea 20.0 cm $24.50
11960-00 insertion tissue expander incl sbsq xpnsj $526.50
11970-00 replacement tiss expander permanent prosthesis $426.47
11971-00 removal tiss expander w/o insertion prosthesis $87.75
11975-00 insertion implantable contraceptive capsules $596.70
11976-00 removal implantable contraceptive capsules $87.75
11977-00 rmvl w/rinsj implantable contraceptive capsules $688.84
12001-00 simple repair scalp/neck/ax/genit/trunk 2.5cm/< $19.50
12002-00 smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm $29.25
12004-00 simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm $48.75
12005-00 smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm $68.25
12006-00 smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm $87.75
12007-00 simple repair scalp/neck/ax/genit/trunk >30.0cm $136.50
12011-00 simple repair f/e/e/n/l/m 2.5cm/< $39.00
12013-00 simple repair f/e/e/n/l/m 2.6cm-5.0cm $48.75
12014-00 simple repair f/e/e/n/l/m 5.1cm-7.5cm $68.25
12015-00 simple repair f/e/e/n/l/m 7.6cm-12.5cm $87.75
12016-00 simple repair f/e/e/n/l/m 12.6cm-20.0cm $141.38
12017-00 simple repair f/e/e/n/l/m 20.1cm-30.0cm $179.89
12020-00 tx superficial wound dehiscence simple closure $29.25
12021-00 tx superficial wound dehiscence w/packing $48.75
12031-00 repair intermediate s/a/t/e 2.5 cm/< $29.25
12032-00 repair intermediate s/a/t/e 2.6-7.5 cm $48.75
12034-00 repair intermediate s/a/t/e 7.6-12.5 cm $68.25
12035-00 repair intermediate s/a/t/e 12.6-20.0cm $87.75
12036-00 repair intermediate s/a/t/e 20.1-30.0 cm $117.00
12041-00 repair intermediate n/h/f/xtrnl gent 2.5cm/< $39.00
12042-00 repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm $68.25
12044-00 repair intermediate n/h/f/xtrnl gent 7.6-12.5cm $82.88
12045-00 repair intermediate n/h/f/xtrnl gent 12.6-20 cm $107.25
12046-00 rpr intermediate n/h/f/xtrnl gent 20.1-30.0 cm $146.25
12051-00 repair intermediate f/e/e/n/l/m&/muc 2.5 cm/< $48.75
12052-00 repair intermediate f/e/e/n/l/m&/muc 2.6-5.0 cm $68.25
12053-00 repair intermediate f/e/e/n/l/m&/muc 5.1-7.5 cm $87.75
12054-00 repair intermediate f/e/e/n/l/m&/muc 7.6-12.5 cm $141.38
12055-00 repair intermediate f/e/e/n/l/m&/muc 12.6-20.0cm $214.50
12056-00 repair intermediate f/e/e/n/l/m&/muc 20.1-30.0cm $243.75
13100-00 repair complex trunk 1.1 cm-2.5 cm $68.25
13101-00 repair complex trunk 2.6 cm-7.5 cm $146.25
13102-00 repair complex trunk ea 5 cm/< $59.48
13120-00 repair complex scalp/arm/leg 1.1 cm-2.5 cm $97.50
13121-00 repair complex scalp/arm/leg 2.6 cm-7.5 cm $217.62
13122-00 repair complex scalp/arm/leg ea 5 cm/< $390.00
13131-00 repair complex f/c/c/m/n/ax/g/h/f 1.1 cm-2.5 cm $136.50
13132-00 repair complex f/c/c/m/n/ax/g/h/f 2.6 cm-7.5 cm $292.50
13133-00 repair complex f/c/c/m/n/ax/g/h/f ea 5 cm/< $390.00
13150-00 repair complex eyelid/nose/ear/lip 1.0 cm/< $97.50
13151-00 repair complex eyelid/nose/ear/lip 1.1-2.5 cm $165.75
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