| CODIGO | PRESTACION | FONASA | AFILIADO | M/C | PART. | VALOR PART. CON CONTRASTE |
|---|---|---|---|---|---|---|
| 04.03.001 | T.A.C CEREBRAL | $105.180 | $72.310 | $17.000 | $112.000 | $129.000 |
| 04.03.002 | T.A.C SILLA TURCA | $110.670 | $76.080 | $17.000 | $117.000 | $134.000 |
| 04.03.003 | T.A.C FOSA POSTERIOR | $95.060 | $65.350 | $17.000 | $102.000 | $119.000 |
| 04.03.006 | T.A.C OIDOS | $91.280 | $62.750 | $17.000 | $99.000 | $116.000 |
| 04.03.007 | T.A.C CAVIDADES PERINASALES | $122.060 | $83.910 | $128.000 | $128.000 | |
| 04.03.007 | T.A.C ORBITAS | $122.060 | $83.910 | $17.000 | $128.000 | $145.000 |
| 04.03.008 | T.A.C COLUMNA CERVICAL | $133.710 | $91.920 | $140.000 | $140.000 | |
| 04.03.018 | T.A.C COLUMNA DORSAL | $117.150 | $80.540 | $124.000 | $124.000 | |
| 04.03.019 | T.A.C COLUMNA LUMBAR | $117.150 | $80.540 | $124.000 | $124.000 | |
| 04.03.012 | T.A.C CUELLO | $98.820 | $67.940 | $17.000 | $106.000 | $123.000 |
| 04.03.013 | T.A.C TORAX | $156.060 | $107.290 | $30.000 | $161.000 | $191.000 |
| 04.03.014 | T.A.C ABDOMEN | $93.970 | $64.600 | $30.000 | $120.000 | $150.000 |
| 04.03.016 | T.A.C PELVIS | $96.370 | $66.250 | $30.000 | $104.000 | $134.000 |
| 04.03.020 | T.A.C. ABDOMEN – PELVIS | $153.360 | $105.430 | $30.000 | $180.000 | $210.000 |
| 04.03.021 | PIELO – T.A.C | $40.380 | $27.760 | $80.000 | $80.000 | |
| 04.03.022 | UROTAC | $90.220 | $62.020 | $30.000 | $130.000 | $160.000 |
| 04.03.017 | T.A.C EXTREMIDADES | $84.130 | $57.840 | $92.000 | $92.000 | |
| 04.03.101 | ANGIOTAC CEREBRAL | $127.470 | $87.630 | $30.000 | $140.000 | $170.000 |
| 04.03.102 | ANGIOTAC TORAX | $191.920 | $131.940 | $30.000 | $196.000 | $226.000 |
| 04.03.103 | ANGIOTAC ABDOMEN | $177.700 | $122.170 | $30.000 | $182.000 | $212.000 |
| 04.03.104 | ANGIOTAC CUELLO | $104.750 | $72.010 | $30.000 | $140.000 | $170.000 |
| 04.03.105 | ANGIOTAC PELVIS | $76.380 | $52.510 | $30.000 | $140.000 | $170.000 |
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