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 />
39220-00 resecj mediastinal tumor $975.00<br />
39400-00 mediastinoscopy w/bx wh<strong>en</strong> performed $273.00<br />
39501-00 rpr lac dphrm any appr $578.18<br />
39503-00 rpr neonatal diphrg hrna +-ch tube insj $897.00<br />
39540-00 rpr diphrg hrna oth/thn neonatal traumtc aqt $780.00<br />
39541-00 rpr diphrg hrna oth/thn neonatal traumtc chrnc $658.13<br />
39545-00 imbrcj of diaphragm $897.00<br />
39560-00 rescj dphrm smpl rpr $577.72<br />
39561-00 rescj dphrm cplx rpr $810.55<br />
40490-00 bx lip $19.50<br />
40500-00 vermilionectomy lip shv w/mucosal advmnt $390.00<br />
40510-00 exc lip transvrs wedge exc w/prim clsr $243.75<br />
40520-00 exc lip v-exc w/prim dir linr clsr $243.75<br />
40525-00 exc lip full thkns rcnstj w/local flap $487.50<br />
40527-00 exc lip full thkns rcnstj w/cross lip flap $487.50<br />
40530-00 rescj lip > one-4th w/o rcnstj $380.25<br />
40650-00 rpr lip full thkns vermilion only $487.50<br />
40652-00 rpr lip full thkns up half ver h8 $497.25<br />
40654-00 rpr lip full thkns > one-half ver h8/cplx $628.88<br />
40700-00 plstc rpr cl lip/nsl dfrm prim prtl/compl uni $682.50<br />
40701-00 plstc rpr cl lip/nsl dfrm prim bi 1 stg px $877.50<br />
40702-00 plstc rpr cl lip/nsl dfrm prim bi 1 2 stgs $585.00<br />
40720-00 plstc rpr cl lip/nsl dfrm sec recrtj dfct&reclsr $682.50<br />
40761-00 plstc rpr cl lip/nsl dfrm w/cross lip pedcl flap $360.75<br />
40800-00 drg absc cst hmtma vestibule mouth smpl $19.50<br />
40801-00 drg absc cst hmtma vestibule mouth comp $78.00<br />
40804-00 rmvl embedded fb vestibule mouth smpl $19.50<br />
40805-00 rmvl embedded fb vestibule mouth comp $126.75<br />
40806-00 inc labial fr<strong>en</strong>um frexomy $19.50<br />
40808-00 bx vestibule mouth $29.25<br />
40810-00 exc les mucosa&sbmcsl vestibule mouth w/o rpr $29.25<br />
40812-00 exc les mucosa&sbmcsl vestibule smpl rpr $39.00<br />
40814-00 exc les mucosa&sbmcsl vestibule cplx rpr $165.75<br />
40816-00 exc les mucosa&sbmcsl vestibule cplx exc musc $58.50<br />
40818-00 exc mucosa vestibule mouth as don grf $53.63<br />
40819-00 exc fr<strong>en</strong>um labial/buccal $78.00<br />
40820-00 dstrj les/scar vestibule mouth physical meths $19.50<br />
40830-00 clsr lac vestibule mouth 2.5 cm/< $19.50<br />
40831-00 clsr lac vestibule mouth > 2.5 cm/cplx $107.25<br />
40840-00 vestibuloplasty ant $400.14<br />
40842-00 vestibuloplasty pst uni $400.14<br />
40843-00 vestibuloplasty pst bi $558.09<br />
40844-00 vestibuloplasty <strong>en</strong>tire arch $737.10<br />
40845-00 vestibuloplasty cplx w/ridge xtn musc rpsg $745.88<br />
41000-00 intraoral i&d tongue/floor lngl $19.50<br />
41005-00 intraoral i&d tongue/floor sublngl supfc $19.50<br />
41006-00 intraoral i&d tongue/floor sublngl dp sprmlhyd $121.88<br />
41007-00 intraoral i&d tongue/floor subm<strong>en</strong>tal space $58.50<br />
41008-00 intraoral i&d tongue/floor submndblr space $58.50<br />
41009-00 intraoral i&d tongue/floor masticator space $58.50<br />
57
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