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

Procedure &
Place of Service
Tarifas
Servicios de Salud
Description Fee
43652-00 laps surg trnsxj vagus nrv slctv/hily slctv $789.75
43653-00 laps surg gastrostomy w/o constj gstr tube spx $357.83
43752-00 naso/oro-gastric tube plmt req phys&fluor gdn $43.88
43753-00 gastric tube plmt w/aspir & lavage $13.07
43754-00 gastric tube dx plmt w/aspir 1 specimen $28.28
43755-00 gastric tube dx plmt w/aspir mult specimens $28.28
43756-00 duodenal tube dx plmt w/img gid 1 specimen $135.86
43757-00 duodenal tube dx plmt w/img gid mult specimen $175.50
43760-00 change gastrostomy tube percutaneous w/o guide $39.00
43761-00 repos naso/oro gastric feeding tube thru duo $43.88
43774-00 laps gastric restrictive px remove device &port $724.11
43800-00 pyloroplasty $487.50
43810-00 gastroduodenostomy $585.00
43820-00 gastrojejunostomy w/o vagotomy $585.00
43825-00 gastrojejunostomy w/vagotomy any typ $731.25
43830-00 gastrostomy opn w/o constj gstr tube spx $390.00
43831-00 gastrostomy opn neonatal feeding $331.50
43832-00 gastrostomy opn w/constj gstr tube $575.25
43840-00 gastrorrhaphy sutr prf8 duol/gstr ulcer wnd/inj $487.50
43846-00 gstr rstcv w/byp w/short limb 150 cm/< $997.72
43847-00 gstr rstcv w/byp w/sm int rcnstj limit absrpj $2,983.50
43848-00 revision open gastric restrictive px not device $1,358.53
43850-00 revj gastroduol anast w/rcnstj w/o vagotomy $877.50
43855-00 revj gastroduol anast w/rcnstj w/vgtmy $975.00
43860-00 revj gstr/jj anast w/rcnstj w/o vgtmy $877.50
43865-00 revj gstr/jj anast w/rcnstj w/vgtmy $975.00
43870-00 clsr gastrostomy surg $390.00
43880-00 clsr gastrocolic fstl $653.25
44005-00 enterolss fring intstinal adhesion spx $585.00
44010-00 duodexomy expl bx/fb rmvl $585.00
44015-00 tube/ndl cath jejunostomy any meth $82.88
44020-00 enterotomy sm int oth/thn duo expl bx/fb rmvl $585.00
44021-00 enterotomy sm int oth/thn duo dcmprn $482.63
44025-00 colotomy expl bx/fb rmvl $633.75
44050-00 rdctj volvulus intussusception int hrna lapt $585.00
44055-00 corrj malrotation bands&/rdctj volvulus $702.00
44100-00 bx int capsl tube proral 1+ specs $97.50
44110-00 exc 1+ < sm/lg int 1 enterotomy $585.00
44111-00 exc 1+ < sm/lg int mlt enterotomies $682.50
44120-00 entrc rescj sm int 1 rescj&anast $682.50
44121-00 entrc rescj sm int ea rescj&anast $186.03
44125-00 entrc rescj sm int w/ntrstm $683.57
44126-00 entrc rescj atresia rescj&anast w/o tapring $1,364.51
44127-00 entrc rescj atresia rescj&anast sgm w/tapring $1,568.97
44128-00 entrc rescj atresia ea rescj&anast $168.48
44130-00 enterontrstm anast int +-cutan ntrstm spx $585.00
44139-00 moblj splenic flxr pfrmd conjunct w/prtl colct $175.50
44140-00 colct prtl w/anast $975.00
44141-00 colct prtl w/skn lvl cecostomy/clst $1,072.50
44143-00 colct prtl w/end clst&clsr dstl sgm $1,004.25
63