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

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Procedure & Place of Service Tarifas Servicios de Salud Description Fee 65805-00 pcnts eye spx ther rls aqueous $97.50 65810-00 pcnts eye spx rmvl vts&/dscj memb $292.50 65815-00 pcnts eye spx rmvl bld $175.50 65820-00 goniotomy $487.50 65850-00 trabeculotomy ab externo $565.50 65855-00 trabeculoplasty laser surg 1+ sess $292.50 65860-00 severing ads ant sgm laser tq spx $307.13 65865-00 severing ads ant sgm incal tq spx goniosynechiae $429.00 65870-00 severing ads ant sgm incal spx ant synechiae $360.75 65875-00 severing ads ant sgm incal spx post synechiae $360.75 65880-00 severing ads ant sgm incal spx corneovitreal $360.75 65900-00 rmvl epithelial downgrowth ant chamber eye $448.50 65920-00 rmvl implted matrl ant sgm eye $731.25 65930-00 rmvl bld clot ant sgm eye $438.75 66020-00 njx ant chamber eye spx air/liq $146.25 66030-00 njx ant chamber eye spx med $146.25 66130-00 exc les scl $302.25 66150-00 fstlj scl glc treph irdec $585.00 66155-00 fstlj scl glc thermocaut irdec $585.00 66160-00 fstlj scl glc sclercomy punch/scissors irdec $585.00 66165-00 fstlj scl glc iridencleisis/iridotasis $544.05 66170-00 fstlj scl glc trbec ab externo $780.00 66172-00 fstlj scl glc trbec ab externo scarring $886.28 66180-00 aqueous shunt eo rsvr $877.50 66185-00 revj aqueous shunt eo rsvr $494.33 66220-00 rpr scll staphyloma w/o grf $392.93 66225-00 rpr scll staphyloma w/grf $729.30 66250-00 revj/rpr oprative wnd ant sgm $399.75 66500-00 iridotomy stab inc spx xcp transfixion $195.00 66505-00 iridotomy stab inc spx transfixion $195.00 66600-00 irdec crnlsclrl/crnl sctj rmvl les $585.00 66605-00 irdec crnlsclrl/crnl sctj cyclectomy $780.00 66625-00 irdec crnlsclrl/crnl sctj prph glc spx $487.50 66630-00 irdec crnlsclrl/crnl sctj sector glc spx $487.50 66635-00 irdec crnlsclrl/crnl sctj optical spx $487.50 66680-00 rpr iris ciliary bdy $390.00 66682-00 sutr iris ciliary bdy spx retrieval sutr $312.00 66700-00 ciliary bdy dstrj dthrm $292.50 66710-00 ciliary bdy dstrj cyclopc transscll $327.60 66711-00 ciliary bdy dstrj cyclopc ndsc $339.59 66720-00 ciliary bdy dstrj crtx $214.50 66740-00 ciliary bdy dstrj cyclodial $487.50 66761-00 iridotomy/irdec laser surg per session $214.50 66762-00 iridoplasty pc 1+ sess $214.50 66770-00 dstrj cst/les iris/ciliary bdy $292.50 66820-00 dscj sec membranous ctrc stab inc $175.50 66821-00 post-cataract laser surgery $233.03 66825-00 rpsg io lens prosth req inc spx $401.70 66830-00 rmvl sec membranous ctrc corneo-scll sctj $459.23 66840-00 rmvl lens matrl aspir tq 1+ stgs $585.00 98
Procedure & Place of Service Tarifas Servicios de Salud Description Fee 66850-00 rmvl lens matrl phacofragmentation aspir $775.13 66852-00 rmvl lens matrl pars plna appr +-vtrc $570.38 66920-00 rmvl lens matrl icapsl $780.00 66930-00 removal lens matrl intracapsular dislocated lens $780.00 66940-00 rmvl lens matrl xcapsl $780.00 66982-00 xcapsl ctrc rmvl insj lens prosth 1 stg $588.80 66983-00 icapsl ctrc xtrj insj io lens prosth 1 stg $1,150.50 66984-00 cataract removal insertion of lens $680.00 66985-00 insj io lens prosth x w/cncrnt rmvl $975.00 66986-00 exchng io lens $640.58 67005-00 rmvl vts ant appr prtl rmvl $585.00 67010-00 rmvl vts ant appr stot rmvl vtrc $1,160.25 67015-00 aspir/rls flu pars plna $292.50 67025-00 njx vts sub pars plna/limbal spx $429.00 67027-00 impltj intravitreal drug dlvr sys rmvl vts $534.30 67028-00 intravitreal njx pharmacologic agt spx $143.33 67030-00 dscj vts strands pars plna $341.25 67031-00 severing vts strands laser 1+ stgs $561.60 67036-00 vtrc mchnl pars plna $1,238.25 67039-00 vtrc mchnl pars plna focal endolaser pc $1,667.25 67040-00 vtrc mchnl pars plna endolaser panrta pc $1,198.28 67041-00 vitrectomy pars plana remove preretinal membrane $851.76 67042-00 vitrectomy pars plana remove int memb retina $1,310.40 67043-00 vitrectomy pars plana remove subretinal membrane $1,310.40 67101-00 rpr rta dtchmnt 1+ sess crtx/dthrm +-drg $438.75 67105-00 rpr rta dtchmnt 1+ sess pc +-drg subrta $975.00 67107-00 rpr rta dtchmnt scll buckling +-implt $975.00 67108-00 rpr rta dtchmnt w/vtrc any meth $1,355.25 67110-00 rpr rta dtchmnt njx air/oth gas $556.73 67112-00 rpr rta dtchmnt scll buckling/vtrc pt $1,101.75 67113-00 rpr complex retina detach vitrectomy & memb peel $975.00 67115-00 rls encircling matrl $390.00 67120-00 rmvl implted matrl post sgm eo $390.00 67121-00 rmvl implted matrl post sgm io $360.75 67141-00 proph rta dtchmnt w/o drg 1+ sess crtx dthrm $390.00 67145-00 proph rta dtchmnt w/o drg 1+ sess $390.00 67208-00 dstrj loclzd les retina 1+ sess crtx dthrm $403.65 67210-00 dstrj loclzd les retina 1+ sess pc $448.50 67218-00 dstrj les retina 1+ sess radj impltj $624.00 67220-00 dstrj les choroid pc 1+ sess $438.75 67221-00 dstrj les choroid pdt $228.15 67225-00 dstrj les choroid pdt 2nd eye 1 sess $22.82 67227-00 destruction retinopathy 1+ sess diathermy $516.75 67228-00 extensive retinopathy 1+ sess photocoagulation $516.75 67229-00 extensive retinopathy 1+ sess preterm infant $637.94 67250-00 scll rnfcmt spx w/o grf $711.75 67255-00 scll rnfcmt spx w/grf $755.63 67311-00 strabismus recession/rescj 1 hrzntl musc $585.00 67312-00 strabismus recession/rescj 2 hrzntl musc $585.00 67314-00 strabismus recession/rescj 1 ver musc $526.50 99
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Listas para Publicar en el Portal-1 (2) - Triple-S Salud

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