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 />
64901-00 nrv grf ea nrv 1 strand $633.00<br />
64902-00 nrv grf ea nrv mlt strands $725.00<br />
64905-00 nrv pedcl tr 1st stg $709.00<br />
64907-00 nrv pedcl tr 2nd stg $1,000.00<br />
64910-00 nerve repair w/conduit ea nerve $461.57<br />
64911-00 nerve repair w/autog<strong>en</strong>ous vein graft ea nerve $561.60<br />
65091-00 evsc oc cnts w/o implt $390.00<br />
65093-00 evsc oc cnts w/implt $487.50<br />
65101-00 <strong>en</strong>cl eye w/o implt $390.00<br />
65103-00 <strong>en</strong>cl eye implt musc x attached implt $487.50<br />
65105-00 <strong>en</strong>cl eye implt musc attached implt $585.00<br />
65110-00 exntj orbit rmvl orb cnts only $585.00<br />
65112-00 exntj orbit rmvl orb cnts w/ther rmvl b1 $663.00<br />
65114-00 exntj orbit rmvl orb cnts w/musc/myoq flap $867.75<br />
65125-00 modificaj oc implt w/plmt/rplcmt pegs spx $43.88<br />
65130-00 insj oc implt sec after evsc scll sh<strong>el</strong>l $585.00<br />
65135-00 insj oc implt after <strong>en</strong>cl musc x attached $429.00<br />
65140-00 insj oc implt after <strong>en</strong>cl musc attached $682.50<br />
65150-00 rinsj oc implt +-cjncl grf $526.50<br />
65155-00 rinsj oc implt rnfcmt&/attachm<strong>en</strong>t musc $526.50<br />
65175-00 rmvl oc implt $351.00<br />
65205-00 rmvl fb xtrnl eye cjncl supfc $9.75<br />
65210-00 rmvl fb xtrnl eye embedded scjncl/scll nonprf8 $19.50<br />
65220-00 rmvl fb xtrnl eye crnl w/o slit lamp $19.50<br />
65222-00 rmvl fb xtrnl eye crnl w/slit lamp $29.25<br />
65235-00 rmvl fb io from ant chamber eye/l<strong>en</strong>s $487.50<br />
65260-00 rmvl fb io from post sgm mag xtrj ant/post route $487.50<br />
65265-00 rmvl fb io from post sgm nonmag xtrj $575.25<br />
65270-00 rpr lac cjnc +-nonprf8 lac scl dir clsr $48.75<br />
65272-00 rpr lac cjnc moblj&reargmt w/o hospization $146.25<br />
65273-00 rpr lac cjnc moblj&reargmt w/hospization $209.63<br />
65275-00 rpr lac crn nonprf8 +-rmvl fb $165.75<br />
65280-00 rpr lac crn&/scl prf8 x invg uveal tiss $546.00<br />
65285-00 rpr lac crn&/scl prf8 w/repos/rescj uveal tiss $663.00<br />
65286-00 rpr lac appl tiss glue wnd crn&/scl $277.29<br />
65290-00 rpr wnd eo muscle t<strong>en</strong>don&/t<strong>en</strong>on's capsule $141.38<br />
65400-00 exc les crn xcp pterygium $292.50<br />
65410-00 bx crn $48.75<br />
65420-00 exc/trpos pterygium w/o grf $292.50<br />
65426-00 exc/trpos pterygium w/grf $331.50<br />
65430-00 cornea scraping diagnostic smear &/culture $9.75<br />
65435-00 rmvl crnl epithe +-chemocaut $39.00<br />
65436-00 rmvl crnl epithe w/appl ch<strong>el</strong>ating agt $107.25<br />
65450-00 dstrj les crn crtx pc/thermocaut $48.75<br />
65730-00 keratoplasty p<strong>en</strong>trg except aphakia/pseudophakia $1,072.50<br />
65755-00 keratoplasty p<strong>en</strong>trg pseudophakia $941.85<br />
65771-00 rdl keratotomy $702.00<br />
65772-00 crnl r<strong>el</strong>axing inc corrj induced astigmatism $373.43<br />
65775-00 crnl wedge rescj corrj induced astigmatism $373.43<br />
65800-00 pcnts eye spx dx aspir aqueous $97.50<br />
97
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