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 />
17273-00 destruction malignant lesion s/n/h/f/g 2.1-3.0cm $142.35<br />
17274-00 destruction malignant lesion s/n/h/f/g 3.1-4.0cm $176.48<br />
17276-00 dstrj mal les s/n/h/f/g les diam > 4.0 cm $219.38<br />
17280-00 destruction malignant lesion f/e/e/n/l/m 0.5cm/< $67.28<br />
17281-00 destruction mal lesion f/e/e/n/l/m 0.6-1.0cm $91.65<br />
17282-00 destruction mal lesion f/e/e/n/l/m 1.1-2.0cm $219.38<br />
17283-00 destruction mal lesion f/e/e/n/l/m 2.1-3.0cm $151.13<br />
17284-00 destruction mal lesion f/e/e/n/l/m 3.1-4.0cm $234.00<br />
17311-00 mohs micrographic h/n/h/f/g 1st stage 5 blocks $292.50<br />
17312-00 mohs micrographic h/n/h/f/g each addl stage $107.25<br />
17313-00 mohs trunk/arm/leg 1st stage 5 blocks $292.50<br />
17314-00 mohs trunk/arm/leg ea stage after 1st stage $107.25<br />
17315-00 mohs trunk/arm/leg ea addl block any stage $21.45<br />
17340-00 cryotherapy co2 slush liq n2 acne $14.63<br />
17380-00 <strong>el</strong>ectrolysis epilation ea 30 minutes $26.33<br />
19000-00 puncture aspiration cyst breast $19.50<br />
19001-00 puncture aspiration breast ea addl cyst $9.75<br />
19020-00 mastotomy w/expl/drainage abscess deep $97.50<br />
19030-00 injection mammary ductogram/galactogram $57.53<br />
19100-00 bx breast needle core w/o imaging guidance spx $58.50<br />
19101-00 biopsy breast op<strong>en</strong> incisional $146.25<br />
19102-00 biopsy breast needle core w/imaging guidance $71.08<br />
19103-00 breast biopsy vacuum assisted/rotating device $84.24<br />
19110-00 nipple exploration $185.25<br />
19112-00 excision lactiferous duct fistula $166.73<br />
19120-00 exc cyst/aberrant breast tissue op<strong>en</strong> 1/> les $185.25<br />
19125-00 exc brst les preop plmt rad marker opn 1 les $240.83<br />
19126-00 exc brst les preop plmt rad marker opn ea addl $124.80<br />
19260-00 excision chest wall tumor including ribs $682.50<br />
19271-00 exc chest tumor w/rcnstj w/o medstnl lmphadec $975.00<br />
19272-00 exc chest tumor w/rcnstj w/medstnl lmphadec $1,170.00<br />
19290-00 preop placem<strong>en</strong>t localization wire breast $46.80<br />
19291-00 preop plmt localization wire breast ea lesion $21.45<br />
19295-00 img gid plmt mtlc loclzj clip prq brst bx/aspir $25.36<br />
19296-00 plmt expandable cath brst following prtl mast $3,289.75<br />
19297-00 plmt expandable cath brst concurr<strong>en</strong>t prtl mast $64.06<br />
19298-00 plmt radthx brachytx brst following prtl mast $1,235.52<br />
19300-00 mastectomy gynecomastia $243.75<br />
19301-00 mastectomy partial $243.75<br />
19302-00 mastectomy partial w/axillary lymphad<strong>en</strong>ectomy $567.20<br />
19303-00 mastectomy simple complete $292.50<br />
19304-00 mastectomy subcutaneous $341.25<br />
19305-00 mast rad w/pectoral muscles axillary lymph nodes $682.50<br />
19306-00 mast rad w/pectoral musc ax int mam lymph nodes $1,062.75<br />
19307-00 mast modf rad w/ax lymph nod w/wo pect/alis min $672.75<br />
19316-00 mastopexy $553.80<br />
19318-00 reduction mammaplasty $1,625.33<br />
19324-00 mammaplasty augm<strong>en</strong>tation w/o prosthetic implant $524.83<br />
19325-00 mammaplasty augm<strong>en</strong>tation w/prosthetic implant $731.25<br />
19328-00 removal intact mammary implant $162.09<br />
7
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