terapia fÍsica -...
TRANSCRIPT
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
1
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
A-01 NADA A-51 $7.00 AA-02 $10.00 A-02 $7.00 A-52 $15.00 AA-03 NADA
A-03 $10.00 A-53 $5.00 AA-04 $7.00 A-04 k $7.00 A-54 $5.00 AA-05 $5.00
A-05 $5.00 A-55 $5.00 AA-06 $7.00
A-06 $5.00 A-56 $5.00 AA-07 $7.00
A-07 c A-57 $7.00 AA-08 $7.00
A-08 $5.00 A-58 * AA-09 $5.00
A-09 NADA A-59 $5.00 AA-10 $7.00
A-10 $7.00 A-60 $5.00 AA-11 $7.00
A-11 $5.00 A-61 $7.00 AA-12 $5.00
A-12 $5.00 A-62 * AA-13 $5.00
A-13 c A-63 * AA-14 $7.00
A-14 $7.00 A-64 * AA-15 $5.00
A-15 $7.00 A-65 $5.00 AA-16 $10.00
A-16 $10.00 A-66 $7.00 AA-17 *
A-17 $5.00 A-67 NADA AA-18 $5.00
A-18 $5.00 A-68 $5.00 AA-19 $7.00
A-19 $5.00 A-69 $7.00 AA-20 NADA
A-20 $7.00 A-70 $5.00 AA-21 $5.00
A-21 $5.00 A-71 $5.00 AA-22 $5.00
A-22 N/C A-72 $5.00 AA-23 $5.00
A-23 N/C A-73 $5.00 AA-24 NADA
A-24 $7.00 A-74 NADA AA-25 $5.00
A-25 $7.00 A-75 $5.00 AA-26 $5.00
A-26 $5.00 A-76 $5.00 AA-27 $10.00
A-27 $5.00 A-77 $5.00 AA-28 $5.00
A-28 $10.00 A-78 $5.00 AA-29 $5.00
A-29 NADA A-79 $5.00 AA-30 $6.50
A-30 $10.00 A-80 f $7.00 AA-31 r $5.00
A-31 NADA A-81 $5.00 AA-32 $5.00
A-32 NADA A-82 $5.00 AA-33 $5.00
A-33 k $7.00 A-83 $5.00 AA-34 *
A-34 $5.00 A-84 h $7.00 AA-35 $5.00
A-35 $5.00 A-85 * AA-36 $5.00
A-36 $5.00 A-86 $5.00 AA-37 $10.00
A-37 k $7.00 A-87 * AA-38 $5.00
A-38 * A-88 $5.00 AA-39 *
A-39 NADA A-89 $10.00 AA-40 $2.00
A-40 * A-90 * AA-41 $5.00
A-41 $5.00 A-91 $20.00 AA-42 $5.00
A-42 * A-92 $7.00 AA-43 *
A-43 $5.00 A-93 $10.00 AA-44 $10.00
A-44 $5.00 A-94 $5.00 AA-45 $5.00
A-45 $5.00 A-95 b $10.00 AA-46 $5.00
A-46 h, $7.00 A-96 $7.00 AA-47 $7.00
A-47 * A-97 $5.00 AA-48 *
A-48 $5.00 A-98 $5.00 AA-49 $7.00
A-49 $5.00 A-99 $7.00 AA-50 $7.00
A-50 $5.00 AA-01 $5.00 AA-51 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
2
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AA-52 $7.00 AB-03 * AB-53 $5.00 AA-53 $5.00 AB-04 $5.00 AB-54 NADA
AA-54 $5.00 AB-05 b $15.00 AB-55 *
AA-55 $5.00 AB-06 $5.00 AB-56 $5.00
AA-56 $5.00 AB-07 $5.00 AB-57 $7.00
AA-57 $5.00 AB-08 $5.00 AB-58 $5.00
AA-58 $5.00 AB-09 $7.00 AB-59 *
AA-59 $7.00 AB-10 $7.00 AB-60 $5.00
AA-60 $5.00 AB-11 $7.00 AB-61 $5.00
AA-61 * AB-12 $5.00 AB-62 $5.00
AA-62 $5.00 AB-13 $5.00 AB-63 c NADA
AA-63 $5.00 AB-14 $5.00 AB-64 $5.00
AA-64 $5.00 AB-15 $10.00 AB-65 $5.00
AA-65 $5.00 AB-16 $7.00 AB-66 $5.00
AA-66 $7.00 AB-17 * AB-67 $5.00
AA-67 $5.00 AB-18 $5.00 AB-68 $5.00
AA-68 $5.00 AB-19 $7.00 AB-69 $5.00
AA-69 $7.00 AB-20 $5.00 AB-70 $5.00
AA-70 $5.00 AB-21 * AB-71 $5.00
AA-71 $5.00 AB-22 $5.00 AB-72 c NADA
AA-72 NADA AB-23 * AB-73 *
AA-73 $5.00 AB-24 $5.00 AB-74 $5.00
AA-74 $7.00 AB-25 $5.00 AB-75 $5.00
AA-75 $5.00 AB-26 $5.00 AB-76 $5.00
AA-76 NADA AB-27 * AB-77 $5.00
AA-77 $7.00 AB-28 $5.00 AB-78 NADA
AA-78 $7.00 AB-29 $7.00 AB-79 $10.00
AA-79 $7.00 AB-30 $7.00 AB-80 $5.00
AA-80 $7.00 AB-31 * AB-81 NADA
AA-81 d $15.00 AB-32 $10.00 AB-82 $5.00
AA-82 $5.00 AB-33 $5.00 AB-83 $5.00
AA-83 * AB-34 $5.00 AB-84 $10.00
AA-84 N/C AB-35 $7.00 AB-85 $5.00
AA-85 $5.00 AB-36 $7.00 AB-86 $5.00
AA-86 $5.00 AB-37 $5.00 AB-87 $7.00
AA-87 $5.00 AB-38 $10.00 AB-88 $5.00
AA-88 $5.00 AB-39 $5.00 AB-89 $7.00
AA-89 $7.00 AB-40 $7.00 AB-90 $5.00
AA-90 $5.00 AB-41 $5.00 AB-91 $7.00
AA-91 $7.00 AB-42 $5.00 AB-92 *
AA-92 NADA AB-43 $5.00 AB-93 $5.00
AA-93 $7.00 AB-44 $5.00 AB-94 $5.00
AA-94 NADA AB-45 $5.00 AB-95 $5.00
AA-95 $5.00 AB-46 $7.00 AB-96 $7.00
AA-96 $5.00 AB-47 NADA AB-97 $7.00
AA-97 $5.00 AB-48 $5.00 AB-98 $5.00
AA-98 $7.00 AB-49 $5.00 AB-99 $10.00
AA-99 $5.00 AB-50 $5.00 AC-01 c
AB-01 $5.00 AB-51 $5.00 AC-02 $7.00
AB-02 NADA AB-52 $10.00 AC-03 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
3
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AC-04 $5.00 AC-55 $7.00 AD-24 $5.00 AC-05 $5.00 AC-56 $5.00 AD-25 $5.00
AC-06 $10.00 AC-57 $5.00 AD-26 $5.00
AC-07 * AC-58 $7.00 AD-27 $7.00
AC-08 $5.00 AC-59 $7.00 AD-28 $5.00
AC-09 $5.00 AC-60 l, $7.00 AD-29 $5.00
AC-10 $5.00 AC-61 $5.00 AD-30 $5.00
AC-11 $5.00 AC-62 * AD-31 $5.00
AC-12 $5.00 AC-63 $5.00 AD-32 $5.00
AC-13 $10.00 AC-64 $5.00 AD-33 NADA
AC-14 $5.00 AC-65 $10.00 AD-34 NADA
AC-15 $5.00 AC-66 $5.00 AD-35 $5.00
AC-16 $5.00 AC-67 $5.00 AD-36 c NADA
AC-17 * AC-68 * AD-37 c NADA
AC-18 $5.00 AC-69 $5.00 AD-38 c NADA
AC-19 $5.00 AC-70 $10.00 AD-39 c NADA
AC-20 $5.00 AC-71 $7.00 AD-40 $7.00
AC-21 $5.00 AC-72 $5.00 AD-41 c NADA
AC-22 $5.00 AC-73 $6.00 AD-42 c NADA
AC-23 $5.00 AC-74 $5.00 AD-43 $7.00
AC-24 $5.00 AC-75 $5.00 AD-44 $5.00
AC-25 $5.00 AC-76 NADA AD-45 $5.00
AC-26 * AC-77 $5.00 AD-46 $7.00
AC-27 * AC-78 $10.00 AD-47 $5.00
AC-28 * AC-79 $5.00 AD-48 *
AC-29 * AC-80 $5.00 AD-49 NADA
AC-30 * AC-81 $5.00 AD-50 $7.00
AC-31 * AC-82 $5.00 AD-51 $5.00
AC-32 $5.00 AC-83 $5.00 AD-52 $5.00
AC-33 * AC-84 $5.00 AD-53 $10.00
AC-34 * AC-85 $5.00 AD-54 $5.00
AC-35 $5.00 AC-86 $5.00 AD-55 $5.00
AC-36 NADA AC-87 $5.00 AD-56 $5.00
AC-37 $5.00 AC-88 $5.00 AD-57 $7.00
AC-38 $8.00 AC-89 $5.00 AD-58 $10.00
AC-39 $5.00 AC-90 $5.00 AD-59 $5.00
AC-40 $5.00 AC-91 c NADA AD-60 $5.00
AC-41 * AC-92 * AD-61 $7.00
AC-42 $5.00 AC-93 c NADA AD-62 $5.00
AC-43 * AC-94 $5.00 AD-63 *
AC-44 * AC-95 $12.00 AD-64 $5.00
AC-45 * AC-96 $5.00 AD-65 $5.00
AC-46 * AC-97 $7.00 AD-66 *
AC-47 NADA AC-98 $10.00 AD-67 *
AC-48 $5.00 AC-99 $5.00 AD-68 $5.00
AC-49 c AD-18 $5.00 AD-69 $5.00
AC-50 NADA AD-19 $5.00 AD-70 $5.00
AC-51 $10.00 AD-20 $7.00 AD-71 $5.00
AC-52 $7.00 AD-21 NADA AD-72 $5.00
AC-53 $5.00 AD-22 $5.00 AD-73 $5.00
AC-54 NADA AD-23 $7.00 AD-74 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
4
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AD-75 $7.00 AE-22 * AE-68 $7.00 AD-76 $5.00 AE-23 $5.00 AE-69 $5.00
AD-77 $5.00 AE-24 NADA AE-70 $5.00
AD-78 $7.00 AE-25 NADA AE-71 $5.00
AD-79 * AE-26 $5.00 AE-72 $7.00
AD-80 NADA AE-27 $5.00 AE-73 $5.00
AD-81 $5.00 AE-28 NADA AE-74 $5.00
AD-82 $5.00 AE-29 $7.00 AE-75 $5.00
AD-83 $7.00 AE-30 $5.00 AE-76 $7.00
AD-84 $10.00 AE-31 $5.00 AE-77 $7.00
AD-85 * AE-32 $5.00 AE-78 $7.00
AD-86 $5.00
AE-33 $15.00 AE-79 $5.00
AD-87 $5.00
AE-34 $7.00 AE-80 $10.00
AD-88 $6.00
AE-35 $5.00 AE-81 $5.00
AD-89 $7.00
AE-36 $5.00 AE-82 c NADA
AD-90 $5.00
AE-37 $5.00 AE-83 $8.00
AD-91 $5.00
AE-38 $5.00 AE-84 * AD-92 * AE-39 $5.00 AE-85 c NADA
AD-93 $5.00
AE-40 $7.00 AE-86 $5.00
AD-94 $10.00
AE-41 $7.00 AE-87 $7.00
AD-95 $10.00
AE-42 $5.00 AE-88 c NADA
AD-96 $10.00
AE-43 $5.00 AE-89 $5.00
AD-97 $7.00
AE-44 * AE-90 $10.00
AD-98 $7.00
AE-45 * AE-91 $7.00
AD-99 c NADA
AE-46 $5.00 AE-92 $5.00
AE-01 $7.00 AE-47 $5.00 AE-93 q $10.00
AE-02 $7.00 AE-48 $7.00 AE-94 $15.00
AE-03 $5.00 AE-49 e $12.00 AE-95 $5.00
AE-04 $7.00 AE-50 e $10.00 AE-96 $5.00
AE-05 $7.00 AE-51 $5.00 AE-97 $5.00
AE-06 $5.00 AE-52 10% AE-98 f $5.00
AE-07 $10.00 AE-53 $5.00 AE-99 $7.00
AE-08 * AE-54 * AF-01 $5.00
AE-09 * AE-55 $7.00 AF-02 80%
AE-10 $7.00 AE-56 $5.00 AF-03 $5.00
AE-11 $7.00 AE-57 $5.00 AF-04 $5.00
AE-12 * AE-58 $5.00 AF-05 $10.00
AE-13 $5.00 AE-59 $7.00 AF-06 *
AE-14 NADA AE-60 * AF-07 $10.00
AE-15 $5.00 AE-61 $7.00 AF-08 $5.00
AE-16 $10.00
AE-62 $7.00 AF-09 $5.00
AE-17 NADA AE-63 NADA AF-10 $5.00
AE-18 NADA AE-64 $10.00 AF-11 $7.00
AE-19 NADA AE-65 $5.00 AF-12 $5.00
AE-20 NADA AE-66 $10.00 AF-13 $5.00
AE-21 NADA AE-67 NADA AF-14 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
5
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AF-15 $5.00 AF-64 $5.00 AG-14 $5.00 AF-16 $7.00 AF-65 NADA AG-15 $7.00
AF-17 $5.00 AF-66 $5.00 AG-16 $5.00
AF-18 * AF-67 $5.00 AG-17 *
AF-19 $7.00 AF-68 $5.00 AG-18 $7.00
AF-20 $7.00 AF-69 NADA AG-19 *
AF-21 $7.00 AF-70 * AG-20 l $5.00
AF-22 $7.00 AF-71 * AG-21 $7.00
AF-23 $7.00 AF-72 * AG-22 $7.00
AF-24 $5.00 AF-73 * AG-23 $5.00
AF-25 $5.00 AF-74 * AG-24 $7.00
AF-26 $5.00 AF-75 * AG-25 $7.00
AF-27 $7.00 AF-76 * AG-26 $7.00
AF-28 $5.00 AF-77 * AG-27 $7.00
AF-29 $5.00 AF-78 * AG-28 $7.00
AF-30 * AF-79 * AG-29 $7.00
AF-31 $7.00 AF-80 * AG-30 $7.00 AF-32 $5.00 AF-81 * AG-31 $7.00
AF-33 $5.00 AF-82 * AG-32 $7.00
AF-34 $7.00 AF-83 * AG-33 $7.00
AF-35 $7.00 AF-84 * AG-34 N/C
AF-36 $5.00 AF-85 * AG-35 $7.00
AF-37 $5.00 AF-86 NADA AG-36 $5.00
AF-38 * AF-87 * AG-37 $7.00
AF-39 * AF-88 $5.00 AG-38 $7.00
AF-40 f, NADA AF-89 * AG-39 $5.00
AF-41 f NADA AF-90 * AG-40 $8.00
AF-42 * AF-91 * AG-41 $5.00
AF-43 $7.00 AF-92 $5.00 AG-42 $5.00
AF-44 $7.00 AF-93 * AG-43 $5.00
AF-45 $7.00 AF-94 $5.00 AG-44 $5.00
AF-46 $7.00 AF-95 $7.00 AG-45 $10.00
AF-47 $7.00 AF-96 $5.00 AG-46 $5.00
AF-48 $7.00 AF-97 $5.00 AG-47 $7.00
AF-49 $7.00 AF-98 NADA AG-48 $5.00
AF-50 $7.00 AF-99 $5.00 AG-49 $5.00
AF-51 $7.00 AG-01 $10.00 AG-50 $5.00
AF-52 $7.00 AG-02 $5.00 AG-51 $5.00
AF-53 $7.00 AG-03 $10.00 AG-52 $8.00
AF-54 $7.00 AG-04 $5.00 AG-53 $5.00
AF-55 $7.00 AG-05 $5.00 AG-54 $5.00
AF-56 $5.00 AG-06 $5.00 AG-55 $5.00
AF-57 $5.00 AG-07 $5.00 AG-56 NADA
AF-58 $5.00 AG-08 $5.00 AG-57 *
AF-59 $5.00 AG-09 $5.00 AG-58 $7.00
AF-60 * AG-10 $10.00 AG-59 $5.00
AF-61 $5.00 AG-11 NADA AG-60 $5.00
AF-62 $5.00 AG-12 $5.00 AG-61 $7.00
AF-63 $5.00 AG-13 $7.00 AG-62 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
6
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AG-63 $5.00 AH-13 $10.00 AH-62 $7.00 AG-64 NADA AH-14 $7.00 AH-63 $5.00 AG-65 $10.00 AH-15 $7.00 AH-64 NADA AG-66 $7.00 AH-16 $8.00 AH-65 * AG-67 $7.00 AH-17 NADA AH-66 $5.00 AG-68 $5.00 AH-18 $5.00 AH-67 *
AG-69 $7.00 AH-19 $7.00 AH-68 $15.00
AG-70 $5.00 AH-20 $5.00 AH-69 *
AG-71 $5.00 AH-21 $7.00 AH-70 $7.00
AG-72 $5.00 AH-22 $5.00 AH-71 $5.00
AG-73 g NADA AH-23 $7.00 AH-72 $7.00 AG-74 $7.00 AH-24 $7.00 AH-73 o $10.00 AG-75 $7.00 AH-25 $15.00 AH-74 $5.00 AG-76 $5.00 AH-26 $7.00 AH-75 $10.00 AG-77 $5.00 AH-27 $7.00 AH-76 $5.00
AG-78 NADA AH-28 $5.00 AH-77 *
AG-79 $5.00 AH-29 * AH-78 $5.00 AG-80 $7.00 AH-30 $7.00 AH-79 $7.00
AG-81 $7.00 AH-31 $5.00 AH-80 $5.00 AG-82 f $7.00 AH-32 $7.00 AH-81 $5.00 AG-83 $7.00 AH-33 $7.00 AH-82 $5.00 AG-84 $7.00 AH-34 $10.00 AH-83 *
AG-85 $7.00 AH-35 $10.00 AH-84 $7.00
AG-86 $5.00 AH-36 NADA AH-85 $7.00 AG-87 $10.00 AH-37 $10.00 AH-86 $7.00 AG-88 $10.00 AH-38 $7.00 AH-87 $15.00
AG-89 $7.00 AH-39 $10.00 AH-88 $7.00 AG-90 $7.00 AH-40 $5.00 AH-89 $15.00 AG-91 $7.00 AH-41 $7.00 AH-90 $5.00
AG-92 $5.00 AH-42 $7.00 AH-91 j $7.00 AG-93 $5.00 AH-43 $7.00 AH-92 j $7.00 AG-94 $7.00 AH-44 NADA AH-93 NADA AG-95 $5.00 AH-45 $5.00 AH-94 l $7.00 AG-96 $5.00 AH-46 $10.00 AH-95 f $7.00
AG-97 e $7.00 AH-47 $10.00 AH-96 $5.00
AG-98 $5.00 AH-48 $10.00 AH-97 $7.00
AG-99 $7.00 AH-49 $12.00 AH-98 $7.00
AH-01 $5.00 AH-50 $8.00 AH-99 $7.00
AH-02 $5.00 AH-51 $8.00 AI-01 $7.00
AH-03 $7.00 AH-52 j NADA AI-02 $7.00
AH-04 f $7.00 AH-53 $5.00 AI-03 $7.00
AH-05 $5.00 AH-54 NADA AI-04 $5.00
AH-06 $10.00 AH-55 $7.00 AI-05 NADA AH-07 $15.00 AH-56 NADA AI-06 * AH-08 N/C AH-57 NADA AI-07 p $10.00 AH-09 $10.00 AH-58 $7.00 AI-08 $5.00 AH-10 $7.00 AH-59 $7.00 AI-09 $7.00
AH-11 $5.00 AH-60 $7.00 AI-10 k $5.00 AH-12 $7.00 AH-61 $7.00 AI-11 l $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
7
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AI-12 $7.00 AI-61 * AJ-11 m $5.00
AI-13 $7.00 AI-62 $7.00 AJ-12 $10.00
AI-14 $7.00 AI-63 * AJ-13 *
AI-15 $5.00 AI-64 $5.00 AJ-14 $5.00
AI-16 $7.00 AI-65 $5.00 AJ-15 $5.00
AI-17 $7.00 AI-66 $5.00 AJ-16 $2.00
AI-18 $5.00 AI-67 $7.00 AJ-17 NADA
AI-19 $5.00 AI-68 $5.00 AJ-18 NADA
AI-20 h $7.00 AI-69 $7.00 AJ-19 NADA
AI-21 $5.00 AI-70 $5.00 AJ-20 $10.00
AI-22 $5.00 AI-71 * AJ-21 $10.00
AI-23 $5.00 AI-72 * AJ-22 $10.00
AI-24 $5.00 AI-73 * AJ-23 $7.00
AI-25 $5.00 AI-74 * AJ-24 $10.00
AI-26 j $5.00 AI-75 * AJ-25 $5.00
AI-27 h $10.00 AI-76 * AJ-26 $7.00
AI-28 $5.00 AI-77 * AJ-27 $5.00
AI-29 $7.00 AI-78 * AJ-28 $7.00
AI-30 NADA AI-79 * AJ-29 $15.00
AI-31 NADA AI-80 * AJ-30 $15.00
AI-32 NADA AI-81 * AJ-31 $7.00
AI-33 $5.00 AI-82 * AJ-32 $10.00
AI-34 $7.00 AI-83 * AJ-33 $10.00
AI-35 $7.00 AI-84 $5.00 AJ-34 * AI-36 $5.00 AI-85 * AJ-35 $7.00
AI-37 $5.00 AI-86 * AJ-36 $7.00
AI-38 $7.00 AI-87 $5.00 AJ-37 $7.00
AI-39 $7.00 AI-88 f $5.00 AJ-38 $5.00
AI-40 $8.00 AI-89 $5.00 AJ-39 $7.00
AI-41 $5.00 AI-90 NADA AJ-40 $7.00
AI-42 $7.00 AI-91 $7.00 AJ-41 $10.00
AI-43 $5.00 AI-92 $7.00 AJ-42 $5.00
AI-44 $5.00 AI-93 $7.00 AJ-43 $10.00
AI-45 $5.00 AI-94 f $7.00 AJ-44 *
AI-46 $5.00 AI-95 $5.00 AJ-45 $7.00
AI-47 $5.00 AI-96 $10.00 AJ-46 $7.00
AI-48 $7.00 AI-97 $5.00 AJ-47 NADA
AI-49 $7.00 AI-98 $7.00 AJ-48 $7.00
AI-50 $7.00 AI-99 $5.00 AJ-49 *
AI-51 * AJ-01 NADA AJ-50 $7.00
AI-52 * AJ-02 NADA AJ-51 $7.00
AI-53 $5.00 AJ-03 NADA AJ-52 $10.00
AI-54 * AJ-04 NADA AJ-53 *
AI-55 * AJ-05 N/C AJ-54 $5.00
AI-56 * AJ-06 NADA AJ-55 m $5.00
AI-57 * AJ-07 $5.00 AJ-56 $10.00
AI-58 * AJ-08 n $7.00 AJ-57 $7.00
AI-59 $10.00 AJ-09 NADA AJ-58 $5.00
AI-60 * AJ-10 $5.00 AJ-59 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
8
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AJ-60 $7.00 AK-10 $7.00 AK-59 $7.00
AJ-61 * AK-11 k $7.00 AK-60 $7.00
AJ-62 $10.00 AK-12 $5.00 AK-61 *
AJ-63 $5.00 AK-13 f $7.00 AK-62 NADA
AJ-64 $5.00 AK-14 $5.00 AK-63 $5.00
AJ-65 * AK-15 f, $10.00 AK-64 $5.00
AJ-66 * AK-16 f $7.00 AK-65 *
AJ-67 $10.00 AK-17 f $7.00 AK-66 $5.00
AJ-68 $10.00 AK-18 * AK-67 $7.00
AJ-69 * AK-19 $7.00 AK-68 *
AJ-70 $5.00 AK-20 $7.00 AK-69 *
AJ-71 $10.00 AK-21 $5.00 AK-70 *
AJ-72 NADA AK-22 $7.00 AK-71 *
AJ-73 $7.00 AK-23 $7.00 AK-72 h $7.00
AJ-74 * AK-24 $7.00 AK-73 *
AJ-75 $10.00 AK-25 k $5.00 AK-74 *
AJ-76 $10.00 AK-26 $5.00 AK-75 $7.00
AJ-77 * AK-27 f $7.00 AK-76 *
AJ-78 $15.00 AK-28 f $7.00 AK-77 $10.00
AJ-79 * AK-29 f $7.00 AK-78 *
AJ-80 $10.00 AK-30 k $7.00 AK-79 *
AJ-81 $10.00 AK-31 f $7.00 AK-80 *
AJ-82 NADA AK-32 j $5.00 AK-81 *
AJ-83 $10.00 AK-33 $5.00 AK-82 *
AJ-84 * AK-34 $7.00 AK-83 *
AJ-85 $5.00 AK-35 j $5.00 AK-84 *
AJ-86 NADA AK-36 k $5.00 AK-85 $5.00
AJ-87 $10.00 AK-37 k $5.00 AK-86 $7.00
AJ-88 $5.00 AK-38 $5.00 AK-87 $10.00
AJ-89 NADA AK-39 $5.00 AK-88 $7.00
AJ-90 * AK-40 k $10.00 AK-89 *
AJ-91 h $7.00 AK-41 $5.00 AK-90 *
AJ-92 * AK-42 $10.00 AK-91 *
AJ-93 h $7.00 AK-43 NADA AK-92 *
AJ-94 $5.00 AK-44 $7.00 AK-93 *
AJ-95 $10.00 AK-45 $7.00 AK-94 $5.00
AJ-96 $5.00 AK-46 $5.00 AK-95 $7.00
AJ-97 $5.00 AK-47 $10.00 AK-96 $7.00
AJ-98 $5.00 AK-48 $7.00 AK-97 *
AJ-99 $7.00 AK-49 * AK-98 *
AK-01 $5.00 AK-50 * AK-99 *
AK-02 NADA AK-51 h $7.00 AL-01 $7.00
AK-03 NADA AK-52 h $7.00 AL-02 $5.00
AK-04 f $15.00 AK-53 $7.00 AL-03 $5.00
AK-05 NADA AK-54 $10.00 AL-04 $5.00
AK-06 NADA AK-55 $7.00 AL-05 f, $5.00
AK-07 NADA AK-56 $5.00 AL-06 f, $5.00
AK-08 $10.00 AK-57 $5.00 AL-07 f, $5.00
AK-09 $5.00 AK-58 $7.00 AL-08 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
9
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AL-09 f $7.00 AL-58 $7.00 AM-08 NADA
AL-10 f, $5.00 AL-59 f, $7.00 AM-09 c NADA
AL-11 f, $5.00 AL-60 $10.00 AM-10 $7.00
AL-12 f, $5.00 AL-61 f, $7.00 AM-11 $5.00
AL-13 f, $5.00 AL-62 f, $7.00 AM-12 $7.00
AL-14 f, $5.00 AL-63 f, $7.00 AM-13 NADA
AL-15 f $7.00 AL-64 f, $7.00 AM-14 $5.00
AL-16 $5.00 AL-65 $7.00 AM-15 $7.00
AL-17 $5.00 AL-66 f, $7.00 AM-16 $7.00
AL-18 f $7.00 AL-67 $7.00 AM-17 $5.00
AL-19 $5.00 AL-68 $7.00 AM-18 $5.00
AL-20 $5.00 AL-69 $5.00 AM-19 $5.00
AL-21 $5.00 AL-70 $10.00 AM-20 $5.00
AL-22 $5.00 AL-71 $5.00 AM-21 $5.00
AL-23 $7.00 AL-72 $7.00 AM-22 $8.00
AL-24 $7.00 AL-73 $7.00 AM-23 $7.00
AL-25 c NADA AL-74 f, $7.00 AM-24 j NADA
AL-26 $5.00 AL-75 f, $7.00 AM-25 NADA
AL-27 $7.00 AL-76 $5.00 AM-26 $5.00
AL-28 $7.00 AL-77 $5.00 AM-27 i $5.00
AL-29 $7.00 AL-78 $7.00 AM-28 $7.00
AL-30 $7.00 AL-79 $5.00 AM-29 $7.00
AL-31 $7.00 AL-80 $7.00 AM-30 NADA
AL-32 $7.00 AL-81 $7.00 AM-31 $7.00 AL-33 $7.00 AL-82 $7.00 AM-32 $5.00
AL-34 $7.00 AL-83 $7.00 AM-33 $5.00
AL-35 $7.00 AL-84 $7.00 AM-34 $7.00
AL-36 $5.00 AL-85 $7.00 AM-35 $5.00
AL-37 $5.00 AL-86 $5.00 AM-36 $5.00
AL-38 $5.00 AL-87 $7.00 AM-37 $5.00
AL-39 $5.00 AL-88 $7.00 AM-38 $7.00
AL-40 $5.00 AL-89 f, $7.00 AM-39 $7.00
AL-41 $5.00 AL-90 $7.00 AM-40 $7.00
AL-42 $7.00 AL-91 f, $7.00 AM-41 $7.00
AL-43 $5.00 AL-92 $7.00 AM-42 $7.00
AL-44 $7.00 AL-93 f, $7.00 AM-43 $7.00
AL-45 $5.00 AL-94 $7.00 AM-44 $2.00
AL-46 $5.00 AL-95 $7.00 AM-45 $5.00
AL-47 $7.00 AL-96 $7.00 AM-46 *
AL-48 f, $7.00 AL-97 $7.00 AM-47 *
AL-49 f, $7.00 AL-98 $7.00 AM-48 *
AL-50 f, $7.00 AL-99 $7.00 AM-49 $7.00
AL-51 f, $7.00 AM-01 $7.00 AM-50 $5.00
AL-52 f, $7.00 AM-02 $5.00 AM-51 m, NADA
AL-53 f, $7.00 AM-03 $5.00 AM-52 m, NADA
AL-54 $5.00 AM-04 NADA AM-53 $5.00
AL-55 f, $7.00 AM-05 $7.00 AM-54 $7.00
AL-56 f, $7.00 AM-06 NADA AM-55 $7.00
AL-57 f, $7.00 AM-07 $7.00 AM-56 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
10
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AM-57 $7.00 * * * *
AM-58 $5.00 * * * *
AM-59 $5.00 * * * *
AM-60 $5.00 * * * *
AM-61 * * * * *
AM-62 h $5.00 * * * *
AM-63 h $5.00 * * * *
AM-64 $7.00 * * * *
AM-65 $5.00 * * * *
AM-66 $5.00 * * * *
AM-67 $7.00 * * * *
AM-68 * * * * *
AM-69 * * * * *
AM-70 * * * * *
AM-71 * * * * *
AM-72 $7.00 * * * *
AM-73 $7.00 * * * *
AM-74 $7.00 * * * *
AM-75 $5.00 * * * *
AM-76 $7.00 * * * *
AM-77 * * * * *
AM-78 $7.00 * * * *
AM-79 $10.00 * * * *
AM-80 $7.00 * * * *
AM-81 $5.00 * * * *
AM-82 NADA * * * *
AM-83 $5.00 * * * *
AM-84 $7.00 * * * *
AM-85 h $7.00 * * * *
AM-86 $5.00 * * * *
AM-87 $5.00 * * * *
AM-88 $5.00 * * * *
AM-89 $7.00 * * * *
AM-90 h $7.00 * * * *
AM-91 f $7.00 * * * *
AM-92 f $7.00 * * * *
AM-93 j $10.00 * * * *
AM-94 $5.00 * * * *
AM-95 $5.00 * * * *
AM-96 $5.00 * * * *
AM-97 $5.00 * * * *
AM-98 $5.00 * * * *
AM-99 $5.00 * * * *
* * * * * *
* * * * * *
* * * * * *
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
11
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AN-01 $5.00 AN-51 $7.00 *
AN-51
AN-52
AN-53
AN-54
AN-55
AN-56
AN-57
AN-58
AN-59
AN-60
AN-61
AN-62
AN-63
AN-64
AN-65
AN-66
AN-67
AN-69
AN-69
AN-70
AN-71
AN-72
AN-73
AN-74
AN-75
AN-76
AN-77
AN-78
AN-79
AN-80
AN-81
AN-82
AN-83
AN-84
AN-85
AN-86
AN-87
AN-88
AN-89
AN-90
AN-91
AN-92
AN-93
AN-94
AN-95
AN-96
AN-97
AN-98
AN-99
*
AN-02 $5.00 AN-52 $5.00 * *
AN-03 $5.00 AN-53 $7.00 * *
AN-04 $5.00 AN-54 f $7.00 * *
AN-05 $5.00 AN-55 $5.00 * *
AN-06 $5.00 AN-56 f $5.00 * *
AN-07 $5.00 AN-57 $7.00 * *
AN-08 NADA AN-58 $7.00 * *
AN-09 NADA AN-59 $5.00 * *
AN-10 NADA AN-60 $7.00 * *
AN-11 $7.00 AN-61 $7.00 * *
AN-12 $7.00 AN-62 $5.00 * *
AN-13 $10.00 AN-63 NADA * *
AN-14 $10.00 AN-64 f $7.00 * *
AN-15 $7.00 AN-65 f $7.00 * *
AN-16 * AN-66 $7.00 * *
AN-17 * AN-67 f $7.00 * *
AN-18 * AN-68 $5.00 * *
AN-19 * AN-69 $7.00 * *
AN-20 h $7.00 AN-70 $7.00 * *
AN-21 * AN-71 * * *
AN-22 $7.00 AN-72 k $5.00 * *
AN-23 * AN-73 $5.00 * *
AN-24 $7.00 AN-74 $5.00 * *
AN-25 * AN-75 $5.00 * *
AN-26 $7.00 AN-76 n $5.00 * *
AN-27 f $7.00 AN-77 NADA * *
AN-28 k $10.00 AN-78 $7.00 * *
AN-29 $15.00 AN-79 $5.00 * *
AN-30 $7.00 AN-80 $7.00 * *
AN-31 $5.00 AN-81 $7.00 * *
AN-32 f $7.00 AN-82 $5.00 * *
AN-33 $7.00 AN-83 $5.00 * *
AN-34 $5.00 AN-84 $5.00 * *
AN-35 $7.00 AN-85 $7.00 * *
AN-36 $7.00 AN-86 $10.00 * *
AN-37 $7.00 AN-87 $10.00 * *
AN-38 $7.00 AN-88 $10.00 * *
AN-39 $7.00 AN-89 $7.00 * *
AN-40 $7.00 AN-90 $10.00 * *
AN-41 $10.00 AN-91 $10.00 * *
AN-42 $7.00 AN-92 $7.00 * *
AN-43 $5.00 AN-93 $7.00 * *
AN-44 NADA AN-94 $7.00 * *
AN-45 * AN-95 $5.00 * *
AN-46 f $7.00 AN-96 * * *
AN-47 p $20.00 AN-97 * * *
AN-48 $10.00 AN-98 $5.00 * *
AN-49 f $5.00 AN-99 $5.00 * *
AN-50 $5.00 * * * *
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
12
CÓDIGO COPAGO CÓDIGO COPAGO CÓDIGO COPAGO
AP-01 * AP-51 $7.00 * *
AP-02 $7.00 AP-52 $5.00 * *
AP-03 $7.00 AP-53 $5.00 * *
AP-04 $5.00 AP-54 $10.00 * *
AP-05 $5.00 AP-55 $7.00 * *
AP-06 $15.00 AP-56 $7.00 * *
AP-07 $10.00 AP-57 $7.00 * *
AP-08 $5.00 AP-58 $7.00 * *
AP-09 $7.00 AP-59 $7.00 * *
AP-10 $5.00 AP-60 $5.00 * *
AP-11 $10.00 AP-61 $5.00 * *
AP-12 $7.00 AP-62 $5.00 * *
AP-13 $10.00 AP-63 $10.00 * *
AP-14 NADA AP-64 $5.00 * *
AP-15 NADA AP-65 $10.00 * *
AP-16 NADA AP-66 $10.00 * *
AP-17 NADA AP-67 k $10.00 * *
AP-18 * AP-68 $7.00 * *
AP-19 $7.00 AP-69 $5.00 * *
AP-20 $5.00 AP-70 $5.00 * *
AP-21 $7.00 AP-71 $10.00 * *
AP-22 $7.00 AP-72 k $7.00 * *
AP-23 $7.00 AP-73 k $5.00 * *
AP-24 $7.00 AP-74 10% * *
AP-25 $7.00 AP-75 k $7.00 * *
AP-26 $5.00 AP-76 h $7.00 * *
AP-27 * AP-77 $5.00 * *
AP-28 $7.00 AP-78 k $5.00 * *
AP-29 $10.00 AP-79 k $5.00 * *
AP-30 $5.00 AP-80 k $20.00 * *
AP-31 20% AP-81 k $20.00 * *
AP-32 $7.00 AP-82 $7.00 * *
AP-33 $7.00 AP-83 $10.00 * *
AP-34 * AP-84 $7.00 * *
AP-35 NADA AP-85 * * *
AP-36 $7.00 AP-86 $12.00 * *
AP-37 $10.00 AP-87 $15.00 * *
AP-38 $15.00 AP-88 $5.00 * *
AP-39 NADA AP-89 $7.00 * *
AP-40 h $7.00 AP-90 $7.00 * *
AP-41 h, $7.00 AP-91 $7.00 * *
AP-42 NADA AP-92 $7.00 * *
AP-43 j $18.00 AP-93 * * *
AP-44 j $12.00 AP-94 * * *
AP-45 $7.00 AP-95 * * *
AP-46 N/C AP-96 * * *
AP-47 $5.00 AP-97 * * *
AP-48 $10.00 AP-98 * * *
AP-49 $10.00 AP-99 $7.00 * *
AP-50 $7.00 * * * *
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
13
NOTAS:
* Código sin asignar. N/C No cubre.
a. Aplica periodo de espera.
b. $5.00 para terapia del habla y terapia ocupacional.
c. Aplica al Programa Medicare Advantage
d. Aplica un límite de veinte (20) terapias, en conjunto, por servicios de acupuntura para el manejo del
dolor prestados por doctores en medicinas, certificados para ejercer estos servicios; de quiroprácticos y de terapia física. No aplica copagos.
e. Aplica un límite de noventa (90) sesiones por terapia física, terapia del habla, terapia ocupacional y
quiroprácticos.
f. Terapia física y manipulaciones de quiroprácticos, hasta un máximo de veinte (20) sesiones, en conjunto, por año póliza. Cubre una visita inicial cada tres (3) años y una visita subsiguiente por año póliza.
g. Cubre 45 terapias adicionales, sujeto a preautorización.
h. Aplica un máximo de veinte (20) terapias físicas y manipulaciones por quiroprácticos, en conjunto.
i. Terapia física y manipulaciones de quiroprácticos, hasta un máximo de veinte (15) sesiones, en
conjunto, por año póliza. Estos servicios están sujetos a un copago de $18.00.
j. Terapia física hasta un máximo de veinte (15) sesiones por año póliza.
k. Aplica un máximo de veinte (20) terapias por año póliza.
l. Aplica un máximo de treinta (30) terapias por año póliza.
m. Terapia física (provista por un médico especialista en fisiatría o bajo la supervisión de éste y facturada por éste), hasta una (1) sesión diaria y hasta un máximo de 30 por año póliza. En este caso la supervisión no requiere la intervención directa (cara a cara) del médico, pero sí su requiere la intervención directa (cara a cara) del médico, pero sí su disponibilidad en el lugar para que pueda evaluar o recomendar un cambio en el plan de tratamiento, de ser necesario. Las terapias físicas pueden ser ofrecidas por quiroprácticos.
n. Terapia física (provista por un médico especialista en fisiatría o bajo la supervisión de éste y facturada
por éste), hasta veinte (20) terapias por año póliza. En este caso la supervisión no requiere la intervención directa (cara a cara) del médico, pero sí pero sí su disponibilidad en el lugar para que pueda evaluar o recomendar un cambio en el plan de tratamiento, de ser necesario.
o. Aplica un máximo de diez (10) terapias por año póliza.
p. Cubre un máximo de 120 días por condición.
q. Cubre 60 terapias por condición.
r. Aplica un máximo de treinta (40) terapias por año póliza.
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
14
() Versión de Cubiertas de Reforma de Salud Federal que incluyen beneficios que se considerarán como Servicios Preventivos
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
15
Grupo Triple-S
CÓDIGO COASEGURO
B1 NADA
B2 $5.00
B3 $5.00
B4 $5.00
B5 NADA
B6 NADA
B7 NADA
B8 NADA
B9 NADA
B10 NADA
B11 NADA
B12 NADA
B13 NADA
B14 NADA
B15 NADA
B16 NADA
B17 $5.00
B18 NADA
B19 NADA
B20 NADA
B21 NADA
B22 NADA
B23 NADA
B24 NADA
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
16
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B25 $7.00 B75 $7.00 B125 $7.00
B26 $7.00 B76 $7.00 B126 $7.00
B27 $7.00 B77 $7.00 B127 $7.00
B28 $7.00 B78 $7.00 B128 $7.00
B29 $7.00 B79 $7.00 B129 $7.00
B30 $7.00 B80 $7.00 B130 $7.00
B31 $7.00 B81 $7.00 B131 $7.00
B32 $7.00 B82 $7.00 B132 $7.00
B33 $7.00 B83 $7.00 B133 $7.00
B34 $7.00 B84 $7.00 B134 $7.00
B35 $7.00 B85 $7.00 B135 $5.00
B36 $7.00 B86 $7.00 B136 $7.00
B37 $7.00 B87 $7.00 B137 $7.00
B38 $7.00 B88 $7.00 B138 $7.00
B39 $7.00 B89 $7.00 B139 $7.00
B40 $7.00 B90 $7.00 B140 $7.00
B41 $7.00 B91 $5.00 B141 $7.00
B42 $7.00 B92 $7.00 B142 $7.00
B43 $7.00 B93 $7.00 B143 $7.00
B44 $7.00 B94 $7.00 B144 $7.00
B45 $7.00 B95 $7.00 B145 $7.00
B46 $7.00 B96 $7.00 B146 $7.00
B47 $7.00 B97 $7.00 B147 $7.00
B48 $7.00 B98 $7.00 B148 $7.00
B49 $7.00 B99 $7.00 B149 $7.00
B50 $7.00 B100 $7.00 B150 $7.00
B51 $7.00 B101 $7.00 B151 $7.00
B52 $7.00 B102 $7.00 B152 $7.00
B53 $7.00 B103 $7.00 B153 $7.00
B54 $7.00 B104 $7.00 B154 $7.00
B55 $7.00 B105 $7.00 B155 $7.00
B56 $7.00 B106 $7.00 B156 $7.00
B57 $7.00 B107 $5.00 B157 $7.00
B58 $7.00 B108 $7.00 B158 $7.00
B59 $7.00 B109 $7.00 B159 $7.00
B60 $7.00 B110 $7.00 B160 $7.00
B61 $7.00 B111 $7.00 B161 $7.00
B62 $7.00 B112 $7.00 B162 $7.00
B63 $7.00 B113 $7.00 B163 $7.00
B64 $7.00 B114 $7.00 B164 $7.00
B65 $7.00 B115 $7.00 B165 $7.00
B66 $7.00 B116 $7.00 B166 $7.00
B67 $7.00 B117 $7.00 B167 $7.00
B68 $7.00 B118 $7.00 B168 $7.00
B69 $7.00 B119 $7.00 B169 $5.00
B70 $7.00 B120 $7.00 B170 $7.00
B71 $7.00 B121 $7.00 B171 $7.00
B72 $7.00 B122 $7.00 B172 $7.00
B73 $7.00 B123 $7.00 B173 $7.00
B74 $7.00 B124 $7.00 B174 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
17
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B175 $7.00 B225 $7.00 B453 $7.00
B176 $7.00 B226 $7.00 B454 $7.00
B177 $7.00 B227 $5.00 B455 $7.00
B178 $7.00 B228 $7.00 B456 $7.00
B179 $7.00 B229 $7.00 B457 $7.00
B180 $7.00 B230 $7.00 B458 $7.00
B181 $7.00 B231 $7.00 B459 $7.00
B182 $7.00 B232 $7.00 B460 $7.00
B183 $7.00 B233 $7.00 B461 $7.00
B184 $7.00 B234 $7.00 B462 $7.00
B185 $7.00 B235 $7.00 B463 $7.00
B186 $7.00 B236 $7.00 B464 $7.00
B187 $7.00 B237 $7.00 B465 $7.00
B188 $7.00 B238 $7.00 B466 $7.00
B189 $7.00 B239 $7.00 B467 $7.00
B190 $7.00 B240 $7.00 B468 $7.00
B191 $7.00 B241 $7.00 B469 $7.00
B192 $7.00 B242 $7.00 B470 $7.00
B193 $7.00 B243 $7.00 B471 $7.00
B194 $7.00 B244 $7.00 B472 $7.00
B195 $7.00 B245 $7.00 B473 $7.00
B196 $7.00 B246 $7.00 B474 $7.00
B197 $7.00 B247 $7.00 B475 $7.00
B198 $7.00 B248 $7.00 B476 $7.00
B199 $7.00 B249 $7.00 B477 $7.00
B200 $7.00 B250 $7.00 B478 $7.00
B201 $7.00 B251 $7.00 B479 $7.00
B202 $7.00 B252 $7.00 B480 $7.00
B203 $7.00 B253 $7.00 B481 $7.00
B204 $7.00 B254 $7.00 B482 $7.00
B205 $7.00 B255 $7.00 B483 $7.00
B206 $7.00 B256 $7.00 B484 $7.00
B207 $7.00 B257 $7.00 B485 $7.00
B208 $7.00 B258 $7.00 B486 $7.00
B209 $7.00 B259 $7.00 B487 $7.00
B210 $7.00 B438 $7.00 B488 $7.00
B211 $7.00 B439 $7.00 B489 $7.00
B212 $7.00 B440 $7.00 B490 $7.00
B213 $7.00 B441 $7.00 B491 $7.00
B214 $7.00 B442 $7.00 B492 $7.00
B215 $7.00 B443 $7.00 B493 $7.00
B216 $7.00 B444 $7.00 B494 $7.00
B217 $7.00 B445 $7.00 B495 $7.00
B218 $7.00 B446 $7.00 B496 $7.00
B219 $7.00 B447 $7.00 B497 $7.00
B220 $7.00 B448 $7.00 B498 $7.00
B221 $7.00 B449 $7.00 B499 $7.00
B222 $7.00 B450 $7.00 B500 $7.00
B223 $7.00 B451 $7.00 B501 $7.00
B224 $7.00 B452 $7.00 B502 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
18
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B503 $7.00 B553 $7.00 B603 $7.00
B504 $7.00 B554 $7.00 B604 $7.00
B505 $7.00 B555 $7.00 B605 $7.00
B506 $7.00 B556 $7.00 B606 $7.00
B507 $7.00 B557 $7.00 B607 $7.00
B508 $7.00 B558 $7.00 B608 $7.00
B509 $7.00 B559 $7.00 B609 $7.00
B510 $7.00 B560 $5.00 B610 $7.00
B511 $7.00 B561 $7.00 B611 $7.00
B512 $7.00 B562 $7.00 B612 $7.00
B513 $7.00 B563 $7.00 B613 $7.00
B514 $7.00 B564 $7.00 B614 $7.00
B515 $7.00 B565 $7.00 B615 $7.00
B516 $7.00 B566 $7.00 B616 $7.00
B517 $7.00 B567 $7.00 B617 $7.00
B518 $7.00 B568 $7.00 B618 $7.00
B519 $7.00 B569 $7.00 B619 $7.00
B520 $7.00 B570 $7.00 B620 $7.00
B521 $7.00 B571 $7.00 B621 $7.00
B522 $7.00 B572 $7.00 B622 $7.00
B523 $7.00 B573 $7.00 B623 $7.00
B524 $7.00 B574 $7.00 B624 $7.00
B525 $7.00 B575 $7.00 B625 $7.00
B526 $7.00 B576 $7.00 B626 $7.00
B527 $7.00 B577 $7.00 B627 $7.00
B528 $7.00 B578 $7.00 B628 $7.00
B529 $7.00 B579 $7.00 B629 $7.00
B530 $7.00 B580 $7.00 B630 $7.00
B531 $7.00 B581 $7.00 B631 $7.00
B532 $7.00 B582 $7.00 B632 $7.00
B533 $7.00 B583 $7.00 B633 $7.00
B534 $7.00 B584 $7.00 B634 $7.00
B535 $7.00 B585 $7.00 B635 $7.00
B536 $7.00 B586 $7.00 B636 $7.00
B537 $7.00 B587 $7.00 B637 $7.00
B538 $7.00 B588 $7.00 B638 $7.00
B539 $7.00 B589 $7.00 B639 $7.00
B540 $7.00 B590 $7.00 B640 $7.00
B541 $7.00 B591 $7.00 B641 $7.00
B542 $7.00 B592 $7.00 B642 $7.00
B543 $7.00 B593 $7.00 B643 $7.00
B544 $7.00 B594 $7.00 B644 $7.00
B545 $7.00 B595 $7.00 B645 $7.00
B546 $7.00 B596 $7.00 B646 $7.00
B547 $7.00 B597 $7.00 B647 $7.00
B548 $7.00 B598 $7.00 B648 $7.00
B549 $7.00 B599 $7.00 B649 $7.00
B550 $7.00 B600 $7.00 B650 $7.00
B551 $7.00 B601 $7.00 B651 $7.00
B552 $7.00 B602 $7.00 B652 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
19
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B653 $7.00 B703 $7.00 B753 $7.00
B654 $7.00 B704 $7.00 B754 $7.00
B655 $7.00 B705 $7.00 B755 $7.00
B656 $7.00 B706 $7.00 B756 $7.00
B657 $7.00 B707 $7.00 B757 $7.00
B658 $7.00 B708 $7.00 B758 $7.00
B659 $7.00 B709 $7.00 B759 $7.00
B660 $7.00 B710 $7.00 B760 $7.00
B661 $7.00 B711 $7.00 B761 $7.00
B662 $7.00 B712 $7.00 B762 $7.00
B663 $7.00 B713 $7.00 B763 $7.00
B664 $7.00 B714 $7.00 B764 $7.00
B665 $7.00 B715 $5.00 B765 $7.00
B666 $7.00 B716 $7.00 B766 $7.00
B667 $7.00 B717 $7.00 B767 $7.00
B668 $7.00 B718 $7.00 B768 $7.00
B669 $7.00 B719 $7.00 B769 $7.00
B670 $7.00 B720 $7.00 B770 $7.00
B671 $7.00 B721 $7.00 B771 $7.00
B672 $7.00 B722 $7.00 B772 $7.00
B673 $7.00 B723 $7.00 B773 $7.00
B674 $7.00 B724 $7.00 B774 $7.00
B675 $7.00 B725 $7.00 B775 $7.00
B676 $7.00 B726 $7.00 B776 $7.00
B677 $7.00 B727 $7.00 B777 $7.00
B678 $7.00 B728 $7.00 B778 $7.00
B679 $7.00 B729 $7.00 B779 $7.00
B680 $7.00 B730 $7.00 B780 $7.00
B681 $7.00 B731 $7.00 B781 $7.00
B682 $7.00 B732 $7.00 B782 $7.00
B683 $7.00 B733 $7.00 B783 $7.00
B684 $7.00 B734 $7.00 B784 $7.00
B685 $7.00 B735 $7.00 B785 $7.00
B686 $7.00 B736 $7.00 B786 $7.00
B687 $7.00 B737 $7.00 B787 $7.00
B688 $7.00 B738 $7.00 B788 $7.00
B689 $7.00 B739 $7.00 B789 $7.00
B690 $7.00 B740 $7.00 B790 $7.00
B691 $7.00 B741 $7.00 B791 $7.00
B692 $7.00 B742 $7.00 B792 $7.00
B693 $7.00 B743 $7.00 B793 $7.00
B694 $7.00 B744 $5.00 B794 $7.00
B695 $7.00 B745 $7.00 B795 $7.00
B696 $7.00 B746 $7.00 B796 $7.00
B697 $7.00 B747 $7.00 B797 $7.00
B698 $7.00 B748 $7.00 B798 $7.00
B699 $7.00 B749 $7.00 B799 $7.00
B700 $7.00 B750 $7.00 B800 $7.00
B701 $7.00 B751 $7.00 B801 $7.00
B702 $7.00 B752 $7.00 B802 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
20
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B803 $7.00 B853 $7.00 B903 $7.00
B804 $7.00 B854 $7.00 B904 $7.00
B805 $7.00 B855 $7.00 B905 $7.00
B806 $7.00 B856 $7.00 B906 $7.00
B807 $7.00 B857 $7.00 B907 $7.00
B808 $7.00 B858 $7.00 B908 $7.00
B809 $7.00 B859 $7.00 B909 $7.00
B810 $7.00 B860 $7.00 B910 $7.00
B811 $7.00 B861 $7.00 B911 $7.00
B812 $7.00 B862 $7.00 B912 $7.00
B813 $7.00 B863 $7.00 B913 $7.00
B814 $7.00 B864 $7.00 B914 $7.00
B815 $7.00 B865 $7.00 B915 $7.00
B816 $7.00 B866 $7.00 B916 $7.00
B817 $7.00 B867 $7.00 B917 $7.00
B818 $7.00 B868 $7.00 B918 $7.00
B819 $7.00 B869 $7.00 B919 $7.00
B820 $7.00 B870 $7.00 B920 $7.00
B821 $7.00 B871 $7.00 B921 $7.00
B822 $7.00 B872 $7.00 B922 $7.00
B823 $7.00 B873 $7.00 B923 $7.00
B824 $7.00 B874 $7.00 B924 $7.00
B825 $7.00 B875 $7.00 B925 $7.00
B826 $7.00 B876 $7.00 B926 $7.00
B827 $5.00 B877 $7.00 B927 $7.00
B828 $7.00 B878 $7.00 B928 $7.00
B829 $7.00 B879 $7.00 B929 $7.00
B830 $7.00 B880 $7.00 B930 $7.00
B831 $7.00 B881 $7.00 B931 $7.00
B832 $7.00 B882 $7.00 B932 $7.00
B833 $7.00 B883 $7.00 B933 $7.00
B834 $7.00 B884 $7.00 B934 $7.00
B835 $7.00 B885 $7.00 B935 $7.00
B836 $7.00 B886 $7.00 B936 $7.00
B837 $7.00 B887 $7.00 B937 $7.00
B838 $7.00 B888 $7.00 B938 $7.00
B839 $7.00 B889 $7.00 B939 $7.00
B840 $7.00 B890 $7.00 B940 $7.00
B841 $7.00 B891 $7.00 B941 $7.00
B842 $7.00 B892 $7.00 B942 $7.00
B843 $7.00 B893 $7.00 B943 $7.00
B844 $7.00 B894 $7.00 B944 $7.00
B845 $7.00 B895 $7.00 B945 $7.00
B846 $7.00 B896 $7.00 B946 $7.00
B847 $7.00 B897 $7.00 B947 $7.00
B848 $7.00 B898 $7.00 B948 $7.00
B849 $7.00 B899 $7.00 B949 $7.00
B850 $7.00 B900 $7.00 B950 $7.00
B851 $7.00 B901 $7.00 B951 $7.00
B852 $7.00 B902 $7.00 B952 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
21
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B953 $7.00 B1003 $7.00 B1053 $7.00
B954 $7.00 B1004 $7.00 B1054 $5.00
B955 $7.00 B1005 $7.00 B1055 $7.00
B956 $7.00 B1006 $7.00 B1056 $7.00
B957 $7.00 B1007 $7.00 B1057 $7.00
B958 $7.00 B1008 $7.00 B1058 $7.00
B959 $7.00 B1009 $7.00 B1059 $7.00
B960 $7.00 B1010 $7.00 B1060 $5.00
B961 $7.00 B1011 $7.00 B1061 $5.00
B962 $7.00 B1012 $7.00 B1062 $7.00
B963 $7.00 B1013 $7.00 B1063 $7.00
B964 $7.00 B1014 $7.00 B1064 $7.00
B965 $7.00 B1015 $7.00 B1065 $5.00
B966 $7.00 B1016 $7.00 B1066 $5.00
B967 $7.00 B1017 $7.00 B1067 $7.00
B968 $7.00 B1018 $7.00 B1068 $7.00
B969 $7.00 B1019 $7.00 B1069 $7.00
B970 $7.00 B1020 $7.00 B1070 $7.00
B971 $7.00 B1021 $7.00 B1071 $7.00
B972 $7.00 B1022 $7.00 B1072 $7.00
B973 $7.00 B1023 $7.00 B1073 $7.00
B974 $7.00 B1024 $7.00 B1074 $7.00
B975 $7.00 B1025 $5.00 B1075 $7.00
B976 $7.00 B1026 $7.00 B1076 $7.00
B977 $7.00 B1027 $7.00 B1077 $7.00
B978 $7.00 B1028 $7.00 B1078 $7.00
B979 $7.00 B1029 $7.00 B1079 $7.00
B980 $7.00 B1030 $7.00 B1080 $7.00
B981 $7.00 B1031 $7.00 B1081 $7.00
B982 $7.00 B1032 $5.00 B1082 $7.00
B983 $7.00 B1033 $7.00 B1083 $7.00
B984 $7.00 B1034 $7.00 B1084 $7.00
B985 $7.00 B1035 $7.00 B1085 $7.00
B986 $7.00 B1036 $7.00 B1086 $7.00
B987 $7.00 B1037 $7.00 B1087 $7.00
B988 $7.00 B1038 $7.00 B1088 $7.00
B989 $7.00 B1039 $7.00 B1089 $7.00
B990 $7.00 B1040 $7.00 B1090 $7.00
B991 $7.00 B1041 $7.00 B1091 $7.00
B992 $7.00 B1042 $7.00 B1092 $7.00
B993 $7.00 B1043 $7.00 B1093 $7.00
B994 $7.00 B1044 $7.00 B1094 $7.00
B995 $7.00 B1045 $7.00 B1095 $7.00
B996 $7.00 B1046 $7.00 B1096 $7.00
B997 $7.00 B1047 $7.00 B1097 $7.00
B998 $7.00 B1048 $7.00 B1098 $7.00
B999 $7.00 B1049 $7.00 B1099 $7.00
B1000 $7.00 B1050 $7.00 B1100 $7.00
B1001 $7.00 B1051 $7.00 B1101 $7.00
B1002 $7.00 B1052 $7.00 B1102 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
22
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B1103 $7.00 B1334 $7.00 B1384 $7.00
B1104 $7.00 B1335 $7.00 B1385 $7.00
B1105 $7.00 B1336 $7.00 B1386 $7.00
B1106 $7.00 B1337 $7.00 B1387 $7.00
B1107 $7.00 B1338 $7.00 B1388 $7.00
B1289 $7.00 B1339 $7.00 B1389 $7.00
B1290 $7.00 B1340 $7.00 B1390 $7.00
B1291 $7.00 B1341 $7.00 B1391 $7.00
B1292 $7.00 B1342 $7.00 B1392 $7.00
B1293 $7.00 B1343 $7.00 B1393 $7.00
B1294 $7.00 B1344 $7.00 B1394 $5.00
B1295 $7.00 B1345 $7.00 B1395 $7.00
B1296 $7.00 B1346 $7.00 B1396 $7.00
B1297 $7.00 B1347 $7.00 B1397 $5.00
B1298 $7.00 B1348 $7.00 B1398 $7.00
B1299 $7.00 B1349 $7.00 B1399 $7.00
B1300 $5.00 B1350 $7.00 B1400 $7.00
B1301 $7.00 B1351 $7.00 B1401 $7.00
B1302 $7.00 B1352 $7.00 B1402 $7.00
B1303 $7.00 B1353 $7.00 B1403 $7.00
B1304 $7.00 B1354 $7.00 B1404 $7.00
B1305 $7.00 B1355 $7.00 B1405 $7.00
B1306 $7.00 B1356 $7.00 B1406 $7.00
B1307 $7.00 B1357 $7.00 B1407 $7.00
B1308 $7.00 B1358 $7.00 B1408 $7.00
B1309 $7.00 B1359 $7.00 B1409 $7.00
B1310 $7.00 B1360 $7.00 B1410 $7.00
B1311 $7.00 B1361 $7.00 B1411 $7.00
B1312 $7.00 B1362 $7.00 B1412 $7.00
B1313 $7.00 B1363 $7.00 B1413 $7.00
B1314 $7.00 B1364 $7.00 B1414 $7.00
B1315 $5.00 B1365 $7.00 B1415 $7.00
B1316 $7.00 B1366 $7.00 B1416 $7.00
B1317 $7.00 B1367 $7.00 B1417 $7.00
B1318 $7.00 B1368 $7.00 B1418 $7.00
B1319 $7.00 B1369 $7.00 B1419 $5.00
B1320 $5.00 B1370 $7.00 B1420 $7.00
B1321 $7.00 B1371 $5.00 B1421 $7.00
B1322 $7.00 B1372 $5.00 B1422 $7.00
B1323 $7.00 B1373 $7.00 B1423 $7.00
B1324 $7.00 B1374 $7.00 B1424 $7.00
B1325 $7.00 B1375 $7.00 B1425 $5.00
B1326 $7.00 B1376 $7.00 B1426 $7.00
B1327 $7.00 B1377 $7.00 B1427 $7.00
B1328 $7.00 B1378 $7.00 B1428 $7.00
B1329 $7.00 B1379 $7.00 B1429 $7.00
B1330 $7.00 B1380 $7.00 B1430 $7.00
B1331 $7.00 B1381 $7.00 B1431 $7.00
B1332 $7.00 B1382 $7.00 B1432 $7.00
B1333 $7.00 B1383 $7.00 B1433 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
23
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B1434 $7.00 B1597 $7.00 B1816 $7.00
B1435 $7.00 B1598 $7.00 B1817 $7.00
B1436 $7.00 B1599 $7.00 B1818 $7.00
B1437 $7.00 B1600 $7.00 B1819 $7.00
B1438 $7.00 B1601 $7.00 B1820 $7.00
B1439 $7.00 B1602 $7.00 B1821 $7.00
B1440 $7.00 B1603 $7.00 B1822 $7.00
B1441 $7.00 B1604 $7.00 B1823 $7.00
B1442 $7.00 B1609 $7.00 B1824 $7.00
B1443 $7.00 B1706 $5.00 B1825 $7.00
B1444 $7.00 B1707 $7.00 B1826 $7.00
B1445 $7.00 B1708 $7.00 B1827 $7.00
B1446 $7.00 B1709 $5.00 B1828 $7.00
B1447 $7.00 B1710 $5.00 B1829 $5.00
B1448 $7.00 B1711 $7.00 B1830 $7.00
B1449 $7.00 B1712 $5.00 B1831 $7.00
B1450 $7.00 B1713 $7.00 B1832 $7.00
B1451 $5.00 B1715 $7.00 B1833 $7.00
B1452 $7.00 B1716 $7.00 B1834 $7.00
B1453 $7.00 B1718 $10.00 B1835 $7.00
B1454 $7.00 B1719 $5.00 B1836 $7.00
B1455 $7.00 B1720 $7.00 B1837 $7.00
B1456 $7.00 B1721 $5.00 B1839 $7.00
B1457 $7.00 B1722 $7.00 B1840 $7.00
B1458 $7.00 B1723 $7.00 B1841 $7.00
B1459 $7.00 B1724 $5.00 B1842 $7.00
B1460 $7.00 B1725 $7.00 B1843 $7.00
B1461 $7.00 B1726 $5.00 B1844 $7.00
B1462 $7.00 B1727 $5.00 B1845 $7.00
B1463 $7.00 B1728 $7.00 B1846 $7.00
B1464 $7.00 B1733 $7.00 B1847 $7.00
B1465 $7.00 B1734 $7.00 B1848 $7.00
B1466 $7.00 B1735 $7.00 B1849 $7.00
B1467 $7.00 B1736 $7.00 B1850 $7.00
B1468 $7.00 B1737 $7.00 B1851 $7.00
B1469 $7.00 B1738 $7.00 B1853 $7.00
B1470 $7.00 B1739 $7.00 B1854 $7.00
B1471 $7.00 B1740 $7.00 B1857 $7.00
B1472 $7.00 B1741 $7.00 B1858 $7.00
B1473 $7.00 B1742 $7.00 B1860 $7.00
B1474 $7.00 B1743 $7.00 B1861 $7.00
B1475 $7.00 B1744 $7.00 B1862 $7.00
B1574 $7.00 B1745 $7.00 B1863 $7.00
B1575 $7.00 B1746 $7.00 B1867 $7.00
B1576 $7.00 B1753 $7.00 B1870 $7.00
B1592 $7.00 B1754 $7.00 B1872 $7.00
B1593 $7.00 B1760 $5.00 B1875 $7.00
B1594 $5.00 B1761 $7.00 B1876 $7.00
B1595 $7.00 B1814 $5.00 B1878 $7.00
B1596 $7.00 B1815 $7.00 B1879 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
24
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B1881 $7.00 B1948 $7.00 B1998 $7.00
B1882 $10.00 B1949 $7.00 B1999 $7.00
B1883 $7.00 B1950 $7.00 B2000 $7.00
B1884 $7.00 B1951 $7.00 B2001 $7.00
B1886 $7.00 B1952 $7.00 B2002 $7.00
B1887 $7.00 B1953 $7.00 B2003 $7.00
B1888 $7.00 B1954 $7.00 B2004 $7.00
B1890 $7.00 B1955 $7.00 B2005 $7.00
B1891 $7.00 B1956 $7.00 B2006 $7.00
B1906 $7.00 B1957 $7.00 B2007 $7.00
B1907 $5.00 B1958 $7.00 B2008 $7.00
B1908 $7.00 B1959 $7.00 B2009 $7.00
B1909 $7.00 B1960 $7.00 B2010 $7.00
B1910 $7.00 B1961 $7.00 B2011 $7.00
B1911 $7.00 B1962 $7.00 B2012 $7.00
B1912 $7.00 B1963 $7.00 B2013 $7.00
B1913 $5.00 B1964 $7.00 B2014 $7.00
B1914 $7.00 B1965 $7.00 B2015 $7.00
B1915 $7.00 B1966 $7.00 B2016 $7.00
B1916 $7.00 B1967 $7.00 B2017 $7.00
B1917 $7.00 B1968 $7.00 B2018 $7.00
B1918 $7.00 B1969 $7.00 B2019 $7.00
B1919 $7.00 B1970 $7.00 B2020 $7.00
B1920 $7.00 B1971 $7.00 B2021 $7.00
B1921 $7.00 B1972 $7.00 B2022 $7.00
B1922 $7.00 B1973 $7.00 B2023 $7.00
B1923 $7.00 B1974 $7.00 B2024 $7.00
B1924 $7.00 B1975 $7.00 B2025 $7.00
B1925 $7.00 B1976 $7.00 B2026 $7.00
B1926 $7.00 B1977 $7.00 B2027 $7.00
B1927 $7.00 B1978 $7.00 B2028 $7.00
B1929 $7.00 B1979 $7.00 B2029 $7.00
B1930 $7.00 B1980 $7.00 B2030 $7.00
B1931 $7.00 B1981 $7.00 B2031 $7.00
B1932 $7.00 B1982 $7.00 B2032 $7.00
B1933 $7.00 B1983 $7.00 B2033 $7.00
B1934 $7.00 B1984 $10.00 B2034 $7.00
B1935 $7.00 B1985 $7.00 B2035 $7.00
B1936 $7.00 B1986 $7.00 B2036 $7.00
B1937 $5.00 B1987 $7.00 B2037 $7.00
B1938 $7.00 B1988 $7.00 B2038 $7.00
B1939 $7.00 B1989 $7.00 B2039 $7.00
B1940 $7.00 B1990 $7.00 B2040 $7.00
B1941 $7.00 B1991 $7.00 B2041 $7.00
B1942 $7.00 B1992 $7.00 B2042 $7.00
B1943 $7.00 B1993 $7.00 B2043 $7.00
B1944 $7.00 B1994 $7.00 B2044 $7.00
B1945 $7.00 B1995 $7.00 B2045 $7.00
B1946 $7.00 B1996 $7.00 B2046 $7.00
B1947 $7.00 B1997 $7.00 B2047 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
25
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2048 $7.00 B2098 $7.00 B2148 $7.00
B2049 $7.00 B2099 $7.00 B2149 $7.00
B2050 $7.00 B2100 $5.00 B2150 $5.00
B2051 $7.00 B2101 $7.00 B2151 $5.00
B2052 $7.00 B2102 $7.00 B2152 $5.00
B2053 $7.00 B2103 $10.00 B2153 N/C
B2054 $7.00 B2104 $7.00 B2154 $5.00
B2055 $7.00 B2105 $7.00 B2155 $7.00
B2056 $7.00 B2106 $7.00 B2156 $7.00
B2057 $7.00 B2107 $10.00 B2157 $7.00
B2058 $7.00 B2108 N/C B2158 $5.00
B2059 $7.00 B2109 $7.00 B2159 $5.00
B2060 $7.00 B2110 $7.00 B2160 $7.00
B2061 $7.00 B2111 $5.00 B2161 N/C
B2062 $7.00 B2112 $7.00 B2162 $7.00
B2063 $5.00 B2113 $7.00 B2163 $7.00
B2064 $5.00 B2114 $7.00 B2164 $5.00
B2065 $5.00 B2115 $7.00 B2165 $5.00
B2066 $7.00 B2116 $10.00 B2166 $7.00
B2067 $7.00 B2117 $7.00 B2167 $7.00
B2068 $7.00 B2118 $7.00 B2168 $7.00
B2069 $7.00 B2119 $7.00 B2169 $7.00
B2070 $5.00 B2120 $7.00 B2170 $7.00
B2071 $7.00 B2121 $7.00 B2171 $7.00
B2072 $7.00 B2122 $5.00 B2172 $7.00
B2073 $5.00 B2123 $5.00 B2173 $7.00
B2074 $7.00 B2124 $7.00 B2174 $7.00
B2075 $7.00 B2125 $5.00 B2175 $7.00
B2076 $7.00 B2126 $7.00 B2176 $7.00
B2077 $5.00 B2127 $7.00 B2177 $7.00
B2078 $7.00 B2128 $7.00 B2178 $7.00
B2079 $7.00 B2129 $7.00 B2179 $7.00
B2080 $7.00 B2130 $7.00 B2180 $7.00
B2081 $7.00 B2131 $5.00 B2181 $7.00
B2082 $7.00 B2132 $5.00 B2182 $7.00
B2083 $7.00 B2133 $7.00 B2183 $7.00
B2084 $5.00 B2134 N/C B2184 $7.00
B2085 $5.00 B2135 N/C B2185 $7.00
B2086 $7.00 B2136 $7.00 B2186 $7.00
B2087 $5.00 B2137 $15.00 B2187 $7.00
B2088 $7.00 B2138 $7.00 B2188 $7.00
B2089 $7.00 B2139 $10.00 B2189 $7.00
B2090 $5.00 B2140 $7.00 B2190 $7.00
B2091 $7.00 B2141 $8.00 B2191 $7.00
B2092 $7.00 B2142 $8.00 B2192 $7.00
B2093 $5.00 B2143 $8.00 B2193 $7.00
B2094 $5.00 B2144 $8.00 B2194 $7.00
B2095 $5.00 B2145 $8.00 B2195 $7.00
B2096 $5.00 B2146 $8.00 B2196 $7.00
B2097 $7.00 B2147 $7.00 B2197 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
26
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2198 $7.00 B2248 $7.00 B2298 $10.00
B2199 $7.00 B2249 $7.00 B2299 $5.00
B2200 $7.00 B2250 $7.00 B2300 $5.00
B2201 $7.00 B2251 $7.00 B2301 $10.00
B2202 $7.00 B2252 $7.00 B2302 $5.00
B2203 $5.00 B2253 $5.00 B2303 $5.00
B2204 $7.00 B2254 $5.00 B2304 $5.00
B2205 $8.00 B2255 $5.00 B2305 $7.00
B2206 $7.00 B2256 $5.00 B2306 $7.00
B2207 $7.00 B2257 $7.00 B2307 $10.00
B2208 $7.00 B2258 $7.00 B2308 $7.00
B2209 $7.00 B2259 $5.00 B2309 $7.00
B2210 $7.00 B2260 $5.00 B2310 $10.00
B2211 $7.00 B2261 $7.00 B2311 $5.00
B2212 $7.00 B2262 $10.00 B2312 $5.00
B2213 $7.00 B2263 $7.00 B2313 $7.00
B2214 $7.00 B2264 $7.00 B2315 $7.00
B2215 $7.00 B2265 $7.00 B2316 $7.00
B2216 $7.00 B2266 $7.00 B2317 $5.00
B2217 $7.00 B2267 $7.00 B2318 $7.00
B2218 $7.00 B2268 $7.00 B2319 $7.00
B2219 $7.00 B2269 $7.00 B2320 $7.00
B2220 $7.00 B2270 $7.00 B2321 $5.00
B2221 $7.00 B2271 $7.00 B2322 $7.00
B2222 $7.00 B2272 $5.00 B2323 $7.00
B2223 $7.00 B2273 $7.00 B2324 N/C
B2224 $7.00 B2274 $5.00 B2325 N/C
B2225 $7.00 B2275 $5.00 B2326 $7.00
B2226 $7.00 B2276 $5.00 B2327 $5.00
B2227 $7.00 B2277 $10.00 B2328 $5.00
B2228 $7.00 B2278 $10.00 B2329 $7.00
B2229 $7.00 B2279 $10.00 B2330 $10.00
B2230 $7.00 B2280 $5.00 B2331 $7.00
B2231 N/C B2281 $5.00 B2332 $7.00
B2232 $7.00 B2282 $7.00 B2333 $7.00
B2233 $7.00 B2283 $7.00 B2334 N/C
B2234 $7.00 B2284 $7.00 B2335 N/C
B2235 $7.00 B2285 $5.00 B2336 $7.00
B2236 $7.00 B2286 $0.00 B2337 $5.00
B2237 $7.00 B2287 $5.00 B2338 $5.00
B2238 $7.00 B2288 $7.00 B2339 $5.00
B2239 $7.00 B2289 $10.00 B2340 $7.00
B2240 $7.00 B2290 $5.00 B2341 $5.00
B2241 $7.00 B2291 $5.00 B2342 $5.00
B2242 $7.00 B2292 $5.00 B2343 $7.00
B2243 $7.00 B2293 $7.00 B2344 $7.00
B2244 $7.00 B2294 $10.00 B2345 $5.00
B2245 $7.00 B2295 $5.00 B2346 $7.00
B2246 $7.00 B2296 $5.00 B2347 $5.00
B2247 $7.00 B2297 $10.00 B2348 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
27
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2349 $7.00 B2399 $7.00 B2449 $5.00
B2350 $5.00 B2400 $5.00 B2450 $5.00
B2351 $5.00 B2401 $5.00 B2451 $12.00
B2352 $5.00 B2402 $7.00 B2452 $7.00
B2353 $5.00 B2403 $7.00 B2453 $7.00
B2354 N/C B2404 $5.00 B2454 $5.00
B2355 $7.00 B2405 $5.00 B2455 $15.00
B2356 $7.00 B2406 $7.00 B2456 $7.00
B2357 $7.00 B2407 $5.00 B2457 $7.00
B2358 $7.00 B2408 N/C B2458 $7.00
B2359 $10.00 B2409 N/C B2459 $7.00
B2360 N/C B2410 $7.00 B2460 $7.00
B2361 $7.00 B2411 $10.00 B2461 $10.00
B2362 $7.00 B2412 $15.00 B2462 $7.00
B2363 $7.00 B2413 $7.00 B2463 $5.00
B2364 $5.00 B2414 $7.00 B2464 $5.00
B2365 $7.00 B2415 $5.00 B2465 $7.00
B2366 $7.00 B2416 $7.00 B2466 $5.00
B2367 $7.00 B2417 $7.00 B2467 $5.00
B2368 $7.00 B2418 $7.00 B2468 $7.00
B2369 $5.00 B2419 $5.00 B2469 $7.00
B2370 $7.00 B2420 N/C B2470 $7.00
B2371 $5.00 B2421 $5.00 B2471 $7.00
B2372 $7.00 B2422 N/C B2472 $7.00
B2373 $7.00 B2423 N/C B2473 $7.00
B2374 $7.00 B2424 $20.00 B2474 $5.00
B2375 $5.00 B2425 $5.00 B2475 $5.00
B2376 $5.00 B2426 $7.00 B2476 $7.00
B2377 $5.00 B2427 $7.00 B2477 N/C
B2378 $7.00 B2428 $7.00 B2478 $7.00
B2379 $7.00 B2429 $7.00 B2479 $7.00
B2380 $7.00 B2430 $7.00 B2480 $7.00
B2381 $5.00 B2431 $7.00 B2481 $7.00
B2382 $8.00 B2432 $7.00 B2482 $7.00
B2383 $8.00 B2433 $7.00 B2483 $5.00
B2384 $7.00 B2434 $7.00 B2484 $7.00
B2385 $5.00 B2435 $7.00 B2485 $7.00
B2386 $7.00 B2436 $7.00 B2486 $5.00
B2387 $5.00 B2437 $7.00 B2487 $5.00
B2388 $5.00 B2438 $7.00 B2488 $5.00
B2389 $7.00 B2439 $7.00 B2489 $5.00
B2390 $7.00 B2440 $7.00 B2490 $7.00
B2391 $7.00 B2441 $7.00 B2491 $7.00
B2392 N/C B2442 $7.00 B2492 $5.00
B2393 $15.00 B2443 $7.00 B2493 $5.00
B2394 $10.00 B2444 N/C B2494 $5.00
B2395 $10.00 B2445 $7.00 B2495 $7.00
B2396 $7.00 B2446 $7.00 B2496 $8.00
B2397 $7.00 B2447 $5.00 B2497 $5.00
B2398 $20.00 B2448 $5.00 B2498 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
28
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2499 $7.00 B2549 $5.00 B2599 $7.00
B2500 $5.00 B2550 $5.00 B2600 $7.00
B2501 $7.00 B2551 $5.00 B2601 $7.00
B2502 $5.00 B2552 $5.00 B2602 $7.00
B2503 $5.00 B2553 $5.00 B2603 $7.00
B2504 $10.00 B2554 $7.00 B2604 $7.00
B2505 $7.00 B2555 $7.00 B2605 $7.00
B2506 $5.00 B2556 $7.00 B2606 $7.00
B2507 $5.00 B2557 $7.00 B2607 $7.00
B2508 $5.00 B2558 $5.00 B2608 $7.00
B2509 $5.00 B2559 $7.00 B2609 $7.00
B2510 $7.00 B2560 $7.00 B2610 $7.00
B2511 $5.00 B2561 $7.00 B2611 $7.00
B2512 $7.00 B2562 $7.00 B2612 $7.00
B2513 $7.00 B2563 $5.00 B2613 $7.00
B2514 $7.00 B2564 $5.00 B2614 $7.00
B2515 $5.00 B2565 N/C B2615 $7.00
B2516 $5.00 B2566 $7.00 B2616 $7.00
B2517 $0.00 B2567 $7.00 B2617 $7.00
B2518 $10.00 B2568 $7.00 B2618 $7.00
B2519 $7.00 B2569 $7.00 B2619 $5.00
B2520 $5.00 B2570 $7.00 B2620 $7.00
B2521 $7.00 B2571 N/C B2621 $7.00
B2522 $0.00 B2572 $7.00 B2622 $5.00
B2523 $7.00 B2573 $7.00 B2623 $7.00
B2524 $5.00 B2574 $7.00 B2624 $7.00
B2525 $5.00 B2575 $5.00 B2625 $7.00
B2526 $5.00 B2576 $7.00 B2626 $7.00
B2527 $5.00 B2577 $7.00 B2627 $7.00
B2528 $5.00 B2578 $7.00 B2628 $7.00
B2529 N/C B2579 $7.00 B2629 $7.00
B2530 N/C B2580 $7.00 B2630 $5.00
B2531 $7.00 B2581 $7.00 B2631 $7.00
B2532 $5.00 B2582 $7.00 B2632 $5.00
B2533 $7.00 B2583 $7.00 B2633 $7.00
B2534 $7.00 B2584 $5.00 B2634 $7.00
B2535 $7.00 B2585 $7.00 B2635 $7.00
B2536 $7.00 B2586 $7.00 B2636 $10.00
B2537 $5.00 B2587 $7.00 B2637 $7.00
B2538 $7.00 B2588 $7.00 B2638 N/C
B2539 $5.00 B2589 $7.00 B2639 $7.00
B2540 $5.00 B2590 $7.00 B2640 $5.00
B2541 $7.00 B2591 $7.00 B2641 $7.00
B2542 $7.00 B2592 $7.00 B2642 $5.00
B2543 N/C B2593 $7.00 B2643 $7.00
B2544 $7.00 B2594 $7.00 B2644 $7.00
B2545 $7.00 B2595 $7.00 B2645 $7.00
B2546 $7.00 B2596 $7.00 B2646 $7.00
B2547 $7.00 B2597 $7.00 B2647 $7.00
B2548 $10.00 B2598 $7.00 B2648 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
29
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2649 $7.00 B2699 $5.00 B2749 $5.00
B2650 $5.00 B2700 $5.00 B2750 $12.00
B2651 $7.00 B2701 $7.00 B2751 $15.00
B2652 $7.00 B2702 $7.00 B2752 $12.00
B2653 $7.00 B2703 $10.00 B2753 $15.00
B2654 $7.00 B2704 $7.00 B2754 $10.00
B2655 $7.00 B2705 $5.00 B2755 $5.00
B2656 $7.00 B2706 $2.00 B2756 $5.00
B2657 $7.00 B2707 $7.00 B2757 $5.00
B2658 $7.00 B2708 $7.00 B2758 $5.00
B2659 $7.00 B2709 $7.00 B2759 $5.00
B2660 $10.00 B2710 $10.00 B2760 $5.00
B2661 $7.00 B2711 $10.00 B2761 $7.00
B2662 $7.00 B2712 $10.00 B2762 $5.00
B2663 $5.00 B2713 N/C B2763 $7.00
B2664 $5.00 B2714 $7.00 B2764 $5.00
B2665 $7.00 B2715 $5.00 B2765 $7.00
B2666 $7.00 B2716 $7.00 B2766 $7.00
B2667 $7.00 B2717 $7.00 B2767 $7.00
B2668 $5.00 B2718 $5.00 B2768 $5.00
B2669 $7.00 B2719 $10.00 B2769 $7.00
B2670 $7.00 B2720 $7.00 B2770 $7.00
B2671 $7.00 B2721 $7.00 B2771 $7.00
B2672 N/C B2722 $5.00 B2772 $7.00
B2673 $7.00 B2723 $5.00 B2773 $7.00
B2674 $7.00 B2724 $5.00 B2774 $7.00
B2675 $5.00 B2725 $5.00 B2775 N/C
B2676 $7.00 B2726 $5.00 B2776 N/C
B2677 $8.00 B2727 $5.00 B2777 N/C
B2678 $5.00 B2728 $5.00 B2778 N/C
B2679 $7.00 B2729 $5.00 B2779 $7.00
B2680 $10.00 B2730 $5.00 B2780 $7.00
B2681 $7.00 B2731 $0.00 B2781 $7.00
B2682 $7.00 B2732 $7.00 B2782 $5.00
B2683 $7.00 B2733 N/C B2783 $7.00
B2684 $7.00 B2734 $10.00 B2784 $7.00
B2685 $10.00 B2735 $5.00 B2785 $7.00
B2686 $10.00 B2736 $7.00 B2786 $8.00
B2687 $5.00 B2737 $5.00 B2787 $5.00
B2688 $5.00 B2738 $5.00 B2788 $8.00
B2689 $5.00 B2739 $5.00 B2789 $7.00
B2690 $7.00 B2740 $7.00 B2790 $7.00
B2691 $7.00 B2741 $7.00 B2791 $2.00
B2692 $7.00 B2742 $10.00 B2792 $2.00
B2693 $7.00 B2743 $10.00 B2793 $7.00
B2694 $10.00 B2744 $10.00 B2794 $5.00
B2695 $10.00 B2745 $10.00 B2795 $7.00
B2696 $7.00 B2746 $10.00 B2796 $7.00
B2697 $5.00 B2747 $5.00 B2797 $7.00
B2698 $7.00 B2748 $5.00 B2798 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
30
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2799 $7.00 B2849 $7.00 B2899 $7.00
B2800 $7.00 B2850 $7.00 B2900 $7.00
B2801 $7.00 B2851 $7.00 B2901 $10.00
B2802 $7.00 B2852 $7.00 B2902 $10.00
B2803 $7.00 B2853 $7.00 B2903 $7.00
B2804 $7.00 B2854 $7.00 B2904 $7.00
B2805 $7.00 B2855 $7.00 B2905 $7.00
B2806 $7.00 B2856 $7.00 B2906 $10.00
B2807 $5.00 B2857 $5.00 B2907 $7.00
B2808 $7.00 B2858 $5.00 B2908 $7.00
B2809 $7.00 B2859 N/C B2909 $7.00
B2810 $7.00 B2860 N/C B2910 $7.00
B2811 $10.00 B2861 $7.00 B2911 $7.00
B2812 $7.00 B2862 $7.00 B2912 $7.00
B2813 $7.00 B2863 $10.00 B2913 $7.00
B2814 $7.00 B2864 $10.00 B2914 $7.00
B2815 $7.00 B2865 $10.00 B2915 $7.00
B2816 $7.00 B2866 $7.00 B2916 $7.00
B2817 $7.00 B2867 $7.00 B2917 $7.00
B2818 $7.00 B2868 $7.00 B2918 $7.00
B2819 $7.00 B2869 $5.00 B2919 $7.00
B2820 $5.00 B2870 $7.00 B2920 $5.00
B2821 $5.00 B2871 $7.00 B2921 $7.00
B2822 $5.00 B2872 $7.00 B2922 $7.00
B2823 $7.00 B2873 $7.00 B2923 $7.00
B2824 $7.00 B2874 $7.00 B2924 $7.00
B2825 $7.00 B2875 $5.00 B2925 $7.00
B2826 $7.00 B2876 $5.00 B2926 $7.00
B2827 $5.00 B2877 $5.00 B2927 $7.00
B2828 $7.00 B2878 $7.00 B2928 $7.00
B2829 $5.00 B2879 $7.00 B2929 $7.00
B2830 $7.00 B2880 $8.00 B2930 $7.00
B2831 $7.00 B2881 $7.00 B2931 $7.00
B2832 $7.00 B2882 $7.00 B2932 $7.00
B2833 $7.00 B2883 $7.00 B2933 $7.00
B2834 $7.00 B2884 $12.00 B2934 $7.00
B2835 $7.00 B2885 $7.00 B2935 $7.00
B2836 $7.00 B2886 $7.00 B2936 $7.00
B2837 $7.00 B2887 $7.00 B2937 $7.00
B2838 $7.00 B2888 $7.00 B2938 $7.00
B2839 $7.00 B2889 $7.00 B2939 $7.00
B2840 $7.00 B2890 $7.00 B2940 $7.00
B2841 $7.00 B2891 $7.00 B2941 $7.00
B2842 $7.00 B2892 $7.00 B2942 $7.00
B2843 $7.00 B2893 $7.00 B2943 $7.00
B2844 $7.00 B2894 $5.00 B2944 $7.00
B2845 $7.00 B2895 $5.00 B2945 $5.00
B2846 $7.00 B2896 $7.00 B2946 $7.00
B2847 $7.00 B2897 $7.00 B2947 $5.00
B2848 $7.00 B2898 $7.00 B2948 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
31
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B2949 $7.00 B2999 $7.00 B3049 $7.00
B2950 $7.00 B3000 $5.00 B3050 $7.00
B2951 $5.00 B3001 $5.00 B3051 $7.00
B2952 $5.00 B3002 $5.00 B3052 $7.00
B2953 $5.00 B3003 $5.00 B3053 $5.00
B2954 $7.00 B3004 $7.00 B3054 $7.00
B2955 $7.00 B3005 $7.00 B3055 $5.00
B2956 $7.00 B3006 $7.00 B3056 $5.00
B2957 $7.00 B3007 $7.00 B3057 $5.00
B2958 $7.00 B3008 $7.00 B3058 $7.00
B2959 $7.00 B3009 $5.00 B3059 $7.00
B2960 $7.00 B3010 $5.00 B3060 $7.00
B2961 $7.00 B3011 $5.00 B3061 $7.00
B2962 $7.00 B3012 $7.00 B3062 $15.00
B2963 $7.00 B3013 $5.00 B3063 NADA
B2964 $7.00 B3014 $5.00 B3064 NADA
B2965 $7.00 B3015 NADA B3065 NADA
B2966 $7.00 B3016 $7.00 B3066 NADA
B2967 $7.00 B3017 $5.00 B3067 NADA
B2968 $7.00 B3018 $5.00 B3068 NADA
B2969 $7.00 B3019 NADA B3069 $5.00
B2970 $7.00 B3020 $5.00 B3070 $5.00
B2971 $7.00 B3021 $5.00 B3071 $5.00
B2972 $5.00 B3022 $0.00 B3072 $7.00
B2973 $5.00 B3023 $5.00 B3073 $7.00
B2974 $5.00 B3024 $5.00 B3074 $5.00
B2975 $5.00 B3025 $5.00 B3075 $7.00
B2976 $10.00 B3026 $5.00 B3076 $5.00
B2977 $7.00 B3027 $5.00 B3077 $5.00
B2978 $5.00 B3028 $5.00 B3078 $10.00
B2979 $7.00 B3029 $5.00 B3079 $10.00
B2980 $5.00 B3030 $5.00 B3080 $15.00
B2981 $7.00 B3031 $5.00 B3081 $5.00
B2982 $7.00 B3032 $5.00 B3082 $7.00
B2983 $7.00 B3033 $7.00 B3083 $5.00
B2984 $5.00 B3034 NADA B3084 $7.00
B2985 $7.00 B3035 NADA B3085 $5.00
B2986 $7.00 B3036 $10.00 B3086 $0.00
B2987 $7.00 B3037 $10.00 B3087 $5.00
B2988 $5.00 B3038 $7.00 B3088 $5.00
B2989 $7.00 B3039 $7.00 B3089 $5.00
B2990 $7.00 B3040 $7.00 B3090 $5.00
B2991 $7.00 B3041 $7.00 B3091 $15.00
B2992 $5.00 B3042 $7.00 B3092 $5.00
B2993 $5.00 B3043 $7.00 B3093 $7.00
B2994 $5.00 B3044 $7.00 B3094 $5.00
B2995 NADA B3045 $7.00 B3095 NADA
B2996 $10.00 B3046 $7.00 B3096 NADA
B2997 $15.00 B3047 $7.00 B3097 $5.00
B2998 $7.00 B3048 $7.00 B3098 NADA
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
32
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3099 $10.00 B3149 NADA B3199 NADA
B3100 $12.00 B3150 $7.00 B3200 $5.00
B3101 $5.00 B3151 $7.00 B3201 $5.00
B3102 $5.00 B3152 $5.00 B3202 $10.00
B3103 $10.00 B3153 $5.00 B3203 $10.00
B3104 $7.00 B3154 $5.00 B3204 NADA
B3105 $7.00 B3155 $7.00 B3205 $5.00
B3106 $7.00 B3156 $7.00 B3206 $7.00
B3107 $10.00 B3157 $7.00 B3207 $5.00
B3108 $5.00 B3158 $10.00 B3208 $5.00
B3109 $7.00 B3159 $7.00 B3209 $5.00
B3110 $7.00 B3160 $5.00 B3210 $7.00
B3111 $10.00 B3161 $5.00 B3211 $7.00
B3112 $10.00 B3162 $7.00 B3212 $7.00
B3113 $5.00 B3163 $7.00 B3213 $7.00
B3114 $10.00 B3164 $7.00 B3214 NADA
B3115 $5.00 B3165 $7.00 B3215 $7.00
B3116 $10.00 B3166 $7.00 B3216 $10.00
B3117 $7.00 B3167 $7.00 B3217 $5.00
B3118 $5.00 B3168 $7.00 B3218 $7.00
B3119 $5.00 B3169 $7.00 B3219 NADA
B3120 NADA B3170 $7.00 B3220 NADA
B3121 NADA B3171 $7.00 B3221 $7.00
B3122 $5.00 B3172 $7.00 B3222 $7.00
B3123 $5.00 B3173 $7.00 B3223 $7.00
B3124 $7.00 B3174 $7.00 B3224 $7.00
B3125 $7.00 B3175 $7.00 B3225 $7.00
B3126 $7.00 B3176 $7.00 B3226 $7.00
B3127 $7.00 B3177 $7.00 B3227 $7.00
B3128 $7.00 B3178 $7.00 B3228 $7.00
B3129 $7.00 B3179 $7.00 B3229 NADA
B3130 $15.00 B3180 $7.00 B3230 $5.00
B3131 $10.00 B3181 $7.00 B3231 $5.00
B3132 $10.00 B3182 $7.00 B3232 $5.00
B3133 $7.00 B3183 $7.00 B3233 $10.00
B3134 $6.50 B3184 $7.00 B3234 $5.00
B3135 $6.50 B3185 $7.00 B3235 $10.00
B3136 NADA B3186 $7.00 B3236 $10.00
B3137 $10.00 B3187 $7.00 B3237 $10.00
B3138 $10.00 B3188 $7.00 B3238 $7.00
B3139 NADA B3189 $7.00 B3239 $10.00
B3140 NADA B3190 $7.00 B3240 $7.00
B3141 NADA B3191 $7.00 B3241 $7.00
B3142 NADA B3192 $7.00 B3242 $7.00
B3143 NADA B3193 $7.00 B3243 $10.00
B3144 $7.00 B3194 $7.00 B3244 $7.00
B3145 $7.00 B3195 $7.00 B3245 NADA
B3146 $15.00 B3196 $7.00 B3246 $7.00
B3147 $10.00 B3197 $7.00 B3247 $7.00
B3148 $7.00 B3198 $7.00 B3248 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
33
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3249 NADA B3299 $7.00 B3349 $7.00
B3250 $7.00 B3300 $7.00 B3350 $7.00
B3251 $7.00 B3301 $5.00 B3351 $15.00
B3252 $7.00 B3302 $7.00 B3352 $20.00
B3253 $7.00 B3303 $7.00 B3353 $7.00
B3254 $7.00 B3304 $7.00 B3354 $7.00
B3255 $7.00 B3305 $7.00 B3355 $5.00
B3256 NADA B3306 $7.00 B3356 $5.00
B3257 $5.00 B3307 $7.00 B3357 $10.00
B3258 $7.00 B3308 $7.00 B3358 $10.00
B3259 $5.00 B3309 $5.00 B3359 $7.00
B3260 $7.00 B3310 NADA B3360 $7.00
B3261 $7.00 B3311 $5.00 B3361 $5.00
B3262 $5.00 B3312 $5.00 B3362 $7.00
B3263 $5.00 B3313 $5.00 B3363 $20.00
B3264 $7.00 B3314 $5.00 B3364 $10.00
B3265 $7.00 B3315 $5.00 B3365 NADA
B3266 $5.00 B3316 NADA B3366 NADA
B3267 $5.00 B3317 $5.00 B3367 $7.00
B3268 NADA B3318 $5.00 B3368 $7.00
B3269 $7.00 B3319 $7.00 B3369 $7.00
B3270 $10.00 B3320 $7.00 B3370 $5.00
B3271 $7.00 B3321 $7.00 B3371 $7.00
B3272 $7.00 B3322 $7.00 B3372 $7.00
B3273 $7.00 B3323 $7.00 B3373 $7.00
B3274 $7.00 B3324 $7.00 B3374 $7.00
B3275 $7.00 B3325 $7.00 B3375 $7.00
B3276 $7.00 B3326 $7.00 B3376 $7.00
B3277 $7.00 B3327 NADA B3377 $7.00
B3278 $10.00 B3328 $7.00 B3378 $7.00
B3279 $10.00 B3329 $7.00 B3379 $7.00
B3280 $10.00 B3330 $5.00 B3380 $7.00
B3281 $7.00 B3331 $5.00 B3381 $7.00
B3282 $7.00 B3332 NADA B3382 $7.00
B3283 $7.00 B3333 $5.00 B3383 $7.00
B3284 $10.00 B3334 $7.00 B3384 $7.00
B3285 $7.00 B3335 $7.00 B3385 $7.00
B3286 $10.00 B3336 $7.00 B3386 $15.00
B3287 $7.00 B3337 $7.00 B3387 $5.00
B3288 $7.00 B3338 $7.00 B3388 $5.00
B3289 $7.00 B3339 $7.00 B3389 $5.00
B3290 $7.00 B3340 $7.00 B3390 $7.00
B3291 $7.00 B3341 $7.00 B3391 $7.00
B3292 NADA B3342 $7.00 B3392 $7.00
B3293 $7.00 B3343 $7.00 B3393 $7.00
B3294 $7.00 B3344 $7.00 B3394 $10.00
B3295 $7.00 B3345 $7.00 B3395 $7.00
B3296 $5.00 B3346 $7.00 B3396 $7.00
B3297 $7.00 B3347 $5.00 B3397 $7.00
B3298 NADA B3348 $7.00 B3398 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
34
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3399 $20.00 B3449 $5.00 B3499 $7.00
B3400 $7.00 B3450 $7.00 B3500 $7.00
B3401 $5.00 B3451 $7.00 B3501 $7.00
B3402 $20.00 B3452 $7.00 B3502 $7.00
B3403 $20.00 B3453 $7.00 B3503 $7.00
B3404 $7.00 B3454 $7.00 B3504 $7.00
B3405 $7.00 B3455 $7.00 B3505 $7.00
B3406 $7.00 B3456 $7.00 B3506 $7.00
B3407 $7.00 B3457 $7.00 B3507 $7.00
B3408 $7.00 B3458 $7.00 B3508 $7.00
B3409 $20.00 B3459 $7.00 B3509 $7.00
B3410 $7.00 B3460 $7.00 B3510 $7.00
B3411 $7.00 B3461 $7.00 B3511 $7.00
B3412 $5.00 B3462 $7.00 B3512 $5.00
B3413 $5.00 B3463 NADA B3513 $7.00
B3414 $7.00 B3464 $7.00 B3514 $7.00
B3415 $7.00 B3465 $5.00 B3515 $7.00
B3416 $7.00 B3466 $10.00 B3516 $7.00
B3417 $7.00 B3467 $10.00 B3517 $7.00
B3418 $10.00 B3468 $7.00 B3518 $7.00
B3419 $7.00 B3469 $7.00 B3519 $7.00
B3420 $7.00 B3470 $7.00 B3520 $7.00
B3421 $5.00 B3471 $7.00 B3521 $7.00
B3422 $7.00 B3472 $7.00 B3522 $7.00
B3423 $7.00 B3473 $5.00 B3523 $7.00
B3424 $7.00 B3474 $10.00 B3524 $7.00
B3425 $7.00 B3475 $7.00 B3525 $7.00
B3426 $7.00 B3476 $7.00 B3526 $7.00
B3427 $10.00 B3477 $7.00 B3527 $7.00
B3428 $10.00 B3478 $7.00 B3528 $7.00
B3429 $10.00 B3479 NADA B3529 $7.00
B3430 $7.00 B3480 $7.00 B3530 $7.00
B3431 $7.00 B3481 $7.00 B3531 $5.00
B3432 $7.00 B3482 $10.00 B3532 $5.00
B3433 $7.00 B3483 $10.00 B3533 $5.00
B3434 $7.00 B3484 $10.00 B3534 $5.00
B3435 $7.00 B3485 $10.00 B3535 $5.00
B3436 $5.00 B3486 $10.00 B3536 $5.00
B3437 NADA B3487 $10.00 B3537 $5.00
B3438 NADA B3488 $7.00 B3538 $7.00
B3439 $5.00 B3489 $7.00 B3539 $10.00
B3440 $5.00 B3490 $10.00 B3540 $10.00
B3441 $5.00 B3491 $7.00 B3541 $10.00
B3442 $7.00 B3492 $7.00 B3542 $7.00
B3443 $7.00 B3493 $5.00 B3543 $5.00
B3444 $7.00 B3494 $5.00 B3544 $10.00
B3445 $7.00 B3495 $7.00 B3545 $7.00
B3446 $7.00 B3496 $7.00 B3546 $5.00
B3447 $7.00 B3497 $7.00 B3547 $10.00
B3448 $7.00 B3498 $5.00 B3548 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
35
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3549 $15.00 B3599 $7.00 B3650 $7.00
B3550 $15.00 B3600 $12.00 B3651 $7.00
B3551 $5.00 B3601 $12.00 B3652 $7.00
B3552 $5.00 B3602 $12.00 B3653 $7.00
B3553 $5.00 B3603 $12.00 B3654 $5.00
B3554 $5.00 B3604 $12.00 B3655 $7.00
B3555 $5.00 B3605 $7.00 B3656 $7.00
B3556 $7.00 B3606 $7.00 B3657 $7.00
B3557 $7.00 B3607 $5.00 B3658 $7.00
B3558 $7.00 B3609 $7.00 B3659 $7.00
B3559 $7.00 B3610 $10.00 B3660 $7.00
B3560 $8.00 B3611 $7.00 B3661 $7.00
B3561 $8.00 B3612 $7.00 B3662 $7.00
B3562 $7.00 B3613 $7.00 B3663 $7.00
B3563 $7.00 B3614 $7.00 B3664 $7.00
B3564 $7.00 B3615 $7.00 B3665 $7.00
B3565 $10.00 B3616 $7.00 B3666 $7.00
B3566 $7.00 B3617 $5.00 B3667 $5.00
B3567 $7.00 B3618 $7.00 B3668 $5.00
B3568 $7.00 B3619 $7.00 B3669 $5.00
B3569 $7.00 B3620 $7.00 B3670 $5.00
B3570 $5.00 B3621 $7.00 B3671 $7.00
B3571 $5.00 B3622 $7.00 B3672 $7.00
B3572 $5.00 B3623 $7.00 B3673 $7.00
B3573 $7.00 B3624 $7.00 B3674 $10.00
B3574 $7.00 B3625 $7.00 B3675 $7.00
B3575 $5.00 B3626 $7.00 B3676 $7.00
B3576 $5.00 B3627 $7.00 B3677 $7.00
B3577 $5.00 B3628 $7.00 B3678 $7.00
B3578 $8.00 B3629 $7.00 B3679 $7.00
B3579 $10.00 B3630 $7.00 B3680 $7.00
B3580 $5.00 B3631 $5.00 B3681 $7.00
B3581 $5.00 B3632 $5.00 B3682 $7.00
B3582 $10.00 B3633 $5.00 B3683 $7.00
B3583 $7.00 B3634 $5.00 B3684 $7.00
B3584 $10.00 B3635 $7.00 B3685 $7.00
B3585 $10.00 B3636 $7.00 B3686 $7.00
B3586 $10.00 B3637 $7.00 B3687 $12.00
B3587 $7.00 B3638 $7.00 B3688 $12.00
B3588 $7.00 B3639 $5.00 B3689 $5.00
B3589 $0.00 B3640 $7.00 B3690 $7.00
B3590 $10.00 B3641 $7.00 B3691 $7.00
B3591 $7.00 B3642 $7.00 B3692 $15.00
B3592 $7.00 B3643 $7.00 B3693 $7.00
B3593 $10.00 B3644 $7.00 B3694 $7.00
B3594 $7.00 B3645 $7.00 B3695 $7.00
B3595 $7.00 B3646 $7.00 B3696 $7.00
B3596 $7.00 B3647 $7.00 B3697 $7.00
B3597 $7.00 B3648 $7.00 B3698 $7.00
B3598 $7.00 B3649 $8.00 B3699 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
36
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3700 $7.00 B3750 $7.00 B3800 $7.00
B3701 $10.00 B3751 $7.00 B3801 $7.00
B3702 $7.00 B3752 $7.00 B3802 $7.00
B3703 $7.00 B3753 $7.00 B3803 $7.00
B3704 $7.00 B3754 $7.00 B3804 $7.00
B3705 $5.00 B3755 $7.00 B3805 $7.00
B3706 $7.00 B3756 $7.00 B3806 $7.00
B3707 $7.00 B3757 $7.00 B3807 $7.00
B3708 $12.00 B3758 $7.00 B3808 $7.00
B3709 $7.00 B3759 $7.00 B3809 $7.00
B3710 $7.00 B3760 $7.00 B3810 $7.00
B3711 $7.00 B3761 $7.00 B3811 $7.00
B3712 $7.00 B3762 $7.00 B3812 $7.00
B3713 $7.00 B3763 $7.00 B3813 $7.00
B3714 $7.00 B3764 $7.00 B3814 $7.00
B3715 $7.00 B3765 $7.00 B3815 $7.00
B3716 $5.00 B3766 $7.00 B3816 $7.00
B3717 $7.00 B3767 $7.00 B3817 $7.00
B3718 $7.00 B3768 $7.00 B3818 $7.00
B3719 $7.00 B3769 $5.00 B3819 $7.00
B3720 $7.00 B3770 $7.00 B3820 $7.00
B3721 $7.00 B3771 $7.00 B3821 $7.00
B3722 $10.00 B3772 $7.00 B3822 $7.00
B3723 $5.00 B3773 $7.00 B3823 $7.00
B3724 NADA B3774 $7.00 B3824 $7.00
B3725 $7.00 B3775 $7.00 B3825 $5.00
B3726 $5.00 B3776 $7.00 B3826 $5.00
B3727 $7.00 B3777 $7.00 B3827 $7.00
B3728 $7.00 B3778 $7.00 B3828 $7.00
B3729 $7.00 B3779 $7.00 B3829 $7.00
B3730 $7.00 B3780 $7.00 B3830 $7.00
B3731 $7.00 B3781 $7.00 B3831 $7.00
B3732 $7.00 B3782 $7.00 B3832 $7.00
B3733 $15.00 B3783 $7.00 B3833 $7.00
B3734 $7.00 B3784 $7.00 B3834 $7.00
B3735 $7.00 B3785 $7.00 B3835 $7.00
B3736 $7.00 B3786 $7.00 B3836 $7.00
B3737 $5.00 B3787 $7.00 B3837 $7.00
B3738 $7.00 B3788 $7.00 B3838 $7.00
B3739 $7.00 B3789 $7.00 B3839 $7.00
B3740 $7.00 B3790 $7.00 B3840 $7.00
B3741 $7.00 B3791 $7.00 B3841 $7.00
B3742 $7.00 B3792 $7.00 B3842 $7.00
B3743 $7.00 B3793 $7.00 B3843 $5.00
B3744 $7.00 B3794 $7.00 B3844 $7.00
B3745 $7.00 B3795 $7.00 B3845 $7.00
B3746 $5.00 B3796 $7.00 B3846 $7.00
B3747 $7.00 B3797 $7.00 B3847 $7.00
B3748 $7.00 B3798 $7.00 B3848 $7.00
B3749 $7.00 B3799 $7.00 B3849 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
37
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B3850 $7.00 B3900 NADA B3950 $7.00
B3851 $7.00 B3901 $7.00 B3951 $7.00
B3852 $7.00 B3902 $7.00 B3952 $7.00
B3853 $7.00 B3903 $7.00 B3953 $7.00
B3854 $7.00 B3904 $7.00 B3954 $7.00
B3855 $8.00 B3905 $7.00 B3955 $7.00
B3856 $8.00 B3906 $7.00 B3956 $7.00
B3857 $7.00 B3907 $7.00 B3957 $7.00
B3858 $7.00 B3908 $7.00 B3958 $7.00
B3859 $7.00 B3909 $7.00 B3959 $7.00
B3860 $7.00 B3910 $7.00 B3960 $7.00
B3861 $7.00 B3911 $7.00 B3961 $7.00
B3862 $7.00 B3912 $7.00 B3962 $7.00
B3863 $7.00 B3913 $7.00 B3963 $7.00
B3864 $7.00 B3914 $7.00 B3964 $7.00
B3865 $5.00 B3915 $7.00 B3965 $7.00
B3866 $7.00 B3916 $7.00 B3966 $7.00
B3867 $7.00 B3917 NADA B3967 $8.00
B3868 $7.00 B3918 $7.00 B3968 $7.00
B3869 $7.00 B3919 $7.00 B3969 $7.00
B3870 $7.00 B3920 $7.00 B3970 $7.00
B3871 $7.00 B3921 $7.00 B3971 $7.00
B3872 $7.00 B3922 $7.00 B3972 $7.00
B3873 $7.00 B3923 $7.00 B3973 $7.00
B3874 $7.00 B3924 $7.00 B3974 $7.00
B3875 $7.00 B3925 $7.00 B3975 $7.00
B3876 $7.00 B3926 $7.00 B3976 $7.00
B3877 $7.00 B3927 $7.00 B3977 $7.00
B3878 $7.00 B3928 $7.00 B3978 $7.00
B3879 $7.00 B3929 $7.00 B3979 $7.00
B3880 $7.00 B3930 $7.00 B3980 $7.00
B3881 $7.00 B3931 $7.00 B3981 $7.00
B3882 $7.00 B3932 $7.00 B3982 $7.00
B3883 $7.00 B3933 $7.00 B3983 $7.00
B3884 $7.00 B3934 $7.00 B3984 $7.00
B3885 $7.00 B3935 $7.00 B3985 $7.00
B3886 $7.00 B3936 $7.00 B3986 $7.00
B3887 $7.00 B3937 $7.00 B3987 $7.00
B3888 $7.00 B3938 $7.00 B3988 $7.00
B3889 $7.00 B3939 $7.00 B3989 $7.00
B3890 $7.00 B3940 $7.00 B3990 $7.00
B3891 $7.00 B3941 $7.00 B3991 $7.00
B3892 $7.00 B3942 $7.00 B3992 $7.00
B3893 $7.00 B3943 $7.00 B3993 $7.00
B3894 $7.00 B3944 $7.00 B3994 $5.00
B3895 $7.00 B3945 $7.00 B3995 $7.00
B3896 $7.00 B3946 $7.00 B3996 $7.00
B3897 $7.00 B3947 $7.00 B3997 $7.00
B3898 $7.00 B3948 $7.00 B3998 $7.00
B3899 NADA B3949 $7.00 B3999 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
38
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4000 $7.00 B4050 $5.00 B4100 $7.00
B4001 $7.00 B4051 $7.00 B4101 $7.00
B4002 $5.00 B4052 $5.00 B4102 $7.00
B4003 $7.00 B4053 $7.00 B4103 $7.00
B4004 $7.00 B4054 $7.00 B4104 $5.00
B4005 $7.00 B4055 $7.00 B4105 $7.00
B4006 $7.00 B4056 $7.00 B4106 $7.00
B4007 $7.00 B4057 $7.00 B4107 $10.00
B4008 $7.00 B4058 $7.00 B4108 $7.00
B4009 $7.00 B4059 $7.00 B4109 $7.00
B4010 $7.00 B4060 $7.00 B4110 $5.00
B4011 $7.00 B4061 $7.00 B4111 $7.00
B4012 $7.00 B4062 $7.00 B4112 $7.00
B4013 $7.00 B4063 $7.00 B4113 $7.00
B4014 $7.00 B4064 $7.00 B4114 $7.00
B4015 $5.00 B4065 $7.00 B4115 $7.00
B4016 $7.00 B4066 $7.00 B4116 $7.00
B4017 $7.00 B4067 $7.00 B4117 $7.00
B4018 $7.00 B4068 $7.00 B4118 $7.00
B4019 $7.00 B4069 $7.00 B4119 $10.00
B4020 $7.00 B4070 $7.00 B4120 $7.00
B4021 $2.00 B4071 $7.00 B4121 $7.00
B4022 NADA B4072 $7.00 B4122 $7.00
B4023 NADA B4073 $7.00 B4123 $7.00
B4024 $7.00 B4074 $7.00 B4124 $7.00
B4025 $5.00 B4075 $7.00 B4125 $7.00
B4026 $7.00 B4076 $7.00 B4126 $7.00
B4027 $7.00 B4077 $7.00 B4127 $5.00
B4028 $7.00 B4078 $7.00 B4128 $5.00
B4029 $7.00 B4079 $7.00 B4129 $5.00
B4030 $7.00 B4080 $7.00 B4130 $5.00
B4031 $5.00 B4081 $7.00 B4131 $7.00
B4032 $5.00 B4082 $7.00 B4132 $7.00
B4033 $5.00 B4083 $7.00 B4133 $7.00
B4034 $7.00 B4084 $7.00 B4134 $7.00
B4035 $7.00 B4085 $7.00 B4135 $7.00
B4036 $7.00 B4086 $7.00 B4136 $7.00
B4037 $7.00 B4087 $7.00 B4137 $7.00
B4038 $7.00 B4088 $7.00 B4138 $7.00
B4039 $7.00 B4089 $7.00 B4139 $7.00
B4040 $5.00 B4090 $7.00 B4140 $7.00
B4041 $7.00 B4091 $5.00 B4141 $7.00
B4042 $7.00 B4092 $5.00 B4142 $7.00
B4043 NADA B4093 $7.00 B4143 $7.00
B4044 NADA B4094 $7.00 B4144 $7.00
B4045 NADA B4095 $7.00 B4145 $7.00
B4046 $7.00 B4096 $7.00 B4146 $7.00
B4047 $7.00 B4097 $7.00 B4147 $7.00
B4048 $7.00 B4098 $7.00 B4148 $7.00
B4049 $5.00 B4099 $7.00 B4149 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
39
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4150 $7.00 B4200 $7.00 B4250 $7.00
B4151 $7.00 B4201 NADA B4251 $7.00
B4152 $7.00 B4202 $7.00 B4252 $10.00
B4153 $7.00 B4203 $5.00 B4253 $7.00
B4154 $7.00 B4204 $7.00 B4254 $7.00
B4155 $7.00 B4205 $7.00 B4255 $7.00
B4156 $7.00 B4206 $7.00 B4256 $7.00
B4157 $10.00 B4207 $7.00 B4257 $7.00
B4158 $7.00 B4208 $5.00 B4258 $7.00
B4159 $7.00 B4209 $7.00 B4259 $7.00
B4160 $7.00 B4210 $7.00 B4260 $7.00
B4161 $5.00 B4211 NADA B4261 $7.00
B4162 $7.00 B4212 $7.00 B4262 $7.00
B4163 $7.00 B4213 $7.00 B4263 $7.00
B4164 $7.00 B4214 $7.00 B4264 $7.00
B4165 $7.00 B4215 $7.00 B4265 $7.00
B4166 $5.00 B4216 $7.00 B4266 $7.00
B4167 $5.00 B4217 $7.00 B4267 $7.00
B4168 $7.00 B4218 $7.00 B4268 $7.00
B4169 $5.00 B4219 $5.00 B4269 $7.00
B4170 $7.00 B4220 $5.00 B4270 $7.00
B4171 $7.00 B4221 $7.00 B4271 $7.00
B4172 $7.00 B4222 $7.00 B4272 $7.00
B4173 $7.00 B4223 $5.00 B4273 $7.00
B4174 $7.00 B4224 $7.00 B4274 $7.00
B4175 $7.00 B4225 $7.00 B4275 $7.00
B4176 $7.00 B4226 $7.00 B4276 $7.00
B4177 $7.00 B4227 $7.00 B4277 $7.00
B4178 $7.00 B4228 $7.00 B4278 $7.00
B4179 $7.00 B4229 $7.00 B4279 $7.00
B4180 $7.00 B4230 $15.00 B4280 $7.00
B4181 $5.00 B4231 $7.00 B4281 $7.00
B4182 $7.00 B4232 $7.00 B4282 $7.00
B4183 $5.00 B4233 $7.00 B4283 $7.00
B4184 $7.00 B4234 $7.00 B4284 $7.00
B4185 $5.00 B4235 $7.00 B4285 $7.00
B4186 $5.00 B4236 $7.00 B4286 $7.00
B4187 $5.00 B4237 $7.00 B4287 $7.00
B4188 $7.00 B4238 $7.00 B4288 $7.00
B4189 $7.00 B4239 $7.00 B4289 $5.00
B4190 NADA B4240 $7.00 B4290 $7.00
B4191 $7.00 B4241 $7.00 B4291 $7.00
B4192 $7.00 B4242 $7.00 B4292 $7.00
B4193 $5.00 B4243 $7.00 B4293 $7.00
B4194 $10.00 B4244 $7.00 B4294 $7.00
B4195 $7.00 B4245 $7.00 B4295 $7.00
B4196 $5.00 B4246 $7.00 B4296 $7.00
B4197 $7.00 B4247 $7.00 B4297 $7.00
B4198 $7.00 B4248 $7.00 B4298 $5.00
B4199 $7.00 B4249 $7.00 B4299 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
40
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4300 $7.00 B4350 $7.00 B4400 $5.00
B4301 $7.00 B4351 $7.00 B4401 $7.00
B4302 $7.00 B4352 $7.00 B4402 $7.00
B4303 $7.00 B4353 $7.00 B4403 $5.00
B4304 $7.00 B4354 $7.00 B4404 $5.00
B4305 $7.00 B4355 $7.00 B4405 $7.00
B4306 $10.00 B4356 $7.00 B4406 $7.00
B4307 $7.00 B4357 $7.00 B4407 $7.00
B4308 $7.00 B4358 $5.00 B4408 $7.00
B4309 $7.00 B4359 $7.00 B4409 $7.00
B4310 $7.00 B4360 $7.00 B4410 $7.00
B4311 $10.00 B4361 $7.00 B4411 $7.00
B4312 $7.00 B4362 $7.00 B4412 NADA
B4313 $7.00 B4363 $7.00 B4413 $7.00
B4314 $7.00 B4364 NADA B4414 $7.00
B4315 $7.00 B4365 $7.00 B4415 $7.00
B4316 $7.00 B4366 $7.00 B4416 $7.00
B4317 $7.00 B4367 $7.00 B4417 $7.00
B4318 $7.00 B4368 $5.00 B4418 $7.00
B4319 $7.00 B4369 $5.00 B4419 $7.00
B4320 $7.00 B4370 $7.00 B4420 $7.00
B4321 NADA B4371 $5.00 B4421 $7.00
B4322 $7.00 B4372 $5.00 B4422 $7.00
B4323 $7.00 B4373 $5.00 B4423 $10.00
B4324 $7.00 B4374 $5.00 B4424 $5.00
B4325 $7.00 B4375 $5.00 B4425 $5.00
B4326 $7.00 B4376 $5.00 B4426 $5.00
B4327 $7.00 B4377 $5.00 B4427 $5.00
B4328 $7.00 B4378 $5.00 B4428 $5.00
B4329 $5.00 B4379 $5.00 B4429 $7.00
B4330 $7.00 B4380 NADA B4430 $7.00
B4331 $7.00 B4381 NADA B4431 $7.00
B4332 $7.00 B4382 $5.00 B4432 $7.00
B4333 $7.00 B4383 NADA B4433 $7.00
B4334 $7.00 B4384 $5.00 B4434 $5.00
B4335 $7.00 B4385 $5.00 B4435 $5.00
B4336 $7.00 B4386 NADA B4436 $7.00
B4337 $7.00 B4387 $5.00 B4437 $5.00
B4338 $7.00 B4388 $5.00 B4438 $7.00
B4339 $7.00 B4389 $5.00 B4439 $7.00
B4340 $7.00 B4390 $5.00 B4440 $5.00
B4341 $7.00 B4391 $7.00 B4441 $10.00
B4342 $7.00 B4392 $7.00 B4442 $7.00
B4343 $7.00 B4393 $7.00 B4443 $5.00
B4344 $7.00 B4394 $7.00 B4444 $5.00
B4345 $7.00 B4395 $7.00 B4445 $7.00
B4346 $7.00 B4396 $5.00 B4446 $10.00
B4347 NADA B4397 $5.00 B4447 $7.00
B4348 $7.00 B4398 $7.00 B4448 $7.00
B4349 $7.00 B4399 $5.00 B4449 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
41
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4450 $5.00 B4500 $8.00 B4550 $7.00
B4451 $10.00 B4501 $10.00 B4551 $7.00
B4452 $7.00 B4502 $5.00 B4552 $10.00
B4453 $5.00 B4503 $7.00 B4553 $5.00
B4454 $10.00 B4504 $5.00 B4554 $7.00
B4455 $7.00 B4505 $7.00 B4555 $5.00
B4456 $5.00 B4506 $7.00 B4556 $5.00
B4457 $7.00 B4507 $7.00 B4557 $5.00
B4458 $7.00 B4508 $7.00 B4558 $5.00
B4459 $7.00 B4509 $7.00 B4559 $5.00
B4460 $7.00 B4510 $7.00 B4560 $7.00
B4461 $7.00 B4511 $7.00 B4561 $7.00
B4462 $7.00 B4512 $7.00 B4562 $7.00
B4463 $5.00 B4513 $7.00 B4563 $5.00
B4464 $7.00 B4514 $7.00 B4564 $5.00
B4465 $7.00 B4515 $7.00 B4565 $7.00
B4466 $5.00 B4516 $7.00 B4566 $7.00
B4467 $7.00 B4517 $7.00 B4567 NADA
B4468 $7.00 B4518 $5.00 B4568 $5.00
B4469 $7.00 B4519 $7.00 B4569 $5.00
B4470 $10.00 B4520 $7.00 B4570 $5.00
B4471 $7.00 B4521 $5.00 B4571 $7.00
B4472 $7.00 B4522 $7.00 B4572 $7.00
B4473 $7.00 B4523 $7.00 B4573 $10.00
B4474 $7.00 B4524 $7.00 B4574 $10.00
B4475 $7.00 B4525 $7.00 B4575 $5.00
B4476 $7.00 B4526 $7.00 B4576 $5.00
B4477 $7.00 B4527 $7.00 B4577 $5.00
B4478 $7.00 B4528 $7.00 B4578 $5.00
B4479 $7.00 B4529 $7.00 B4579 $5.00
B4480 $7.00 B4530 $7.00 B4580 $5.00
B4481 $7.00 B4531 $7.00 B4581 $5.00
B4482 $7.00 B4532 $7.00 B4582 $7.00
B4483 $7.00 B4533 $7.00 B4583 $5.00
B4484 $7.00 B4534 $5.00 B4584 $7.00
B4485 $8.00 B4535 $7.00 B4585 NADA
B4486 $8.00 B4536 $7.00 B4586 $7.00
B4487 $7.00 B4537 $7.00 B4587 $7.00
B4488 $7.00 B4538 $7.00 B4588 $7.00
B4489 $7.00 B4539 $7.00 B4589 $5.00
B4490 $7.00 B4540 $7.00 B4590 $5.00
B4491 $7.00 B4541 $5.00 B4591 $5.00
B4492 $7.00 B4542 $7.00 B4592 $5.00
B4493 $7.00 B4543 $7.00 B4593 $7.00
B4494 $7.00 B4544 NADA B4594 $7.00
B4495 $10.00 B4545 $5.00 B4595 $5.00
B4496 $7.00 B4546 $5.00 B4596 $7.00
B4497 $7.00 B4547 $7.00 B4597 $7.00
B4498 $7.00 B4548 $7.00 B4598 $5.00
B4499 $7.00 B4549 $10.00 B4599 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
42
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4600 NADA B4650 $5.00 B4700 $10.00
B4601 $5.00 B4651 $5.00 B4701 $10.00
B4602 $7.00 B4652 $7.00 B4702 $5.00
B4603 $7.00 B4653 $7.00 B4703 $5.00
B4604 $5.00 B4654 $7.00 B4704 $7.00
B4605 $7.00 B4655 $7.00 B4705 $15.00
B4606 $7.00 B4656 $7.00 B4706 $7.00
B4607 $5.00 B4657 $5.00 B4707 $15.00
B4608 $7.00 B4658 $5.00 B4708 $7.00
B4609 $7.00 B4659 $5.00 B4709 $7.00
B4610 $5.00 B4660 $5.00 B4710 $7.00
B4611 $7.00 B4661 $7.00 B4711 $15.00
B4612 $7.00 B4662 $10.00 B4712 $7.00
B4613 $5.00 B4663 $7.00 B4713 $7.00
B4614 NADA B4664 $7.00 B4714 $5.00
B4615 $5.00 B4665 $5.00 B4715 $7.00
B4616 $7.00 B4666 $7.00 B4716 $7.00
B4617 $7.00 B4667 $7.00 B4717 $7.00
B4618 $7.00 B4668 $7.00 B4718 $7.00
B4619 $7.00 B4669 $7.00 B4719 $7.00
B4620 $7.00 B4670 $7.00 B4720 $15.00
B4621 $7.00 B4671 $5.00 B4721 $7.00
B4622 $7.00 B4672 $7.00 B4722 $7.00
B4623 $7.00 B4673 $7.00 B4723 $7.00
B4624 $7.00 B4674 $5.00 B4724 $7.00
B4625 $7.00 B4675 $7.00 B4725 $7.00
B4626 $7.00 B4676 $7.00 B4726 $7.00
B4627 $7.00 B4677 $7.00 B4727 $7.00
B4628 $5.00 B4678 $7.00 B4728 $15.00
B4629 $7.00 B4679 $7.00 B4729 $7.00
B4630 $7.00 B4680 $7.00 B4730 $7.00
B4631 $7.00 B4681 $7.00 B4731 $7.00
B4632 $7.00 B4682 $7.00 B4732 $7.00
B4633 $5.00 B4683 $5.00 B4733 $10.00
B4634 $7.00 B4684 $7.00 B4734 $7.00
B4635 $7.00 B4685 $7.00 B4735 $7.00
B4636 $7.00 B4686 $7.00 B4736 $7.00
B4637 $7.00 B4687 $15.00 B4737 $7.00
B4638 $7.00 B4688 $7.00 B4738 $7.00
B4639 $7.00 B4689 $7.00 B4739 $7.00
B4640 $7.00 B4690 $7.00 B4740 $7.00
B4641 $7.00 B4691 $7.00 B4741 $7.00
B4642 $7.00 B4692 $7.00 B4742 $7.00
B4643 $7.00 B4693 $10.00 B4743 $7.00
B4644 $7.00 B4694 $15.00 B4744 $7.00
B4645 $7.00 B4695 $10.00 B4745 $7.00
B4646 $5.00 B4696 $7.00 B4746 $7.00
B4647 $7.00 B4697 $15.00 B4747 $7.00
B4648 $7.00 B4698 $10.00 B4748 $7.00
B4649 $5.00 B4699 $15.00 B4749 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
43
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4750 $12.00 B4800 $15.00 B4850 $7.00
B4751 $15.00 B4801 $7.00 B4851 $7.00
B4752 $15.00 B4802 $7.00 B4852 $7.00
B4753 $7.00 B4803 $10.00 B4853 $7.00
B4754 $7.00 B4804 $10.00 B4854 $7.00
B4755 $7.00 B4805 $7.00 B4855 $7.00
B4756 $7.00 B4806 $20.00 B4856 $7.00
B4757 $7.00 B4807 $7.00 B4857 $5.00
B4758 $7.00 B4808 $7.00 B4858 $5.00
B4759 $7.00 B4809 $5.00 B4859 $5.00
B4760 $7.00 B4810 $12.00 B4860 $7.00
B4761 $7.00 B4811 $15.00 B4861 $7.00
B4762 $7.00 B4812 $7.00 B4862 $7.00
B4763 $7.00 B4813 $7.00 B4863 $7.00
B4764 $7.00 B4814 $7.00 B4864 $12.00
B4765 $7.00 B4815 $7.00 B4865 $5.00
B4766 $7.00 B4816 $7.00 B4866 $5.00
B4767 $7.00 B4817 $7.00 B4867 $5.00
B4768 $7.00 B4818 $7.00 B4868 $15.00
B4769 $7.00 B4819 $7.00 B4869 $7.00
B4770 $7.00 B4820 $7.00 B4870 $7.00
B4771 $7.00 B4821 $7.00 B4871 $7.00
B4772 $7.00 B4822 $7.00 B4872 $10.00
B4773 $7.00 B4823 $7.00 B4873 $10.00
B4774 $7.00 B4824 $7.00 B4874 $10.00
B4775 $7.00 B4825 $7.00 B4875 $10.00
B4776 $7.00 B4826 $7.00 B4876 $10.00
B4777 $7.00 B4827 $7.00 B4877 $12.00
B4778 $15.00 B4828 $7.00 B4878 $7.00
B4779 $7.00 B4829 $7.00 B4879 $7.00
B4780 $7.00 B4830 $7.00 B4880 $7.00
B4781 $7.00 B4831 $7.00 B4881 $7.00
B4782 $7.00 B4832 $7.00 B4882 $7.00
B4783 $7.00 B4833 $7.00 B4883 $5.00
B4784 $7.00 B4834 $7.00 B4884 $7.00
B4785 $7.00 B4835 $7.00 B4885 $7.00
B4786 $7.00 B4836 $20.00 B4886 $7.00
B4787 $5.00 B4837 NADA B4887 $7.00
B4788 $7.00 B4838 NADA B4888 $5.00
B4789 $7.00 B4839 $15.00 B4889 $7.00
B4790 $7.00 B4840 $7.00 B4890 $7.00
B4791 $7.00 B4841 $7.00 B4891 $7.00
B4792 $7.00 B4842 $7.00 B4892 $7.00
B4793 $7.00 B4843 $7.00 B4893 $7.00
B4794 $7.00 B4844 $7.00 B4894 $7.00
B4795 $7.00 B4845 $7.00 B4895 $7.00
B4796 $7.00 B4846 $7.00 B4896 $7.00
B4797 $7.00 B4847 $15.00 B4897 $7.00
B4798 $7.00 B4848 $12.00 B4898 $15.00
B4799 $7.00 B4849 $12.00 B4899 $12.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
44
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B4900 $7.00 B4950 $7.00 B5000 $7.00
B4901 $7.00 B4951 $7.00 B5001 $5.00
B4902 $7.00 B4952 $5.00 B5002 $5.00
B4903 $7.00 B4953 $7.00 B5003 $7.00
B4904 $5.00 B4954 $7.00 B5004 $7.00
B4905 $7.00 B4955 $7.00 B5005 $7.00
B4906 $7.00 B4956 $7.00 B5006 $15.00
B4907 $7.00 B4957 $7.00 B5007 $12.00
B4908 $7.00 B4958 $7.00 B5008 $5.00
B4909 $7.00 B4959 $7.00 B5009 $5.00
B4910 $7.00 B4960 $7.00 B5010 $7.00
B4911 $12.00 B4961 $7.00 B5011 $7.00
B4912 $7.00 B4962 $5.00 B5012 $15.00
B4913 $7.00 B4963 $5.00 B5013 $7.00
B4914 $7.00 B4964 $10.00 B5014 $7.00
B4915 $7.00 B4965 $10.00 B5015 $7.00
B4916 $7.00 B4966 $15.00 B5016 $7.00
B4917 $7.00 B4967 $7.00 B5017 $7.00
B4918 $7.00 B4968 $10.00 B5018 $12.00
B4919 $7.00 B4969 $5.00 B5019 $7.00
B4920 $7.00 B4970 $10.00 B5020 $7.00
B4921 NADA B4971 $10.00 B5021 $10.00
B4922 $7.00 B4972 $10.00 B5022 $5.00
B4923 $7.00 B4973 $7.00 B5023 $7.00
B4924 $5.00 B4974 $7.00 B5024 $10.00
B4925 $5.00 B4975 $7.00 B5025 $7.00
B4926 $5.00 B4976 $7.00 B5026 $7.00
B4927 $7.00 B4977 $7.00 B5027 $10.00
B4928 $7.00 B4978 $7.00 B5028 $7.00
B4929 $7.00 B4979 $7.00 B5029 $7.00
B4930 $7.00 B4980 $7.00 B5030 $10.00
B4931 $5.00 B4981 $7.00 B5031 $10.00
B4932 $7.00 B4982 $7.00 B5032 $10.00
B4933 $7.00 B4983 $7.00 B5033 $7.00
B4934 $10.00 B4984 $5.00 B5034 $10.00
B4935 $7.00 B4985 $7.00 B5035 $7.00
B4936 $7.00 B4986 $5.00 B5036 $7.00
B4937 $7.00 B4987 $7.00 B5037 $7.00
B4938 $7.00 B4988 $7.00 B5038 $7.00
B4939 $5.00 B4989 $7.00 B5039 $7.00
B4940 $12.00 B4990 $7.00 B5040 $7.00
B4941 $5.00 B4991 $7.00 B5041 $7.00
B4942 $12.00 B4992 $10.00 B5042 $7.00
B4943 $7.00 B4993 $7.00 B5043 $7.00
B4944 $7.00 B4994 $7.00 B5044 $7.00
B4945 $7.00 B4995 $7.00 B5045 $7.00
B4946 $7.00 B4996 $7.00 B5046 $7.00
B4947 $7.00 B4997 $7.00 B5047 $7.00
B4948 $7.00 B4998 $7.00 B5048 $7.00
B4949 $7.00 B4999 $7.00 B5049 $10.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
45
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5050 $7.00 B5100 $7.00 B5150 $7.00
B5051 $7.00 B5101 $7.00 B5151 $5.00
B5052 $7.00 B5102 $7.00 B5152 $7.00
B5053 $7.00 B5103 $5.00 B5153 $7.00
B5054 $7.00 B5104 $7.00 B5154 $7.00
B5055 $7.00 B5105 $7.00 B5155 $7.00
B5056 $7.00 B5106 $7.00 B5156 $7.00
B5057 $7.00 B5107 $10.00 B5157 $7.00
B5058 $12.00 B5108 $7.00 B5158 $7.00
B5059 $7.00 B5109 $7.00 B5159 $7.00
B5060 $5.00 B5110 $7.00 B5160 $7.00
B5061 $7.00 B5111 $10.00 B5161 $7.00
B5062 $5.00 B5112 $7.00 B5162 $7.00
B5063 $7.00 B5113 $7.00 B5163 $5.00
B5064 $7.00 B5114 $7.00 B5164 $5.00
B5065 $7.00 B5115 $7.00 B5165 $7.00
B5066 $7.00 B5116 $7.00 B5166 $7.00
B5067 $7.00 B5117 $7.00 B5167 $5.00
B5068 $7.00 B5118 $7.00 B5168 $7.00
B5069 $5.00 B5119 $7.00 B5169 $7.00
B5070 $5.00 B5120 $5.00 B5170 $7.00
B5071 $5.00 B5121 $7.00 B5171 $5.00
B5072 $7.00 B5122 $7.00 B5172 $7.00
B5073 $7.00 B5123 $5.00 B5173 $7.00
B5074 $15.00 B5124 $5.00 B5174 $7.00
B5075 $7.00 B5125 $7.00 B5175 $7.00
B5076 $5.00 B5126 $7.00 B5176 $7.00
B5077 $7.00 B5127 $7.00 B5177 $7.00
B5078 $5.00 B5128 $7.00 B5178 $7.00
B5079 $5.00 B5129 $7.00 B5179 $7.00
B5080 $7.00 B5130 $7.00 B5180 $5.00
B5081 $7.00 B5131 $7.00 B5181 $7.00
B5082 $7.00 B5132 $5.00 B5182 $15.00
B5083 $5.00 B5133 $5.00 B5183 $5.00
B5084 $7.00 B5134 $5.00 B5184 $7.00
B5085 $7.00 B5135 $7.00 B5185 $7.00
B5086 $5.00 B5136 $7.00 B5186 $7.00
B5087 $5.00 B5137 $7.00 B5187 $7.00
B5088 $5.00 B5138 $7.00 B5188 $7.00
B5089 $5.00 B5139 $7.00 B5189 $7.00
B5090 $7.00 B5140 $12.00 B5190 $7.00
B5091 $7.00 B5141 $7.00 B5191 $7.00
B5092 $7.00 B5142 $7.00 B5192 $15.00
B5093 $5.00 B5143 $7.00 B5193 $7.00
B5094 $5.00 B5144 $8.00 B5194 $7.00
B5095 $7.00 B5145 $7.00 B5195 $7.00
B5096 $7.00 B5146 $7.00 B5196 $7.00
B5097 $15.00 B5147 $8.00 B5197 $7.00
B5098 $5.00 B5148 $7.00 B5198 $7.00
B5099 $7.00 B5149 $7.00 B5199 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
46
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5200 $7.00 B5250 $7.00 B5301 $10.00
B5201 $5.00 B5251 $7.00 B5302 $5.00
B5202 $5.00 B5252 $5.00 B5303 $5.00
B5203 $5.00 B5253 $7.00 B5304 $5.00
B5204 $7.00 B5254 $5.00 B5305 $5.00
B5205 $7.00 B5255 $15.00 B5306 $5.00
B5206 $5.00 B5256 $7.00 B5307 $5.00
B5207 $5.00 B5257 $5.00 B5308 $12.00
B5208 $7.00 B5258 $7.00 B5309 $7.00
B5209 $10.00 B5259 $7.00 B5310 $7.00
B5210 $10.00 B5260 $15.00 B5311 $7.00
B5211 $10.00 B5261 $7.00 B5312 $7.00
B5212 $7.00 B5262 $7.00 B5313 NADA
B5213 $7.00 B5263 $7.00 B5314 $7.00
B5214 $5.00 B5264 $7.00 B5315 NADA
B5215 $10.00 B5265 $7.00 B5316 NADA
B5216 $10.00 B5266 $7.00 B5317 $7.00
B5217 $10.00 B5267 $7.00 B5318 NADA
B5218 $10.00 B5268 $7.00 B5319 $7.00
B5219 $5.00 B5269 $7.00 B5320 $7.00
B5220 $7.00 B5270 $7.00 B5321 $12.00
B5221 $7.00 B5271 $7.00 B5322 $5.00
B5222 $7.00 B5272 $7.00 B5323 $7.00
B5223 $7.00 B5273 $7.00 B5324 $7.00
B5224 $7.00 B5274 $7.00 B5325 $7.00
B5225 $7.00 B5275 $7.00 B5326 $7.00
B5226 $12.00 B5276 $5.00 B5327 NADA
B5227 $7.00 B5277 $8.00 B5328 $7.00
B5228 $7.00 B5278 $7.00 B5329 $5.00
B5229 $7.00 B5279 $7.00 B5330 $5.00
B5230 $7.00 B5280 $7.00 B5331 $7.00
B5231 $7.00 B5281 $15.00 B5332 $7.00
B5232 $7.00 B5282 $7.00 B5333 $7.00
B5233 $5.00 B5283 $7.00 B5334 $7.00
B5234 $10.00 B5284 $7.00 B5335 $12.00
B5235 $7.00 B5286 $7.00 B5336 $7.00
B5236 $12.00 B5287 $7.00 B5337 $12.00
B5237 $7.00 B5288 $7.00 B5338 $7.00
B5238 $7.00 B5289 $7.00 B5339 $7.00
B5239 $7.00 B5290 $5.00 B5340 $10.00
B5240 $7.00 B5291 $7.00 B5341 $5.00
B5241 $7.00 B5292 $12.00 B5342 NADA
B5242 $7.00 B5293 $12.00 B5343 NADA
B5243 $7.00 B5294 $7.00 B5344 $5.00
B5244 $7.00 B5295 $7.00 B5345 $5.00
B5245 NADA B5296 $12.00 B5346 NADA
B5246 NADA B5297 $15.00 B5347 NADA
B5247 $7.00 B5298 $12.00 B5348 NADA
B5248 $7.00 B5299 NADA B5349 NADA
B5249 $7.00 B5300 $10.00 B5350 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
47
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5351 NADA B5401 $7.00 B5451 $7.00
B5352 NADA B5402 $7.00 B5452 $7.00
B5353 NADA B5403 $7.00 B5453 $7.00
B5354 NADA B5404 $7.00 B5454 $7.00
B5355 $5.00 B5405 $10.00 B5455 $7.00
B5356 NADA B5406 $10.00 B5456 $7.00
B5357 NADA B5407 $7.00 B5457 $7.00
B5358 NADA B5408 $7.00 B5458 $7.00
B5359 NADA B5409 $10.00 B5459 $7.00
B5360 $12.00 B5410 $10.00 B5460 $5.00
B5361 $7.00 B5411 $10.00 B5461 $5.00
B5362 $7.00 B5412 $10.00 B5462 $5.00
B5363 NADA B5413 $7.00 B5463 $5.00
B5364 NADA B5414 $10.00 B5464 $5.00
B5365 NADA B5415 $7.00 B5465 $5.00
B5366 $5.00 B5416 $7.00 B5466 $5.00
B5367 $5.00 B5417 $7.00 B5467 $5.00
B5368 $5.00 B5418 $7.00 B5468 $5.00
B5369 $7.00 B5419 $7.00 B5469 $5.00
B5370 $7.00 B5420 $5.00 B5470 $5.00
B5371 $7.00 B5421 NADA B5471 $5.00
B5372 $7.00 B5422 NADA B5472 $7.00
B5373 $7.00 B5423 NADA B5473 $5.00
B5374 $7.00 B5424 NADA B5474 $5.00
B5375 $10.00 B5425 $7.00 B5475 $7.00
B5376 $10.00 B5426 $15.00 B5476 NADA
B5377 $7.00 B5427 $7.00 B5477 $7.00
B5378 $15.00 B5428 $12.00 B5478 $7.00
B5379 $15.00 B5429 $7.00 B5479 $5.00
B5380 $15.00 B5430 $7.00 B5480 $5.00
B5381 $8.00 B5431 $5.00 B5481 $7.00
B5382 $10.00 B5431 $5.00 B5482 $7.00
B5383 NADA B5432 NADA B5483 $5.00
B5384 NADA B5433 $5.00 B5484 $7.00
B5385 $7.00 B5434 $7.00 B5485 $7.00
B5386 $7.00 B5436 $7.00 B5486 $7.00
B5387 $7.00 B5437 $7.00 B5487 $5.00
B5388 $7.00 B5438 $7.00 B5488 $5.00
B5389 $7.00 B5439 $7.00 B5489 $5.00
B5390 $7.00 B5440 $7.00 B5490 $7.00
B5391 $7.00 B5441 $5.00 B5491 $5.00
B5392 $7.00 B5442 $7.00 B5492 $5.00
B5393 $12.00 B5443 $7.00 B5493 $5.00
B5394 $5.00 B5444 $7.00 B5494 $7.00
B5395 $7.00 B5445 $5.00 B5495 $5.00
B5396 $7.00 B5446 $5.00 B5496 $5.00
B5397 $7.00 B5447 $7.00 B5497 $5.00
B5398 NADA B5448 $7.00 B5498 $5.00
B5399 $7.00 B5449 $7.00 B5499 $5.00
B5400 $7.00 B5450 $7.00 B5500 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
48
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5501 $7.00 B5551 $15.00 B5601 $7.00
B5502 $7.00 B5552 $12.00 B5602 $7.00
B5503 $7.00 B5553 $12.00 B5603 $7.00
B5504 NADA B5554 $5.00 B5604 NADA
B5505 NADA B5555 $5.00 B5605 $10.00
B5506 $7.00 B5556 $7.00 B5606 $12.00
B5507 NADA B5557 $7.00 B5607 $7.00
B5508 NADA B5558 $7.00 B5608 NADA
B5509 $7.00 B5559 $12.00 B5609 $5.00
B5510 NADA B5560 $15.00 B5610 $7.00
B5511 NADA B5561 $7.00 B5611 $7.00
B5512 $5.00 B5562 $7.00 B5612 $7.00
B5513 $5.00 B5563 $5.00 B5613 $7.00
B5514 NADA B5564 $15.00 B5614 $7.00
B5515 NADA B5565 $15.00 B5615 $7.00
B5516 NADA B5566 $7.00 B5616 $7.00
B5517 $7.00 B5567 $7.00 B5617 $7.00
B5518 $7.00 B5568 $15.00 B5618 $7.00
B5519 NADA B5569 $20.00 B5619 $7.00
B5520 $12.00 B5570 $20.00 B5620 $7.00
B5521 NADA B5571 $20.00 B5621 $7.00
B5522 NADA B5572 $5.00 B5622 $7.00
B5523 NADA B5573 $15.00 B5623 $7.00
B5524 NADA B5574 $12.00 B5624 $7.00
B5525 $5.00 B5575 $7.00 B5625 $12.00
B5526 $7.00 B5576 $7.00 B5626 $7.00
B5527 $7.00 B5577 $12.00 B5627 $7.00
B5528 $7.00 B5578 $20.00 B5628 NADA
B5529 $10.00 B5579 $20.00 B5629 $7.00
B5530 $10.00 B5580 $20.00 B5630 $15.00
B5531 NADA B5581 $7.00 B5631 $7.00
B5532 NADA B5582 $10.00 B5632 $7.00
B5533 NADA B5583 $7.00 B5633 $7.00
B5534 $10.00 B5584 $7.00 B5634 $7.00
B5535 $7.00 B5585 $7.00 B5635 $7.00
B5536 NADA B5586 $7.00 B5636 $7.00
B5537 $7.00 B5587 $12.00 B5637 $7.00
B5538 NADA B5588 $5.00 B5638 $10.00
B5539 $5.00 B5589 $7.00 B5639 $7.00
B5540 $7.00 B5590 $7.00 B5640 $7.00
B5541 $10.00 B5591 $7.00 B5641 $5.00
B5542 $10.00 B5592 $10.00 B5642 $7.00
B5543 $7.00 B5593 NADA B5643 $7.00
B5544 $7.00 B5594 NADA B5644 $7.00
B5545 $12.00 B5595 $7.00 B5645 $7.00
B5546 $5.00 B5596 NADA B5646 $7.00
B5547 $5.00 B5597 $5.00 B5647 $7.00
B5548 $7.00 B5598 $5.00 B5648 $7.00
B5549 $7.00 B5599 $5.00 B5649 $7.00
B5550 $15.00 B5600 $5.00 B5650 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
49
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5651 $7.00 B5701 $7.00 B5770 $7.00
B5652 $7.00 B5702 $10.00 B5771 $5.00
B5653 $7.00 B5703 $5.00 B5772 $5.00
B5654 $7.00 B5704 $7.00 B5773 $5.00
B5655 $7.00 B5705 $7.00 B5774 $5.00
B5656 $15.00 B5706 $12.00 B5777 NADA
B5657 $5.00 B5707 $5.00 B5778 $7.00
B5658 $7.00 B5708 $5.00 B5781 $10.00
B5659 $5.00 B5709 $5.00 B5782 $10.00
B5660 $5.00 B5710 $5.00 B5783 $7.00
B5661 $5.00 B5711 $5.00 B5784 $7.00
B5662 $7.00 B5712 $5.00 B5785 $5.00
B5663 $5.00 B5713 $5.00 B5786 $5.00
B5664 $5.00 B5714 $5.00 B5787 $5.00
B5665 $12.00 B5715 $5.00 B5788 $5.00
B5666 $7.00 B5716 $12.00 B5789 $5.00
B5667 $5.00 B5717 $7.00 B5790 $5.00
B5668 $12.00 B5718 $5.00 B5797 $7.00
B5669 $15.00 B5719 $7.00 B5798 $7.00
B5670 $7.00 B5720 $10.00 B5799 NADA
B5671 $7.00 B5721 NADA B5800 NADA
B5672 $7.00 B5722 NADA B5801 NADA
B5673 $7.00 B5725 $7.00 B5803 $5.00
B5674 $5.00 B5726 $7.00 B5807 $7.00
B5675 $5.00 B5729 $7.00 B5808 $7.00
B5676 $7.00 B5730 $15.00 B5810 $10.00
B5677 $5.00 B5731 $7.00 B5811 NADA
B5678 $10.00 B5732 $10.00 B5812 NADA
B5679 $7.00 B5733 $10.00 B5813 $5.00
B5680 $7.00 B5734 $10.00 B5814 $5.00
B5681 $5.00 B5735 $10.00 B5815 $10.00
B5682 $10.00 B5736 $5.00 B5817 $5.00
B5683 $7.00 B5737 $5.00 B5818 $7.00
B5684 $7.00 B5738 $10.00 B5819 $10.00
B5685 $5.00 B5740 $10.00 B5820 $10.00
B5686 $7.00 B5741 $10.00 B5821 $15.00
B5687 $7.00 B5742 NADA B5822 $12.00
B5688 $10.00 B5745 NADA B5823 $7.00
B5689 $10.00 B5746 $15.00 B5824 $7.00
B5690 $7.00 B5749 $7.00 B5825 $7.00
B5691 NADA B5754 $7.00 B5826 $7.00
B5692 $7.00 B5755 $7.00 B5827 $10.00
B5693 $7.00 B5757 $7.00 B5828 $10.00
B5694 $5.00 B5760 $5.00 B5829 $10.00
B5695 $10.00 B5761 $12.00 B5830 $10.00
B5696 $15.00 B5762 $10.00 B5831 $10.00
B5697 $7.00 B5764 $12.00 B5832 $7.00
B5698 $5.00 B5765 NADA B5833 $10.00
B5699 NADA B5766 $7.00 B5834 $7.00
B5700 NADA B5769 $7.00 B5835 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
50
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5836 $5.00 B5887 $7.00 B5940 $10.00
B5837 $5.00 B5888 NADA B5941 $10.00
B5838 $10.00 B5889 $5.00 B5942 $7.00
B5839 NADA B5890 $5.00 B5943 $10.00
B5840 NADA B5891 $7.00 B5944 $7.00
B5841 $8.00 B5892 NADA B5945 $7.00
B5842 $7.00 B5893 $5.00 B5946 $7.00
B5843 $7.00 B5894 $5.00 B5947 $7.00
B5844 $7.00 B5895 $5.00 B5948 $7.00
B5845 $15.00 B5896 $5.00 B5949 $10.00
B5846 $7.00 B5897 $10.00 B5950 $7.00
B5847 $5.00 B5898 $10.00 B5951 $10.00
B5848 $8.00 B5899 $10.00 B5952 $10.00
B5849 NADA B5900 $7.00 B5953 $7.00
B5850 $5.00 B5901 $10.00 B5954 $5.00
B5851 $5.00 B5902 $7.00 B5955 $7.00
B5852 $5.00 B5903 $10.00 B5956 $10.00
B5853 $7.00 B5904 $7.00 B5957 $7.00
B5854 $7.00 B5905 NADA B5958 $5.00
B5855 $7.00 B5906 NADA B5959 $7.00
B5856 $7.00 B5907 NADA B5961 $7.00
B5857 $7.00 B5908 $7.00 B5962 $5.00
B5858 $8.00 B5909 $5.00 B5963 $10.00
B5859 $5.00 B5910 $5.00 B5964 $5.00
B5860 NADA B5911 $7.00 B5965 $5.00
B5861 $5.00 B5912 $7.00 B5966 $7.00
B5862 $5.00 B5913 $5.00 B5967 $10.00
B5863 $5.00 B5914 $7.00 B5968 $5.00
B5864 $5.00 B5915 $5.00 B5969 $5.00
B5865 $5.00 B5916 $8.00 B5970 $5.00
B5866 NADA B5917 $15.00 B5971 $7.00
B5867 NADA B5918 $10.00 B5972 $7.00
B5868 NADA B5919 $10.00 B5973 $7.00
B5869 $10.00 B5920 $7.00 B5974 $5.00
B5870 $7.00 B5921 $10.00 B5975 $10.00
B5871 $7.00 B5923 $5.00 B5976 $7.00
B5872 $5.00 B5924 $10.00 B5977 $7.00
B5873 $7.00 B5925 $10.00 B5978 $7.00
B5874 $15.00 B5926 $10.00 B5979 $7.00
B5875 $7.00 B5927 $7.00 B5980 $10.00
B5876 $5.00 B5928 $10.00 B5981 $7.00
B5877 $5.00 B5931 $5.00 B5982 $10.00
B5878 $7.00 B5932 $7.00 B5983 $5.00
B5879 $7.00 B5933 $7.00 B5984 $7.00
B5880 $5.00 B5934 $7.00 B5985 $5.00
B5881 $5.00 B5935 $7.00 B5986 $5.00
B5883 $7.00 B5936 $7.00 B5987 $5.00
B5884 $7.00 B5937 $7.00 B5988 $10.00
B5885 NADA B5938 $10.00 B5989 $7.00
B5886 NADA B5939 $7.00 B5990 $10.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
51
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B5991 $7.00 B6042 $7.00 B6092 $7.00
B5992 $5.00 B6043 $7.00 B6093 NADA
B5993 $10.00 B6044 $7.00 B6094 $7.00
B5994 $7.00 B6045 $7.00 B6095 $7.00
B5995 $7.00 B6046 $7.00 B6096 $7.00
B5996 $7.00 B6047 $7.00 B6097 $7.00
B5997 $10.00 B6048 $7.00 B6098 $7.00
B5998 $8.00 B6049 NADA B6099 $7.00
B5999 $7.00 B6050 $7.00 B6100 $15.00
B6000 $7.00 B6051 $7.00 B6101 $7.00
B6001 $7.00 B6052 $5.00 B6102 $7.00
B6002 $7.00 B6053 NADA B6103 $7.00
B6003 $10.00 B6054 $7.00 B6104 $7.00
B6004 $7.00 B6055 $7.00 B6105 $7.00
B6005 $7.00 B6056 $7.00 B6106 $5.00
B6006 $7.00 B6057 $5.00 B6109 $7.00
B6007 $7.00 B6058 $10.00 B6110 $7.00
B6008 $7.00 B6059 $5.00 B6111 $10.00
B6009 $10.00 B6060 $10.00 B6112 $7.00
B6010 $7.00 B6061 $7.00 B6113 $10.00
B6011 $7.00 B6062 $7.00 B6115 $7.00
B6012 $7.00 B6063 $7.00 B6116 NADA
B6013 $7.00 B6064 $7.00 B6117 NADA
B6014 $10.00 B6065 $7.00 B6118 $10.00
B6015 $5.00 B6066 $10.00 B6119 $10.00
B6016 $5.00 B6067 $7.00 B6120 $7.00
B6017 $10.00 B6068 $7.00 B6121 NADA
B6018 $7.00 B6069 $7.00 B6122 $7.00
B6019 $10.00 B6070 $7.00 B6123 $7.00
B6020 $5.00 B6071 $7.00 B6124 $5.00
B6021 $7.00 B6072 $5.00 B6125 $7.00
B6022 $7.00 B6073 $10.00 B6126 NADA
B6023 $7.00 B6074 $7.00 B6127 $10.00
B6024 $10.00 B6075 $5.00 B6128 NADA
B6025 $10.00 B6076 $5.00 B6129 $10.00
B6026 $10.00 B6077 $7.00 B6130 $10.00
B6027 $7.00 B6078 $7.00 B6131 $7.00
B6028 $10.00 B6079 $7.00 B6132 NADA
B6029 $7.00 B6080 $10.00 B6133 $5.00
B6030 $10.00 B6081 $10.00 B6134 $10.00
B6031 $7.00 B6082 $7.00 B6135 NADA
B6032 $7.00 B6083 $7.00 B6136 NADA
B6033 $10.00 B6084 $7.00 B6137 $7.00
B6034 $10.00 B6085 $10.00 B6138 $5.00
B6036 $10.00 B6086 $7.00 B6139 $5.00
B6037 $10.00 B6087 $15.00 B6140 $10.00
B6038 $7.00 B6088 $5.00 B6141 $7.00
B6039 $7.00 B6089 $7.00 B6142 $10.00
B6040 $10.00 B6090 $7.00 B6143 $5.00
B6041 $7.00 B6091 $7.00 B6144 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
52
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6145 $10.00 B6210 $5.00 B6261 $7.00
B6146 $7.00 B6211 $7.00 B6262 $10.00
B6147 $10.00 B6212 $5.00 B6263 $7.00
B6148 $7.00 B6213 $5.00 B6264 $5.00
B6149 $10.00 B6214 $5.00 B6265 $7.00
B6150 $10.00 B6215 $5.00 B6266 $5.00
B6151 $7.00 B6216 $5.00 B6267 $5.00
B6152 $10.00 B6217 $10.00 B6268 NADA
B6153 $10.00 B6218 $5.00 B6269 $5.00
B6154 $7.00 B6219 $5.00 B6270 $5.00
B6156 $7.00 B6220 $8.00 B6271 $5.00
B6159 $7.00 B6221 $7.00 B6273 $5.00
B6160 $7.00 B6222 $5.00 B6274 $7.00
B6163 $10.00 B6223 $5.00 B6275 $10.00
B6164 $7.00 B6224 $5.00 B6277 $10.00
B6165 $8.00 B6225 $5.00 B6278 $15.00
B6166 $10.00 B6226 $15.00 B6279 $7.00
B6167 $10.00 B6227 $5.00 B6280 $7.00
B6168 $10.00 B6228 $5.00 B6281 NADA
B6172 $10.00 B6229 $15.00 B6282 $5.00
B6173 $7.00 B6230 $7.00 B6283 $10.00
B6180 $10.00 B6231 $7.00 B6284 $7.00
B6181 $7.00 B6232 $5.00 B6285 $10.00
B6182 $7.00 B6233 $5.00 B6286 NADA
B6183 $5.00 B6234 $5.00 B6287 $7.00
B6184 $7.00 B6235 $2.00 B6288 $7.00
B6185 $7.00 B6236 $5.00 B6289 $7.00
B6187 NADA B6237 $5.00 B6290 $10.00
B6188 NADA B6238 $7.00 B6291 $7.00
B6189 $7.00 B6239 $5.00 B6292 $7.00
B6190 NADA B6240 $5.00 B6293 $7.00
B6191 NADA B6241 $5.00 B6295 $7.00
B6192 $5.00 B6242 $5.00 B6296 $7.00
B6193 $10.00 B6243 $5.00 B6297 $7.00
B6194 $10.00 B6244 $7.00 B6299 $7.00
B6195 $5.00 B6245 $7.00 B6300 $7.00
B6196 $10.00 B6246 $7.00 B6301 $7.00
B6197 $5.00 B6248 $7.00 B6302 $7.00
B6198 $10.00 B6249 $7.00 B6303 $10.00
B6199 $10.00 B6250 $7.00 B6304 $7.00
B6200 NADA B6251 $7.00 B6305 NADA
B6201 $10.00 B6252 $5.00 B6307 $7.00
B6202 $10.00 B6253 $5.00 B6308 $7.00
B6203 NADA B6254 $5.00 B6309 $7.00
B6204 $7.00 B6255 $5.00 B6312 $15.00
B6205 $7.00 B6256 $5.00 B6313 $7.00
B6206 NADA B6257 NADA B6314 $7.00
B6207 $7.00 B6258 $5.00 B6315 $10.00
B6208 NADA B6259 $7.00 B6316 $5.00
B6209 $5.00 B6260 $5.00 B6317 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
53
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6319 $10.00 B6370 $7.00 B6420 $7.00
B6321 $7.00 B6371 $7.00 B6421 $7.00
B6322 $7.00 B6372 $10.00 B6422 $7.00
B6323 $7.00 B6373 $10.00 B6423 $7.00
B6324 $7.00 B6374 $10.00 B6424 $15.00
B6325 $7.00 B6375 $5.00 B6425 NADA
B6326 $7.00 B6376 $5.00 B6426 $5.00
B6327 $5.00 B6377 $5.00 B6427 $5.00
B6328 $7.00 B6378 $7.00 B6428 $5.00
B6329 $5.00 B6379 $7.00 B6429 NADA
B6330 $5.00 B6380 $5.00 B6430 NADA
B6331 $5.00 B6381 $10.00 B6431 $10.00
B6332 $5.00 B6382 $7.00 B6432 $7.00
B6333 $7.00 B6383 $7.00 B6433 $5.00
B6334 $7.00 B6384 $10.00 B6434 $7.00
B6335 $7.00 B6385 $7.00 B6435 $5.00
B6336 $5.00 B6386 $5.00 B6436 $7.00
B6337 $7.00 B6387 $5.00 B6437 $7.00
B6338 $7.00 B6388 $5.00 B6438 $10.00
B6339 $7.00 B6389 $10.00 B6439 $5.00
B6340 $7.00 B6390 $5.00 B6440 $7.00
B6341 $7.00 B6391 $7.00 B6441 $7.00
B6342 $7.00 B6392 $7.00 B6442 $10.00
B6343 $7.00 B6393 $10.00 B6443 $7.00
B6344 $7.00 B6394 $10.00 B6444 $7.00
B6345 $7.00 B6395 $10.00 B6445 $7.00
B6346 $10.00 B6396 $15.00 B6446 $5.00
B6347 $7.00 B6397 $7.00 B6447 $7.00
B6348 $5.00 B6398 $7.00 B6448 $7.00
B6349 $10.00 B6399 $7.00 B6449 $7.00
B6350 $7.00 B6400 $7.00 B6450 $7.00
B6351 $7.00 B6401 $7.00 B6451 $10.00
B6352 $7.00 B6402 $7.00 B6452 $7.00
B6353 $7.00 B6403 $7.00 B6453 $7.00
B6354 $10.00 B6404 $7.00 B6454 NADA
B6355 $10.00 B6405 $7.00 B6455 $10.00
B6356 $10.00 B6406 $7.00 B6456 $7.00
B6357 $5.00 B6407 $7.00 B6457 $10.00
B6358 $5.00 B6408 $10.00 B6458 $7.00
B6359 $5.00 B6409 $5.00 B6459 $5.00
B6360 $5.00 B6410 $7.00 B6460 $7.00
B6361 $5.00 B6411 $7.00 B6461 $7.00
B6362 $7.00 B6412 $20.00 B6462 $10.00
B6363 $7.00 B6413 $20.00 B6463 $7.00
B6364 $5.00 B6414 $20.00 B6464 $5.00
B6365 $10.00 B6415 $7.00 B6465 $5.00
B6366 $7.00 B6416 $20.00 B6466 $7.00
B6367 $7.00 B6417 $20.00 B6467 $5.00
B6368 $7.00 B6418 $20.00 B6468 $5.00
B6369 $7.00 B6419 $7.00 B6469 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
54
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6470 $5.00 B6529 $7.00 B6579 $7.00
B6471 $5.00 B6530 $7.00 B6580 $5.00
B6472 $7.00 B6531 $7.00 B6581 NADA
B6473 $7.00 B6532 $7.00 B6582 NADA
B6474 NADA B6533 NADA B6583 NADA
B6475 $5.00 B6534 $7.00 B6584 NADA
B6476 $7.00 B6535 $5.00 B6585 NADA
B6477 $5.00 B6536 $7.00 B6586 $7.00
B6478 $5.00 B6537 $5.00 B6587 $7.00
B6479 $7.00 B6538 $5.00 B6588 $5.00
B6480 $7.00 B6539 $10.00 B6589 $5.00
B6481 $7.00 B6540 $7.00 B6590 $5.00
B6483 $7.00 B6541 $7.00 B6591 $5.00
B6484 $7.00 B6542 $7.00 B6592 $5.00
B6485 $7.00 B6543 $7.00 B6593 $7.00
B6486 $10.00 B6544 $15.00 B6594 $5.00
B6487 $7.00 B6545 $7.00 B6595 $5.00
B6488 $7.00 B6546 $12.00 B6596 $5.00
B6489 $7.00 B6547 $7.00 B6597 $5.00
B6490 $10.00 B6548 $7.00 B6598 $7.00
B6493 $7.00 B6549 $7.00 B6599 $5.00
B6494 $7.00 B6550 $10.00 B6600 $5.00
B6495 $7.00 B6551 NADA B6601 $5.00
B6496 $5.00 B6552 NADA B6602 $5.00
B6498 $5.00 B6553 $7.00 B6603 $5.00
B6499 $10.00 B6554 $5.00 B6604 $5.00
B6500 $5.00 B6555 $7.00 B6605 NADA
B6501 $5.00 B6556 $7.00 B6606 NADA
B6502 $5.00 B6557 $7.00 B6607 $7.00
B6503 $7.00 B6558 $10.00 B6608 $5.00
B6504 $7.00 B6559 $7.00 B6609 $5.00
B6506 $7.00 B6560 $7.00 B6610 $10.00
B6507 $7.00 B6561 $7.00 B6611 $10.00
B6508 $7.00 B6562 $5.00 B6612 $10.00
B6509 $10.00 B6563 $7.00 B6613 $10.00
B6510 $5.00 B6564 $5.00 B6614 $7.00
B6513 $5.00 B6565 $5.00 B6615 $7.00
B6514 $5.00 B6566 $5.00 B6616 $5.00
B6515 $5.00 B6567 $7.00 B6617 $10.00
B6518 $7.00 B6568 $5.00 B6618 $10.00
B6519 $12.00 B6569 $5.00 B6619 $5.00
B6520 $12.00 B6570 $5.00 B6620 $7.00
B6521 NADA B6571 $7.00 B6621 $10.00
B6522 $7.00 B6572 $7.00 B6622 $7.00
B6523 NADA B6573 $5.00 B6623 NADA
B6524 NADA B6574 $10.00 B6624 NADA
B6525 $5.00 B6575 $7.00 B6625 $7.00
B6526 $7.00 B6576 $10.00 B6626 $7.00
B6527 $7.00 B6577 $5.00 B6627 $7.00
B6528 $10.00 B6578 $5.00 B6628 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
55
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6629 NADA B6679 $7.00 B6729 $10.00
B6630 NADA B6680 $7.00 B6730 $5.00
B6631 $7.00 B6681 $7.00 B6731 $7.00
B6632 NADA B6682 $7.00 B6732 $10.00
B6633 NADA B6683 NADA B6733 $10.00
B6634 $7.00 B6684 NADA B6734 $10.00
B6635 $8.00 B6685 $10.00 B6735 $10.00
B6636 $8.00 B6686 NADA B6736 $10.00
B6637 $5.00 B6687 $5.00 B6737 $5.00
B6638 $5.00 B6688 $10.00 B6738 $5.00
B6639 $5.00 B6689 $10.00 B6739 $5.00
B6640 $5.00 B6690 $7.00 B6740 $7.00
B6641 $5.00 B6691 $7.00 B6741 $10.00
B6642 NADA B6692 $10.00 B6742 $5.00
B6643 NADA B6693 $7.00 B6743 $7.00
B6644 $7.00 B6694 $5.00 B6744 $7.00
B6645 $5.00 B6695 $7.00 B6745 $7.00
B6646 $5.00 B6696 NADA B6746 $7.00
B6647 $5.00 B6697 $10.00 B6747 $7.00
B6648 NADA B6698 $10.00 B6748 $12.00
B6649 NADA B6699 $5.00 B6749 $7.00
B6650 NADA B6700 $5.00 B6750 $7.00
B6651 $7.00 B6701 $7.00 B6751 $7.00
B6652 $7.00 B6702 $10.00 B6752 $7.00
B6653 $5.00 B6703 $7.00 B6753 $5.00
B6654 $5.00 B6704 $5.00 B6754 $7.00
B6655 $5.00 B6705 $7.00 B6755 $15.00
B6656 $5.00 B6706 $10.00 B6756 $5.00
B6657 $5.00 B6707 $7.00 B6757 $7.00
B6658 $7.00 B6708 $7.00 B6758 $10.00
B6659 $12.00 B6709 $7.00 B6759 $10.00
B6660 $7.00 B6710 $5.00 B6760 $5.00
B6661 NADA B6711 $10.00 B6761 $7.00
B6662 $7.00 B6712 $10.00 B6762 $5.00
B6663 $10.00 B6713 $7.00 B6763 NADA
B6664 $5.00 B6714 $7.00 B6764 NADA
B6665 $5.00 B6715 $7.00 B6765 NADA
B6666 $15.00 B6716 NADA B6766 NADA
B6667 $7.00 B6717 $5.00 B6767 $7.00
B6668 $15.00 B6718 $5.00 B6768 $10.00
B6669 $5.00 B6719 $7.00 B6769 $7.00
B6670 $5.00 B6720 $10.00 B6770 $7.00
B6671 NADA B6721 $7.00 B6771 $7.00
B6672 NADA B6722 $7.00 B6772 $7.00
B6673 $5.00 B6723 $7.00 B6773 $7.00
B6674 $5.00 B6724 $10.00 B6774 $7.00
B6675 $5.00 B6725 $7.00 B6775 $10.00
B6676 $10.00 B6726 $5.00 B6776 $7.00
B6677 $10.00 B6727 $7.00 B6777 $7.00
B6678 $10.00 B6728 NADA B6778 $5.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
56
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6779 $5.00 B6831 NADA B6881 $7.00
B6780 $5.00 B6832 $7.00 B6882 $7.00
B6781 $5.00 B6833 $10.00 B6883 $7.00
B6782 $5.00 B6834 $10.00 B6884 NADA
B6783 $5.00 B6835 NADA B6885 $7.00
B6784 $5.00 B6836 $5.00 B6886 $10.00
B6785 $5.00 B6837 $7.00 B6887 $7.00
B6788 $7.00 B6838 $5.00 B6888 $7.00
B6789 $7.00 B6839 $10.00 B6889 $7.00
B6790 $5.00 B6840 NADA B6890 $10.00
B6791 $5.00 B6841 $7.00 B6891 $7.00
B6792 $7.00 B6842 $7.00 B6892 $7.00
B6793 $7.00 B6843 $7.00 B6893 NADA
B6794 $7.00 B6844 $7.00 B6894 $7.00
B6795 $7.00 B6845 $7.00 B6895 $7.00
B6796 $5.00 B6846 NADA B6896 $7.00
B6797 $7.00 B6847 NADA B6897 $10.00
B6798 $10.00 B6848 $7.00 B6898 $15.00
B6799 $7.00 B6849 $7.00 B6899 $5.00
B6800 $7.00 B6850 $7.00 B6900 $5.00
B6801 $7.00 B6851 $7.00 B6901 $7.00
B6802 $7.00 B6852 $10.00 B6902 $10.00
B6803 $7.00 B6853 $10.00 B6903 $7.00
B6804 $7.00 B6854 $7.00 B6904 $7.00
B6805 $7.00 B6855 $7.00 B6905 $10.00
B6806 $7.00 B6856 $7.00 B6906 $8.00
B6807 $7.00 B6857 $10.00 B6907 $5.00
B6808 $10.00 B6858 $7.00 B6908 $10.00
B6809 $5.00 B6859 $7.00 B6909 $5.00
B6810 $5.00 B6860 $7.00 B6910 $7.00
B6811 $5.00 B6861 NADA B6911 $7.00
B6812 $7.00 B6862 $7.00 B6912 $10.00
B6813 $7.00 B6863 $7.00 B6913 $15.00
B6814 $7.00 B6864 $7.00 B6914 $10.00
B6815 $5.00 B6865 $7.00 B6915 $5.00
B6816 $7.00 B6866 $7.00 B6916 $5.00
B6817 $5.00 B6867 $7.00 B6917 $5.00
B6818 $10.00 B6868 $7.00 B6918 $7.00
B6819 $7.00 B6869 $7.00 B6919 $10.00
B6820 $7.00 B6870 $10.00 B6920 $7.00
B6821 $7.00 B6871 $10.00 B6921 $7.00
B6822 $7.00 B6872 $7.00 B6922 $10.00
B6823 $7.00 B6873 $5.00 B6923 $10.00
B6824 $7.00 B6874 $7.00 B6924 $7.00
B6825 $7.00 B6875 $7.00 B6925 $10.00
B6826 $7.00 B6876 $7.00 B6926 $5.00
B6827 $7.00 B6877 $7.00 B6927 $5.00
B6828 NADA B6878 $5.00 B6928 $7.00
B6829 $7.00 B6879 $10.00 B6929 $7.00
B6830 $7.00 B6880 $5.00 B6930 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
57
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B6931 $5.00 B6981 $10.00 B7033 $5.00
B6932 $7.00 B6982 $15.00 B7034 NADA
B6933 $10.00 B6983 $5.00 B7035 $7.00
B6934 $10.00 B6984 $10.00 B7036 NADA
B6935 $7.00 B6985 $10.00 B7037 $7.00
B6936 $10.00 B6986 $5.00 B7038 $10.00
B6937 $5.00 B6987 $7.00 B7039 $7.00
B6938 $10.00 B6988 $10.00 B7040 $10.00
B6939 $5.00 B6989 NADA B7041 $10.00
B6940 $7.00 B6990 $7.00 B7042 $10.00
B6941 $5.00 B6991 $7.00 B7043 $7.00
B6942 $5.00 B6992 $10.00 B7044 $7.00
B6943 $5.00 B6993 $10.00 B7045 $7.00
B6944 $7.00 B6994 $5.00 B7046 $7.00
B6945 $10.00 B6995 $7.00 B7047 $7.00
B6946 $7.00 B6996 $7.00 B7048 $7.00
B6947 $5.00 B6997 $7.00 B7049 $7.00
B6948 $7.00 B6998 $10.00 B7050 $7.00
B6949 $5.00 B6999 $7.00 B7051 $7.00
B6950 $7.00 B7000 NADA B7052 $10.00
B6951 $7.00 B7001 $7.00 B7053 $7.00
B6952 $7.00 B7002 $7.00 B7054 $10.00
B6953 $5.00 B7003 $10.00 B7055 $10.00
B6954 $5.00 B7004 $7.00 B7056 $7.00
B6955 $5.00 B7005 $5.00 B7057 NADA
B6956 $7.00 B7006 $7.00 B7058 $7.00
B6957 $7.00 B7007 NADA B7059 $10.00
B6958 $5.00 B7008 $7.00 B7060 $10.00
B6959 $5.00 B7009 $7.00 B7061 $10.00
B6960 $7.00 B7010 $7.00 B7062 $10.00
B6961 $7.00 B7011 $7.00 B7063 $7.00
B6962 $7.00 B7012 $5.00 B7064 $10.00
B6963 $7.00 B7013 $10.00 B7065 $7.00
B6964 $7.00 B7014 $15.00 B7066 $10.00
B6965 $7.00 B7015 $7.00 B7067 $10.00
B6966 $7.00 B7016 $7.00 B7068 $7.00
B6967 $10.00 B7017 $7.00 B7069 $10.00
B6968 $7.00 B7018 $10.00 B7070 NADA
B6969 $7.00 B7020 $7.00 B7071 $7.00
B6970 $7.00 B7022 $7.00 B7072 $7.00
B6971 $10.00 B7023 $5.00 B7073 $10.00
B6972 $10.00 B7024 $10.00 B7074 $10.00
B6973 $5.00 B7025 $10.00 B7075 $10.00
B6974 $5.00 B7026 NADA B7076 NADA
B6975 $5.00 B7027 $7.00 B7077 $7.00
B6976 $5.00 B7028 $10.00 B7079 $5.00
B6977 $5.00 B7029 $10.00 B7080 $10.00
B6978 $7.00 B7030 $7.00 B7081 $7.00
B6979 $5.00 B7031 $7.00 B7082 $5.00
B6980 NADA B7032 $7.00 B7083 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
58
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B7084 $7.00 B7142 $5.00 B7192 $5.00
B7085 $7.00 B7143 $5.00 B7193 $5.00
B7086 $5.00 B7144 $5.00 B7194 $5.00
B7087 $10.00 B7145 $5.00 B7195 $10.00
B7088 $15.00 B7146 $5.00 B7196 $10.00
B7089 $15.00 B7147 $7.00 B7197 $10.00
B7090 $7.00 B7148 $5.00 B7198 $7.00
B7091 $5.00 B7149 $5.00 B7199 $7.00
B7092 $7.00 B7150 $5.00 B7200 $7.00
B7093 $7.00 B7151 $5.00 B7201 $7.00
B7094 $10.00 B7152 $5.00 B7202 $10.00
B7095 $7.00 B7153 $5.00 B7203 NADA
B7096 $10.00 B7154 $5.00 B7204 NADA
B7097 NADA B7155 NADA B7205 $7.00
B7099 $10.00 B7156 $10.00 B7206 $7.00
B7100 $10.00 B7157 $5.00 B7207 $7.00
B7101 $7.00 B7158 $10.00 B7208 $7.00
B7104 $5.00 B7159 $10.00 B7209 $5.00
B7109 $10.00 B7160 $10.00 B7210 $7.00
B7111 $7.00 B7161 $7.00 B7211 $10.00
B7112 $5.00 B7162 NADA B7213 $7.00
B7113 $10.00 B7163 $5.00 B7214 $10.00
B7114 $7.00 B7164 $5.00 B7218 $10.00
B7115 $7.00 B7165 $5.00 B7219 $5.00
B7116 $5.00 B7166 $5.00 B7220 NADA
B7117 $10.00 B7167 $10.00 B7221 $7.00
B7118 $10.00 B7168 $7.00 B7222 $7.00
B7119 $10.00 B7169 NADA B7223 $7.00
B7120 $10.00 B7170 NADA B7224 $7.00
B7121 $5.00 B7171 $5.00 B7225 $10.00
B7122 $5.00 B7172 $5.00 B7226 $7.00
B7123 $5.00 B7173 $5.00 B7227 $7.00
B7124 $5.00 B7174 $5.00 B7228 $7.00
B7125 $7.00 B7175 $7.00 B7229 $5.00
B7126 $7.00 B7176 $5.00 B7230 $8.00
B7127 $7.00 B7177 $5.00 B7231 $7.00
B7128 $5.00 B7178 $5.00 B7234 $5.00
B7129 $5.00 B7179 $5.00 B7235 $7.00
B7130 $5.00 B7180 $5.00 B7236 $7.00
B7131 $5.00 B7181 $5.00 B7237 $5.00
B7132 $10.00 B7182 $5.00 B7238 $7.00
B7133 $5.00 B7183 $7.00 B7240 $10.00
B7134 $5.00 B7184 $5.00 B7241 $7.00
B7135 $5.00 B7185 $7.00 B7242 $5.00
B7136 NADA B7186 $5.00 B7243 $8.00
B7137 NADA B7187 $5.00 B7244 $7.00
B7138 $5.00 B7188 $5.00 B7245 $7.00
B7139 $5.00 B7189 $5.00 B7246 $7.00
B7140 $5.00 B7190 $5.00 B7247 $7.00
B7141 $7.00 B7191 $5.00 B7248 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
59
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
B7249 $7.00 B7309 $10.00 * *
B7250 $7.00 B7310 $10.00 * *
B7251 $5.00 B7313 $10.00 * *
B7252 $7.00 B7314 $7.00 * *
B7253 $7.00 B7315 $7.00 * *
B7254 $7.00 B7316 $10.00 * *
B7255 $7.00 B7317 $10.00 * *
B7256 $7.00 B7318 $10.00 * *
B7257 $7.00 B7319 $10.00 * *
B7258 $5.00 B7320 $10.00 * *
B7259 $7.00 B7321 $10.00 * *
B7260 $7.00 B7322 $10.00 * *
B7261 $7.00 B7323 $5.00 * *
B7262 $5.00 B7324 $7.00 * *
B7263 $7.00 B7325 $10.00 * *
B7264 $5.00 B7326 $10.00 * *
B7265 $5.00 B7330 NADA * *
B7266 $5.00 B7331 $7.00 * *
B7267 $5.00 B7332 $7.00 * *
B7268 $5.00 B7333 $7.00 * *
B7269 $2.00 B7334 $7.00 * *
B7270 $5.00 * * * *
B7271 $7.00 * * * *
B7272 $7.00 * * * *
B7273 $10.00 * * * *
B7274 $10.00 * * * *
B7275 $7.00 * * * *
B7276 $10.00 * * * *
B7277 $10.00 * * * *
B7278 $10.00 * * * *
B7279 $7.00 * * * *
B7280 $10.00 * * * *
B7281 $7.00 * * * *
B7283 $7.00 * * * *
B7284 $7.00 * * * *
B7285 $10.00 * * * *
B7286 $7.00 * * * *
B7288 $7.00 * * * *
B7290 $7.00 * * * *
B7291 $7.00 * * * *
B7292 $5.00 * * * *
B7297 $7.00 * * * *
B7298 $7.00 * * * *
B7299 $7.00 * * * *
B7300 $5.00 * * * *
B7301 $5.00 * * * *
B7303 $5.00 * * * *
B7304 $10.00 * * * *
B7305 $7.00 * * * *
B7308 $5.00 * * * *
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
60
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
BA1 $7.00 BA257 $7.00 BA312 $7.00
BA2 $7.00 BA258 $7.00 BA313 $7.00
BA3 $7.00 BA259 $7.00 BA314 $7.00
BA4 $7.00 BA260 $7.00 BA316 $7.00
BA5 $7.00 BA261 $7.00 BA319 $7.00
BA6 $7.00 BA262 $7.00 BA320 $5.00
BA7 $7.00 BA263 $7.00 BA322 $7.00
BA8 $7.00 BA264 $7.00 BA323 $7.00
BA9 $7.00 BA265 $7.00 BA324 $7.00
BA10 $7.00 BA266 $7.00 BA325 $7.00
BA11 $7.00 BA267 $7.00 BA326 $7.00
BA12 $7.00 BA268 $7.00 BA327 $7.00
BA13 $7.00 BA269 $7.00 BA328 $7.00
BA14 $7.00 BA270 $5.00 BA330 $7.00
BA15 $7.00 BA271 $7.00 BA331 $7.00
BA16 $7.00 BA272 $7.00 BA333 $7.00
BA17 $7.00 BA274 $7.00 BA334 $7.00
BA18 $7.00 BA275 $7.00 BA335 $7.00
BA19 $7.00 BA276 $5.00 BA336 $7.00
BA20 $7.00 BA277 $7.00 BA337 $7.00
BA21 $7.00 BA278 $5.00 BA338 $7.00
BA22 $7.00 BA279 $7.00 BA339 $7.00
BA23 $7.00 BA280 $7.00 BA340 $7.00
BA24 $7.00 BA281 $7.00 BA341 $7.00
BA25 $7.00 BA282 $7.00 BA342 $7.00
BA26 $7.00 BA283 $7.00 BA343 $7.00
BA27 $7.00 BA284 $7.00 BA344 $7.00
BA28 $7.00 BA285 $7.00 BA345 $7.00
BA29 $7.00 BA286 $7.00 BA346 $7.00
BA30 $7.00 BA287 $7.00 BA347 $7.00
BA31 $7.00 BA288 $7.00 BA348 $7.00
BA32 $7.00 BA289 $7.00 BA349 $7.00
BA33 $7.00 BA290 $7.00 BA350 $7.00
BA34 $7.00 BA291 $7.00 BA352 $7.00
BA35 $7.00 BA292 $7.00 BA353 $7.00
BA36 $7.00 BA293 $7.00 BA354 $7.00
BA37 $7.00 BA294 $7.00 BA355 $7.00
BA220 $7.00 BA295 $7.00 BA356 $7.00
BA221 $7.00 BA297 $7.00 BA357 $7.00
BA222 $7.00 BA298 $7.00 BA358 $7.00
BA247 $7.00 BA299 $7.00 BA359 $7.00
BA248 $7.00 BA301 $7.00 BA360 $7.00
BA249 $7.00 BA303 $7.00 BA361 $7.00
BA250 $5.00 BA304 $7.00 BA362 $7.00
BA251 $7.00 BA305 $7.00 BA364 $7.00
BA252 $7.00 BA306 $7.00 BA365 $7.00
BA253 $7.00 BA307 $7.00 BA366 $7.00
BA254 $7.00 BA308 $7.00 BA367 $7.00
BA255 $7.00 BA310 $7.00 BA368 $7.00
BA256 $7.00 BA311 $7.00 BA369 $7.00
TERAPIA FÍSICA Códigos de Cubiertas/Copagos
08-13-2015
61
CÓDIGO COASEGURO CÓDIGO COASEGURO CÓDIGO COASEGURO
BA370 $7.00 BA429 $7.00 * *
BA371 $7.00 BA430 $7.00 * *
BA372 $7.00 BA431 $7.00 * *
BA373 $7.00 BA432 $7.00 * *
BA375 $7.00 BA433 $7.00 * *
BA377 $7.00 BA434 $7.00 * *
BA378 $7.00 BA435 $5.00 * *
BA379 $7.00 BA436 $7.00 * *
BA380 $7.00 BA437 $7.00 * *
BA382 $7.00 BA438 $7.00 * *
BA383 $7.00 BA439 $7.00 * *
BA384 $7.00 BA440 $7.00 * *
BA385 $7.00 BA462 $7.00 * *
BA386 $7.00 BA463 $7.00 * *
BA387 $7.00 BA464 $7.00 * *
BA389 $7.00 BA465 $7.00 * *
BA390 $7.00 BA466 $7.00 * *
BA391 $7.00 BA467 $7.00 * *
BA392 $7.00 BA468 $5.00 * *
BA393 $7.00 BA469 $7.00 * *
BA394 $7.00 BA470 $7.00 * *
BA395 $7.00 BA471 $7.00 * *
BA396 $7.00 BA472 $7.00 * *
BA397 $7.00 BA473 $7.00 * *
BA398 $7.00 BA474 $7.00 * *
BA399 $7.00 BA475 $7.00 * *
BA400 $7.00 BA476 $7.00 * *
BA401 $7.00 BA496 $7.00 * *
BA402 $7.00 BA498 $7.00 * *
BA403 $7.00 BA499 $7.00 * *
BA404 $7.00 BA500 $7.00 * *
BA405 $5.00 BA517 $7.00 * *
BA406 $7.00 BA518 $7.00 * *
BA407 $7.00 BA519 $7.00 * *
BA408 $7.00 BA520 $7.00 * *
BA409 $7.00 BA521 $7.00 * *
BA410 $7.00 BA522 $7.00 * *
BA411 $7.00 * * * *
BA412 $7.00 * * * *
BA415 $5.00 * * * *
BA416 $7.00 * * * *
BA417 $5.00 * * * *
BA418 $7.00 * * * *
BA419 $7.00 * * * *
BA420 $7.00 * * * *
BA421 $7.00 * * * *
BA422 $7.00 * * * *
BA423 $7.00 * * * *
BA424 $7.00 * * * *
BA426 $7.00 * * * *