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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
41010-00 inc lngl frenum frexomy $19.50
41015-00 xtroral i&d absc cst/hmtma floor mouth sublngl $39.00
41016-00 xtroral i&d absc cst/hmtma floor mouth submental $58.50
41017-00 xtroral i&d absc cst/hmtma floor mouth submndblr $58.50
41018-00 xtroral i&d floor masticator space $58.50
41019-00 placement needle head/neck radioelement applicat $307.13
41100-00 bx tongue ant 2-3rd $29.25
41105-00 bx tongue pst one-3rd $48.75
41108-00 bx floor mouth $19.50
41110-00 exc les tongue w/o clsr $78.00
41112-00 exc les tongue w/clsr ant 2-3rd $136.50
41113-00 exc les tongue w/clsr pst one-3rd $195.00
41114-00 exc les tongue w/clsr w/local tongue flap $117.00
41115-00 exc lngl frenum frenectomy $68.25
41116-00 exc les floor mouth $68.25
41120-00 glssc < one-half tongue $331.50
41130-00 glssc hemiglssc $390.00
41135-00 glssc prtl w/uni rad nck dsj $897.00
41140-00 glssc compl/tot +-trachs w/o rad nck dsj $682.50
41145-00 glssc compl/tot +-trachs w/uni rad nck dsj $1,062.75
41150-00 glssc composit w/rescj floor&mndblr rescj $1,101.75
41153-00 glssc composit rescj floor suprahyoid nck dsj $1,101.75
41155-00 glssc composit rescj flr mndblr rescj&rad nck $1,530.75
41250-00 rpr lac 2.5 cm/< floor mouth&/ant 2-3rd tongue $39.00
41251-00 rpr lac 2.5 cm/< pst one-3rd tongue $48.75
41252-00 rpr lac tongue floor mouth > 2.6 cm/cplx $165.75
41500-00 fixj tongue mchnl oth/thn sutr $230.36
41510-00 sutr tongue lip micrognathia $214.99
41512-00 tongue base suspension permanent suture tq $398.39
41520-00 frenoplasty surg revj frenum eg w/z-plasty $165.75
41800-00 drg absc cst hmtma from dentoalveolar struxs $19.50
41805-00 rmvl embedded fb from dentalvlr struxs soft tiss $53.63
41806-00 rmvl embedded fb from dentoalveolar struxs b1 $68.25
42000-00 drg absc palate uvula $19.50
42100-00 bx palate uvula $29.25
42104-00 exc les palate uvula w/o clsr $195.00
42106-00 exc les palate uvula w/smpl prim clsr $165.75
42107-00 exc les palate uvula w/local flap clsr $224.25
42120-00 rescj palate/x10sv rescj les $390.00
42140-00 uvulectomy exc uvula $29.25
42145-00 palatopharyngoplasty $514.80
42160-00 dstrj les palate/uvula thermal cryo/chem $19.50
42180-00 rpr lac palate up 2 cm $102.38
42182-00 rpr lac palate > 2 cm/cplx $224.25
42200-00 palatop cl palate soft&/hard palate only $585.00
42205-00 palatop w/clsr alveolar ridge soft tiss $804.38
42210-00 palatop clsr alveolar ridge grf alveolar ridge $901.88
42215-00 palatop cl palate major revj $585.00
42220-00 palatop cl palate sec lngth px $682.50
42225-00 palatop cl palate attachment pharyngeal flap $585.00
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