CÓDIGOS DE CUBIERTAS / COPAGOS VISITAS SIQUIÁTRICAS Y...

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CÓDIGOS DE CUBIERTAS / COPAGOS 1 08/13/2015 VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS A-01 NADA # # A-26 g $10.00 20 12 A-01 NADA # A-26 $5.00 20 A-02 $15.00 # # A-27 $12.00 # # A-02 $5.00 # A-27 $5.00 # A-03 gt $10.00 20 b A-28 g $10.00 15 12 A-03 t $5.00 20 A-28 $5.00 20 A-04 $10.00 # # A-29 g $15.00 20 12 A-04 $5.00 # A-29 $5.00 20 A-05 g $15.00 20 12 A-30 g $15.00 # # A-05 $5.00 20 A-30 $5.00 # A-06 g $10.00 20 12 A-31 g r $15.00 20 12 A-06 $5.00 20 A-31 NADA 20 A-07 * * * A-32 g $9.00 20 12 A-07 * * A-32 $5.00 20 A-08 g $10.00 20 12 A-33 $10.00 # # A-08 $5.00 20 A-33 $5.00 # A-09 NADA # # A-34 g $10.00 20 b A-09 NADA # A-34 $5.00 20 A-10 $15.00 # # A-35 g $10.00 20 12 A-10 $5.00 20 A-35 $5.00 20 A-11 g $15.00 20 12 A-36 g $15.00 20 12 A-11 $5.00 20 A-36 $5.00 20 A-12 g $15.00 20 12 A-37 $12.00 # # A-12 $5.00 20 A-37 $5.00 # A-13 $10.00 A-38 g $10.00 20 12 A-13 NADA * A-38 $5.00 20 A-14 g $15.00 20 12 A-39 g $5.00 20 12 A-14 $5.00 20 A-39 $5.00 20 A-15 $15.00 # # A-40 * * * A-15 $5.00 # A-40 * * A-16 $20.00 # # A-41 s t $18.00 20 12 A-16 $5.00 # A-41 t $5.00 20 A-17 g $10.00 20 12 A-42 * * * A-17 $5.00 20 A-42 * * A-18 * * * A-43 g $10.00 20 12 A-18 * * A-43 $5.00 20 A-19 $10.00 # # A-44 g $15.00 20 12 A-19 $10.00 # A-44 $5.00 20 A-20 $15.00 # # A-45 go $15.00 20 12 A-20 $5.00 # A-45 $5.00 20 A-21 $15.00 # # A-46 $18.00 # # A-21 $5.00 # A-46 $5.00 # A-22 $15.00 15 15 A-47 * * * A-22 $5.00 15 A-47 * * A-23 $15.00 15 15 A-48 g $10.00 20 12 A-23 $5.00 15 A-48 $5.00 20 A-24 * * * A-49 ogt $12.00 20 b A-24 * * A-49 o,i $5.00 20 A-25 g $15.00 15 15 A-50 g $10.00 20 12 A-25 $5.00 20 A-50 $5.00 20

Transcript of CÓDIGOS DE CUBIERTAS / COPAGOS VISITAS SIQUIÁTRICAS Y...

Page 1: CÓDIGOS DE CUBIERTAS / COPAGOS VISITAS SIQUIÁTRICAS Y ...services.ssspr.com/...colaterales-terapia-grupo.pdf · cÓdigos de cubiertas / copagos 1 08/13/2015 visitas siquiÁtricas

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

A-01 NADA # # A-26 g $10.00 20 12 A-01 NADA # A-26 $5.00 20

A-02 $15.00 # # A-27 $12.00 # # A-02 $5.00 # A-27 $5.00 #

A-03 gt $10.00 20 b A-28 g $10.00 15 12 A-03 t $5.00 20 A-28 $5.00 20

A-04 $10.00 # # A-29 g $15.00 20 12 A-04 $5.00 # A-29 $5.00 20

A-05 g $15.00 20 12 A-30 g $15.00 # # A-05 $5.00 20 A-30 $5.00 #

A-06 g $10.00 20 12 A-31 g r $15.00 20 12 A-06 $5.00 20 A-31 NADA 20

A-07 * * * A-32 g $9.00 20 12 A-07 * * A-32 $5.00 20

A-08 g $10.00 20 12 A-33 $10.00 # # A-08 $5.00 20 A-33 $5.00 #

A-09 NADA # # A-34 g $10.00 20 b A-09 NADA # A-34 $5.00 20

A-10 $15.00 # # A-35 g $10.00 20 12 A-10 $5.00 20 A-35 $5.00 20

A-11 g $15.00 20 12 A-36 g $15.00 20 12 A-11 $5.00 20 A-36 $5.00 20

A-12 g $15.00 20 12 A-37 $12.00 # # A-12 $5.00 20 A-37 $5.00 #

A-13 $10.00 A-38 g $10.00 20 12 A-13 NADA * A-38 $5.00 20

A-14 g $15.00 20 12 A-39 g $5.00 20 12 A-14 $5.00 20 A-39 $5.00 20

A-15 $15.00 # # A-40 * * * A-15 $5.00 # A-40 * *

A-16 $20.00 # # A-41 s t $18.00 20 12 A-16 $5.00 # A-41 t $5.00 20

A-17 g $10.00 20 12 A-42 * * * A-17 $5.00 20 A-42 * *

A-18 * * * A-43 g $10.00 20 12 A-18 * * A-43 $5.00 20

A-19 $10.00 # # A-44 g $15.00 20 12 A-19 $10.00 # A-44 $5.00 20

A-20 $15.00 # # A-45 go $15.00 20 12 A-20 $5.00 # A-45 $5.00 20

A-21 $15.00 # # A-46 $18.00 # # A-21 $5.00 # A-46 $5.00 #

A-22 $15.00 15 15 A-47 * * * A-22 $5.00 15 A-47 * *

A-23 $15.00 15 15 A-48 g $10.00 20 12 A-23 $5.00 15 A-48 $5.00 20

A-24 * * * A-49 ogt $12.00 20 b A-24 * * A-49 o,i $5.00 20

A-25 g $15.00 15 15 A-50 g $10.00 20 12 A-25 $5.00 20 A-50 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

A-01 NADA # # A-26 g $10.00 20 12 A-01 NADA # A-26 $5.00 20

A-02 $15.00 # # A-27 $12.00 # # A-02 $5.00 # A-27 $5.00 #

A-03 gt $10.00 20 b A-28 g $10.00 15 12 A-03 t $5.00 20 A-28 $5.00 20

A-04 $10.00 # # A-29 g $15.00 20 12 A-04 $5.00 # A-29 $5.00 20

A-05 g $15.00 20 12 A-30 g $15.00 # # A-05 $5.00 20 A-30 $5.00 #

A-06 g $10.00 20 12 A-31 g r $15.00 20 12 A-06 $5.00 20 A-31 NADA 20

A-07 * * * A-32 g $9.00 20 12 A-07 * * A-32 $5.00 20

A-08 g $10.00 20 12 A-33 $10.00 # # A-08 $5.00 20 A-33 $5.00 #

A-09 NADA # # A-34 g $10.00 20 b A-09 NADA # A-34 $5.00 20

A-10 $15.00 # # A-35 g $10.00 20 12 A-10 $5.00 20 A-35 $5.00 20

A-11 g $15.00 20 12 A-36 g $15.00 20 12 A-11 $5.00 20 A-36 $5.00 20

A-12 g $15.00 20 12 A-37 $12.00 # # A-12 $5.00 20 A-37 $5.00 #

A-13 $10.00 A-38 g $10.00 20 12 A-13 NADA * A-38 $5.00 20

A-14 g $15.00 20 12 A-39 g $5.00 20 12 A-14 $5.00 20 A-39 $5.00 20

A-15 $15.00 # # A-40 * * * A-15 $5.00 # A-40 * *

A-16 $20.00 # # A-41 s t $18.00 20 12 A-16 $5.00 # A-41 t $5.00 20

A-17 g $10.00 20 12 A-42 * * * A-17 $5.00 20 A-42 * *

A-18 * * * A-43 g $10.00 20 12 A-18 * * A-43 $5.00 20

A-19 $10.00 # # A-44 g $15.00 20 12 A-19 $10.00 # A-44 $5.00 20

A-20 $15.00 # # A-45 go $15.00 20 12 A-20 $5.00 # A-45 $5.00 20

A-21 $15.00 # # A-46 $18.00 # # A-21 $5.00 # A-46 $5.00 #

A-22 $15.00 15 15 A-47 * * * A-22 $5.00 15 A-47 * *

A-23 $15.00 15 15 A-48 g $10.00 20 12 A-23 $5.00 15 A-48 $5.00 20

A-24 * * * A-49 ogt $12.00 20 b A-24 * * A-49 o,i $5.00 20

A-25 g $15.00 15 15 A-50 g $10.00 20 12 A-25 $5.00 20 A-50 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DE TERAPIAS

A-51 g $10.00 15 15 A-76 $15.00 # # A-51 $7.00 15 A-76 $5.00 #

A-52 g $18.00 20 12 A-77 g $7.00 20 12 A-52 $5.00 20 A-77 $5.00 20

A-53 g $15.00 20 12 A-78 g $3.00 20 12 A-53 $5.00 20 A-78 $5.00 20

A-54 g $10.00 20 12 A-79 g $12.00 20 12 A-54 $5.00 20 A-79 $5.00 20

A-55 g $10.00 20 12 A-80 $20.00 # # A-55 $5.00 20 A-80 $5.00 #

A-56 g $10.00 20 12 A-81 g $15.00 20 12 A-56 $5.00 20 A-81 $5.00 20

A-57 g $10.00 20 U A-82 g $12.00 20 12 A-57 U u A-82 $5.00 20

A-58 * * * A-83 g $10.00 20 12 A-58 * * A-83 $5.00 20

A-59 g $10.00 20 12 A-84 $35.00 # # A-59 $5.00 20 A-84 $5.00 #

A-60 g $15.00 20 12 A-85 g $10.00 20 12 A-60 $5.00 20 A-85 $5.00 20

A-61 g $15.00 20 12 A-86 g $12.00 20 12 A-61 $5.00 20 A-86 $5.00 20

A-62 * * * A-87 * * * A-62 * * A-87 * *

A-63 * * * A-88 g $15.00 15 115 A-63 * * A-88 $5.00 15

A-64 * * * A-89 $15.00 # # A-64 * * A-89 $10.00 #

A-65 g $10.00 20 12 A-90 * * * A-65 $5.00 20 A-90 * *

A-66 $15.00 # # A-91 $15.00 # # A-66 $15.00 # A-91 $10.00 #

A-67 g NADA 20 12 A-92 $15.00 # # A-67 NADA 20 A-92 $7.00 #

A-68 g $15.00 20 12 A-93 $12.00 # # A-68 $5.00 20 A-93 $10.00 #

A-69 g $12.00 15 N/C A-94 g $12.00 20 12 A-69 N/C N/C A-94 $5.00 20

A-70 g $15.00 20 12 A-95 g $10.00 E e A-70 $5.00 20 A-95 $10.00 E

A-71 $15.00 # # A-96 $10.00 # # A-71 $5.00 # A-96 $5.00 #

A-72 g $7.00 15 12 A-97 g $12.00 20 b A-72 i $5.00 20 A-97 $5.00 20

A-73 g $15.00 15 15 A-98 b 50% # # A-73 $5.00 15 A-98 50% #

A-74 $6.00 15 15 A-99 g $15.00 # # A-74 t $6.00 15 A-99 $7.00 #

A-75 g $12.00 20 12 AA-01 $15.00 # # A-75 $5.00 20 AA-01 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AA-02 $20.00 # # AA-27g $7.00 20 12 AA-02 $5.00 # AA-27 $5.00 20

AA-03 g $2.00 12 12 AA-28 t N/C N/C N/C AA-03 $2.00 20 AA-28 t N/C N/C

AA-04 € € € AA-29 $15.00 # # AA-04 € € AA-29 $15.00 #

AA-05 t $12.00 30 30 AA-30 g t $12.00 20 12 AA-05 t $5.00 30 AA-30 t $6.50 20

AA-06 $10.00 # # AA-31 g t $10.00 20 b AA-06 $10.00 # AA-31 t $5.00 20

AA-07 g $15.00 20 12 AA-32 g $15.00 20 b AA-07 $5.00 20 AA-32 $5.00 20

AA-08 g $10.00 15 15 AA-33gpuv $10.00 20 N/C AA-08 $7.00 15 AA-33 N/C N/C

AA-09 € € € AA-34 * * * AA-09 € € AA-34 * *

AA-10 $15.00 # # AA-35 g $7.00 15 15 AA-10 $5.00 # AA-35 $5.00 15

AA-11 $12.00 # # AA-36 g $15.00 20 12 AA-11 $5.00 # AA-36 $5.00 20

AA-12 g $12.00 # # AA-37 $15.00 # # AA-12 $5.00 # AA-37 $5.00 #

AA-13 g $15.00 15 12 AA-38 g $15.00 20 12 AA-13 $5.00 20 AA-38 $5.00 20

AA-14 $12.00 # # AA-39 * * * AA-14 $5.00 # AA-39 * *

AA-15 gt $21.00 20 N/C AA-40 g $7.00 20 12 AA-15 t N/C N/C AA-40 $5.00 20

AA-16 $15.00 20 12 AA-41 g $15.00 20 12 AA-16 $5.00 20 AA-41 $5.00 20

AA-17 g $15.00 20 12 AA-42 $15.00 # # AA-17 $5.00 20 AA-42 $15.00 #

AA-18 g $12.00 20 12 AA-43 * * * AA-18 $5.00 20 AA-43 * *

AA-19 $18.00 # # AA-44 g $15.00 20 12 AA-19 $5.00 # AA-44 $5.00 20

AA-20 NADA # # AA-45 g $15.00 20 12 AA-20 NADA # AA-45 $5.00 20

AA-21 g $10.00 20 12 AA-46 g $15.00 20 12 AA-21 $5.00 20 AA-46 $5.00 20

AA-22 g $15.00 20 12 AA-47 g $12.00 20 N/C AA-22 $5.00 20 AA-47 N/C N/C

AA-23 g $10.00 20 12 AA-48 * * * AA-23 $5.00 20 AA-48 * *

AA-24 g $10.00 20 12 AA-49 g $15.00 20 N/C AA-24 $5.00 20 AA-49 N/C N/C

AA-25 g $15.00 15 N/C AA-50 $15.00 # # AA-25 N/C N/C AA-50 $5.00 #

AA-26 $10.00 # # AA-51 g $15.00 20 N/C AA-26 $5.00 # AA-51 N/C N/C

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AA-52 $15.00 # # AA-77ag $10.00 15 12 AA-52 $5.00 # AA-77 a $7.00 15

AA-53 g $10.00 20 12 AA-78 g $10.00 15 12 AA-53 $5.00 20 AA-78 $7.00 15

AA-54 g * * * AA-79ag $12.00 15 8 AA-54 * * AA-79 a N/C N/C

AA-55 og $10.00 20 12 AA-80 g $12.00 15 8 AA-55 oi $5.00 20 AA-80 N/C N/C

AA-56 $15.00 20 12 AA-81 * * * AA-56 $5.00 20 AA-81 * *

AA-57 H 12 12 AA-82 g $15.00 # # AA-57 h 20 AA-82 $5.00 #

AA-58 g $15.00 20 12 AA-83 g $10.00 20 12 AA-58 $5.00 20 AA-83 $5.00 20

AA-59 g $15.00 15 8 AA-84 $15.00 # # AA-59 N/C AA-84 $5.00 #

AA-60g, $10.00 # # AA-85 g $10.00 20 12 AA-60 $5.00 # AA-85 $5.00 20

AA-61 * * * AA-86 g $15.00 20 12 AA-61 * * AA-86 $5.00 20

AA-62g, $10.00 20 12 AA-87 g $15.00 20 12 AA-62 $5.00 20 AA-87 $5.00 20

AA-63g, $10.00 # # AA-88 g $15.00 20 12 AA-63 $5.00 # AA-88 $5.00 20

AA-64 g $10.00 20 12 AA-89 $15.00 15 8 AA-64 $5.00 20 AA-89 N/C

AA-65 g $10.00 20 12 AA-90 g * * * AA-65 $5.00 20 AA-90 * *

AA-66g, $12.00 #, € #, € AA-91 g $7.00 30 12 AA-66 $12.00 #, € AA-91 $5.00 20

AA-67 g $15.00 20 12 AA-92g, $15.00 # # AA-67 $5.00 20 AA-92 $5.00 #

AA-68 $10.00 20 12 AA-93 g $10.00 20 12 AA-68 $5.00 20 AA-93 $5.00 20

AA-69 $20.00 #, € #, € AA-94 g, $12.00 # # AA-69 $20.00 #, € AA-94 $5.00 #

AA-70 g, $10.00 # # AA-95 g $5.00 20 12 AA-70 $5.00 # AA-95 $5.00 20

AA-71 g $10.00 20 12 AA-96 g $12.00 15 12 AA-71 $5.00 20 AA-96 $5.00 20

AA-72 $6.00 15 15 AA-97 g $15.00 20 12 AA-72 $6.00 15 AA-97 $5.00 20

AA-73og $12.00 20 12 AA-98 g $15.00 20 12 AA-73o i $5.00 20 AA-98 $5.00 20

AA-74 g $10.00 15 12 AA-99 g $10.00 20 12 AA-74 $7.00 15 AA-99 $5.00 20

AA-75 g $15.00 # # AB-01 $10.00 # # AA-75 $5.00 # AB-01 $10.00 #

AA-76 g $12.00 20 12 AB-02 g, $15.00 # # AA-76 $5.00 20 AB-02 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AB-03 * * * AB-28 g $10.00 20 12 AB-03 * * AB-28 $5.00 20

AB-04g, $10.00 # # AB-29 g $7.00 30 12 AB-04 $5.00 # AB-29 $5.00 20

AB-05 g $18.00 20 12 AB-30 g $15.00 20 12 AB-05 $5.00 20 AB-30 $5.00 20

AB-06 g $15.00 15 b AB-31 * * * AB-06 $5.00 20 AB-31 * *

AB-07go $15.00 20 12 AB-32 $18.00 # # AB-07 $5.00 20 AB-32 $5.00 #

AB-08 g $15.00 20 12 AB-33 g $10.00 20 12 AB-08 $5.00 20 AB-33 $5.00 20

AB-09 g $20.00 # # AB-34g $15.00 20 12 AB-09 $5.00 # AB-34 $5.00 20

AB-10 g $18.00 # # AB-35 $7.00 X X AB-10 $5.00 # AB-35 * *

AB-11 g $12.00 # # AB-36 $15.00 # # AB-11 $5.00 # AB-36 $5.00 #

AB-12 g $15.00 20 12 AB-37 g $12.00 # # AB-12 $5.00 20 AB-37 $5.00 #

AB-13 g $15.00 20 12 AB-38 $15.00 # # AB-13 $5.00 20 AB-38 $5.00 #

AB-14 g $10.00 20 12 AB-39 g $10.00 20 12 AB-14 $5.00 20 AB-39 $5.00 20

AB-15 $20.00 # # AB-40 $12.00 X X AB-15 $5.00 # AB-40 * *

AB-16 $15.00 # # AB-41 g $7.00 20 12 AB-16 $5.00 # AB-41 $5.00 20

AB-17 g $10.00 30 12 AB-42 g $15.00 20 12 AB-17 $5.00 20 AB-42 $5.00 20

AB-18 g $15.00 20 12 AB-43 g $10.00 20 12 AB-18 $5.00 20 AB-43 $5.00 20

AB-19 g $10.00 20 12 AB-44 g $15.00 15 15 AB-19 $5.00 20 AB-44 $5.00 15

AB-20 g $15.00 20 12 AB-45 $10.00 # # AB-20 $5.00 20 AB-45 $5.00 #

AB-21 * * * AB-46 g $15.00 20 12 AB-21 * * AB-46 $5.00 20

AB-22 g $15.00 20 12 AB-47 $10.00 # # AB-22 $5.00 20 AB-47 $5.00 #

AB-23 * * * AB-48 g $10.00 20 12 AB-23 * * AB-48 $5.00 20

AB-24 g $10.00 20 12 AB-49 $12.00 12 12 AB-24 $5.00 20 AB-49 $5.00 20

AB-25 $12.00 # # AB-50 g $15.00 20 12 AB-25 $5.00 # AB-50 $5.00 20

AB-26 $15.00 # # AB-51 g $10.00 20 12 AB-26 $5.00 # AB-51 $5.00 20

AB-27 * * * AB-52 g $12.00 20 12 AB-27 * * AB-52 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AB-53 g $10.00 20 12 AB-78 g $10.00 20 12 AB-53 $5.00 20 AB-78 $5.00 20

AB-54 $2.00 # # AB-79 g $12.00 20 12 AB-54 NADA # AB-79 $5.00 20

AB-55 g $15.00 20 12 AB-80 g $15.00 20 12 AB-55 $5.00 20 AB-80 $5.00 20

AB-56 g $15.00 20 12 AB-81 g $8.00 20 12 AB-56 $5.00 20 AB-81 $5.00 20

AB-57 $15.00 # # AB-82 g $15.00 20 12 AB-57 $15.00 # AB-82 $5.00 20

AB-58 g $15.00 20 12 AB-83 $15.00 # # AB-58 $5.00 20 AB-83 $5.00 #

AB-59 * * * AB-84 $15.00 # # AB-59 * * AB-84 $5.00 #

AB-60 g $15.00 20 12 AB-85 g $5.00 20 12 AB-60 $5.00 20 AB-85 $5.00 20

AB-61 g $15.00 20 12 AB-86 g $10.00 20 12 AB-61 $5.00 20 AB-86 $5.00 20

AB-62 NADA # # AB-87 g * * * AB-62 NADA # AB-87 * *

AB-63 * * * AB-88 g $15.00 20 12 AB-63 * * AB-88 $5.00 20

AB-64 $8.00 # # AB-89 $10.00 # # AB-64 f $8.00 # AB-89 $5.00 #

AB-65 g $15.00 20 12 AB-90 $15.00 # # AB-65 $5.00 20 AB-90 $15.00 #

AB-66 g $7.00 20 12 AB-91 $15.00 # # AB-66 $5.00 20 AB-91 $15.00 #

AB-67 $10.00 # # AB-92 * * * AB-67 $15.00 # AB-92 * *

AB-68 g $15.00 20 12 AB-93 g * * * AB-68 $5.00 20 AB-93 * *

AB-69 $8.00 # # AB-94 g, $15.00 20 12 AB-69 $10.00 # AB-94 $15.00 20

AB-70 g $7.00 20 12 AB-95 g $10.00 20 12 AB-70 $5.00 20 AB-95 $5.00 20

AB-71 $15.00 # # AB-96 $20.00 # # AB-71 $5.00 # AB-96 $5.00 #

AB-72 * * * AB-97 ot $15.00 20 N/C AB-72 * * AB-97iot N/C N/C

AB-73 g $10.00 20 12 AB-98 € € € AB-73 $5.00 20 AB-98 € €

AB-74 g $12.00 20 12 AB-99 $20.00 # # AB-74 $5.00 20 AB-99 $5.00 #

AB-75 g $7.00 20 12 AC-01 g * * * AB-75 $5.00 20 AC-01 y y

AB-76 $15.00 # # AC-02 $15.00 # # AB-76 $5.00 # AC-02 $5.00 #

AB-77 g $10.00 20 12 AC-03 $15.00 # # AB-77 $5.00 20 AC-03 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AC-04 g $15.00 20 12 AC-29 * * * AC-04 $5.00 20 AC-29 oi * *

AC-05 g $12.00 20 12 AC-30 * * * AC-05 $5.00 20 AC-30 * *

AC-06 $22.00 # # AC-31 * * * AC-06 $5.00 # AC-31 * *

AC-07 * * * AC-32 g $10.00 30 12 AC-07 * * AC-32 $5.00 20

AC-08 t $7.00 # # AC-33 * * * AC-08 t $5.00 # AC-33 * *

AC-09 g $15.00 20 12 AC-34 * * * AC-09 * * AC-34 * *

AC-10 g $12.00 20 b AC-35 g $15.00 15 15 AC-10 $5.00 20 AC-35 15 15

AC-11 $10.00 # # AC-36 ¥ $5.00 15 15 AC-11 $5.00 # AC-36 ¥ $5.00 15

AC-12 g $15.00 20 12 AC-37 g $15.00 20 12 AC-12 $5.00 20 AC-37 $5.00 20

AC-13 g $15.00 20 12 AC-38 g $10.00 20 12 AC-13 $5.00 20 AC-38 $5.00 20

AC-14 g $15.00 20 12 AC-39 g $12.00 20 12 AC-14 $5.00 20 AC-39 $5.00 20

AC-15 g $15.00 20 12 AC-40 g $10.00 20 12 AC-15 $5.00 20 AC-40 $5.00 20

AC-16 g $15.00 20 12 AC-41 * * * AC-16 $5.00 20 AC-41 * *

AC-17 * * * AC-42 $15.00 # # AC-17 * * AC-42 $5.00 #

AC-18 g $8.00 20 12 AC-43 * * * AC-18 $5.00 20 AC-43 * *

AC-19 g * * * AC-44 g $10.00 p q q AC-19 * * AC-44 $10.00 q

AC-20 g $10.00 20 15 AC-45 * * * AC-20 $5.00 20 AC-45 * *

AC-21 g $10.00 20 12 AC-46 * * * AC-21 $5.00 20 AC-46 * *

AC-22 g $12.00 20 12 AC-47 g $15.00 20 12 AC-22 $5.00 20 AC-47 $5.00 20

AC-23 g $12.00 20 12 AC-48 g $15.00 20 12 AC-23 $5.00 20 AC-48 $5.00 20

AC-24 g $15.00 20 15 AC-49 y AC-24 $5.00 15 AC-49 y

AC-25 g $15.00 20 12 AC-50 g $15.00 20 12 AC-25 $5.00 20 AC-50 $5.00 20

AC-26 * * * AC-51 $18.00 # # AC-26 * * AC-51 $5.00 #

AC-27 * * * AC-52 $15.00 # # AC-27 * * AC-52 $5.00 #

AC-28 * * * AC-53 $10.00 # # AC-28 i * * AC-53 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DE TERAPIAS CUBIERTA COA/DED TERAPIAS

AC-54 t N/C N/C N/C AC-80 g $15.00 20 12 AC-54 t N/C N/C AC-80 $5.00 20

AC-55 $10.00 # # AC-81 g $3.00 20 12 AC-55 $10.00 # AC-81 $5.00 20

AC-56 g $12.00 20 12 AC-82 g $10.00 15 15 AC-56 $5.00 20 AC-82 $5.00 15

AC-57 $7.00 # # AC-83 g $15.00 20 12 AC-57 $7.00 # AC-83 $5.00 20

AC-58 g,u $10.00 20 12 AC-84 $10.00 # # AC-58 N/C N/C AC-84 $5.00 #

AC-59 g $10.00 20 12 AC-85 g, $7.00 20 12 AC-59 $5.00 20 AC-85 $5.00 20

AC-60 € € € AC-86 $18.00 # # AC-60 € € AC-86 $5.00 #

AC-61 g $5.00 20 12 AC-87 $10.00 # # AC-61 $5.00 20 AC-87 $5.00 #

AC-62 * * * AC-88 g $15.00 20 12 AC-62 * * AC-88 $5.00 20

AC-63 g $12.00 20 12 AC-89 $15.00 # # AC-63 50% 20 AC-89 $5.00 #

AC-64 g $10.00 20 12 AC-90 $12.00 20 b, s AC-64 $5.00 20 AC-90 $5.00 20

AC-65 g $10.00 20 b AC-91 * * * AC-65 i $5.00 20 AC-91 * *

AC-66 g $15.00 15 N/C AC-92 g $15.00 20 12 AC-66 N/C N/C AC-92 $5.00 20

AC-67 a,g $15.00 20 12 AC-93 y AC-67 a $5.00 20 AC-93 y

AC-68 * * * AC-94 g $15.00 20 12 AC-68 * * AC-94 $5.00 20

AC-69 g $10.00 20 12 AC-95 $15.00 # # AC-69 $5.00 20 AC-95 $5.00 #

AC-70 $18.00 # # AC-96 g $12.00 20 12 AC-70 $5.00 # AC-96 $5.00 20

AC-71 $15.00 # # AC-97 g $7.00 20 12 AC-71 $5.00 # AC-97 $5.00 20

AC-72 g $15.00 20 12 AC-98 $12.00 # # AC-72 $5.00 20 AC-98 $5.00 #

AC-73 s $12.00 20 12 AC-99 g $20.00 20 12 AC-73 $5.00 20 AC-99 $5.00 20

AC-74 $10.00 # # AD-18 g $10.00 15 12 AC-74 $5.00 # AD-18 $5.00 20

AC-75 $12.00 # # AD-21 g $7.00 20 12 AC-75 $5.00 # AD-21 $5.00 20

AC-76 $15.00 # # AD-22 g $10.00 20 12 AC-76 NADA # AD-22 $5.00 20

AC-77 $15.00 # # AD-23 g $20.00 20 12 AC-77 $5.00 # AD-23 $5.00 20

AC-78 $12.00 # # AD-24 g $15.00 20 12 AC-78 $5.00 # AD-24 $5.00 20

AC-79 gi $15.00 20 12 AC-79 i $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AD-25 $12.00 20 12 AD-50 g $10.00 15 12 AD-25 $5.00 20 AD-50 $7.00 15

AD-26 g $10.00 20 12 AD-51 g $15.00 20 12 AD-26 $5.00 20 AD-51 $5.00 20

AD-27 $15.00 20 12 AD-52 g $7.00 20 12 AD-27 $5.00 20 AD-52 $5.00 20

AD-28 $15.00 20 12 AD-53 s,x $15.00 20 12 AD-28 $5.00 20 AD-53 $5.00 20

AD-29 $10.00 # # AD-54 g $8.00 20 12 AD-29 $10.00 # AD-54 $5.00 20

AD-30 g $12.00 15 12 AD-55 g $10.00 20 12 AD-30 $5.00 20 AD-55 $5.00 20

AD-31 g $12.00 20 12 AD-56 g $10.00 20 12 AD-31 $5.00 20 AD-56 $5.00 20

AD-32 g $15.00 20 12 AD-57 $8.00 # # AD-32 $5.00 20 AD-57 $5.00 #

AD-33 $9.00 # # AD-58 $15.00 # # AD-33 $5.00 # AD-58 $5.00 #

AD-34 $12.00 # # AD-59 g $8.00 20 12 AD-34 $5.00 # AD-59 $5.00 20

AD-35 g $10.00 20 12 AD-60 $10.00 p q q AD-35 $5.00 20 AD-60 $10.00 q

AD-36 y * * * AD-61 $15.00 # # AD-36 y * * AD-61 $5.00 #

AD-37 y * * * AD-62 g $12.00 20 12 AD-37 y * * AD-62 $5.00 20

AD-38 y * * * AD-63 * * * AD-38 y * * AD-63 * *

AD-39 y * * * AD-64 $15.00 # # AD-39 y * * AD-64 $5.00 #

AD-40 $15.00 # # AD-65 g $20.00 20 12 AD-40 $5.00 # AD-65 $5.00 20

AD-41 y * * * AD-66 * * * AD-41 y * * AD-66 * *

AD-42 * * * AD-67 * * * AD-42 * * AD-67 * *

AD-43 g $15.00 15 N/C AD-68 g $12.00 20 12 AD-43 N/C N/C AD-68 $5.00 20

AD-44 $15.00 # # AD-69 g $15.00 20 12 AD-44 $5.00 # AD-69 $5.00 20

AD-45 $12.00 20 12 AD-70 g $10.00 30 12 AD-45 $5.00 20 AD-70 $5.00 20

AD-46 $15.00 # # AD-71 g $15.00 15 15 AD-46 $7.00 # AD-71 $5.00 15

AD-47 g $10.00 20 12 AD-72 g $15.00 20 12 AD-47 $5.00 20 AD-72 $5.00 20

AD-48 * * * AD-73 g $10.00 20 12 AD-48 * * AD-73 $5.00 20

AD-49 NADA # # AD-74 g $10.00 20 12 AD-49 NADA # AD-74 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AD-75 g $10.00 20 12 AD-88 $15.00 20 12 AD-75 $5.00 20 AD-88 $5.00 20

AD-76 g $15.00 20 12 AD-89 $12.00 20 12 AD-76 $5.00 20 AD-89 $5.00 20

AD-77 g $10.00 50 50 AD-90 $10.00 20 12 AD-77 N/C N/C AD-90 $5.00 20

AD-78 g $10.00 20 12 AD-91 $15.00 20 12 AD-78 $5.00 20 AD-91 $5.00 20

AD-79 * * * AD-92 * * * AD-79 * * AD-92 * *

AD-80 g $15.00 20 12 AD-93 $15.00 20 12 AD-80 $5.00 20 AD-93 $5.00 20

AD-81 $8.00 # # AD-94 g $15.00 20 12 AD-81 $5.00 # AD-94 $5.00 20

AD-82 g $15.00 20 12 AD-95 $15.00 20 N/C AD-82 $5.00 20 AD-95 N/C N/C

AD-83 $15.00 # # AD-96 g $15.00 20 12 AD-83 $5.00 # AD-96 $5.00 20

AD-84 $10.00 # # AD-97 g $12.00 20 12 AD-84 $5.00 # AD-97 $5.00 20

AD-85 * * * AD-98 $7.00 30 12 AD-85 * * AD-98 $5.00 20

AD-86 $10.00 15 15 AD-99 y y y AD-86 $5.00 15 AD-99 * *

AD-87 $10.00 15 15 AE-01 $5.00 # # AD-87 $5.00 15 AE-01 $5.00 #

AE-02 $12.00 # # AE-14 $10.00 # # AE-02 $5.00 # AE-14 $5.00 #

AE-03 $15.00 # # AE-15 g $15.00 20 12 AE-03 $15.00 # AE-15 $5.00 20

AE-04 $10.00 # # AE-16 $10.00 # # AE-04 $5.00 # AE-16 $5.00 #

AE-05 $8.00 # # AE-17 g $7.00 12 12 AE-05 $5.00 # AE-17 NADA 20

AE-06 g $15.00 20 12 AE-18 g $7.00 12 12 AE-06 $15.00 20 AE-18 NADA 20

AE-07 g $15.00 20 12 AE-19 g $5.00 12 12 AE-07 $5.00 20 AE-19 NADA 20

AE-08 * * * AE-20 g $5.00 12 12 AE-08 * * AE-20 NADA 20

AE-09 * * * AE-21 $5.00 # # AE-09 * * AE-21 NADA #

AE-10 * * * AE-22 * * * AE-10 * * AE-22 * *

AE-11 $7.00 # # AE-23 $10.00 20 12 AE-11 $5.00 # AE-23 $5.00 20

AE-12 * * * AE-24 $12.00 # # AE-12 * * AE-24 $5.00 #

AE-13 $8.00 # # AE-25 $12.00 # # AE-13 $5.00 # AE-25 $5.00 #

AE-26 $15.00 # # AE-26 $5.00 #

AE-27 $15.00 # # AE-27 $5.00 #

AE-28 $10.00 # # AE-28 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AE-29 $20.00 # # AE-58 $15.00 # # AE-29 $10.00 # AE-58 $5.00 #

AE-30 g $15.00 20 12 AE-59 $15.00 15 15 AE-30 $5.00 20 AE-59 $5.00 15

AE-31 g $15.00 20 12 AE-60 * * * AE-31 $5.00 20 AE-60 * *

AE-32 g $15.00 20 12 AE-61 g $15.00 20 12 AB-32 $5.00 20 AE-61 N/C N/C

AE-33 $10.00 # # AE-62 * * * AE-33 $5.00 # AE-62 * *

AE-34 g $12.00 20 12 AE-63 * * * AE-34 $5.00 20 AE-63 * *

AE-35 g $12.00 20 12 AE-64 $15.00 20 N/C AE-35 $5.00 20 AE-64 N/C N/C

AE-36 $20.00 20 12 AE-65 $12.00 20 20 AE-36 $5.00 20 AE-65 $5.00 20

AE-37 $15.00 # # AE-66 $15.00 20 20 AE-37 $5.00 # AE-66 $5.00 20

AE-38 $15.00 20 12 AE-67 NADA 15 N/C AE-38 $5.00 20 AE-67 NADA N/C

AE-39 $18.00 20 12 AE-68 $15.00 # # AE-39 $5.00 20 AE-68 $5.00 #

AE-40 $7.00 20 12 AE-69 g $15.00 20 12 AE-40 $5.00 20 AE-69 $5.00 20

AE-41 $15.00 20 12 AE-70 g $15.00 20 20 AE-41 $5.00 20 AE-70 $5.00 20

AE-42 $18.00 # # AE-71 g $15.00 20 12 AE-42 $5.00 # AE-71 $5.00 20

AE-43 g $15.00 20 12 AE-72 $15.00 # # AE-43 $5.00 20 AE-72 $5.00 #

AE-44 * * * AE-73 $15.00 # # AE-44 * * AE-73 $5.00 #

AE-45 * * * AE-74 g $20.00 20 20 AE-45 * * AE-74 $5.00 20

AE-46 $15.00 20 12 AE-75 g $15.00 20 12 AE-46 $5.00 20 AE-75 $5.00 20

AE-47 g 15.00 20 12 AE-76 g $7.00 # # AE-47 $5.00 20 AE-76 $5.00 #

AE-48 g $6.00 20 N/C AE-77 g $15.00 20 12 AE-48 N/C N/C AE-77 $5.00 20

AE-49 $12.00 30 30 AE-78 g $15.00 20 12 AE-49 $5.00 20 AE-78 $5.00 20

AE-50 $10.00 30 30 AE-79 g $15.00 20 12 AE-50 $5.00 20 AE-79 $5.00 20

AE-51 $18.00 # # AE-80 g $20.00 20 12 AE-51 $5.00 # AE-80 $10.00 20

AE-52 20% # # AE-81 g $15.00 20 12 AE-52 20% # AE-81 $5.00 20

AE-53 $7.00 # # AE-82 y * * * AE-53 $7.00 # AE-82 y * *

AE-54 g $7.00 20 12 AE-83 $18.00 20 12 AE-54 $5.00 20 AE-83 N/C N/C

AE-55 $7.00 20 12 AE-84 * * * AE-55 $5.00 20 AE-84 * *

AE-56 $15.00 # # AE-85 y * * * AE-56 $5.00 # AE-85 y * *

AE-57 g $15.00 20 12 AE-86 g $15.00 20 12 AE-57 $5.00 20 AE-86 $5.00 20

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CÓDIGOS DE CUBIERTAS / COPAGOS

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AE-87 $15.00 # # AF-17 g $18.00 20 12 AE-87 $15.00 # AF-17 $5.00 20

AE-88 NADA # # AF-18 * * * AE-88 NADA # AF-18 * *

AE-89 g $15.00 20 12 AF-19 $10.00 20 12 AE-89 $5.00 20 AF-19 $7.00 20

AE-90 g $10.00 # # AF-20 $10.00 20 12 AE-90 $5.00 # AF-20 $7.00 20

AE-91 g $15.00 20 12 AF-21 $15.00 20 12 AE-91 $5.00 20 AF-21 N/C

AE-92 g $12.00 20 12 AF-22 * * * AE-92 $5.00 20 AF-22 * *

AE-93 g $10.00 E e AF-23 g $10.00 20 12 AE-93 $5.00 e AF-23 $5.00 20

AE-94 g $18.00 20 12 AF-24 g $15.00 20 12 AE-94 $5.00 20 AF-24 $5.00 20

AE-95 g $15.00 20 12 AF-25 g $15.00 20 12 AE-95 $5.00 20 AF-25 $5.00 20

AE-96 $12.00 # # AF-26 $15.00 20 12 AE-96 $5.00 # AF-26 $5.00 20

AE-97 g $10.00 20 12 AF-27 g $15.00 20 12 AE-97 $5.00 20 AF-27 $5.00 20

AE-98 g $12.00 20 12 AF-28 g $12.00 20 12 AE-98 $5.00 20 AF-28 $5.00 20

AE-99 $15.00 # # AF-29 o,g $15.00 20 12 AE-99 $5.00 # AF-29 $5.00 20

AF-01 g $18.00 20 12 AF-30 * * * AF-01 $5.00 20 AF-30 * *

AF-02 80% # # AF-31 $15.00 20 12 AF-02 80% # AF-31 N/C

AF-03 $12.00 # # AF-32 $15.00 20 12 AF-03 $12.00 # AF-32 $5.00 20

AF-04 $15.00 # # AF-33 g $15.00 20 12 AF-04 $5.00 # AF-33 $5.00 20

AF-05 $15.00 # # AF-34 g $10.00 20 12 AF-05 $5.00 # AF-34 $5.00 20

AF-06 * * * AF-35 g $12.00 20 12 AF-06 * * AF-35 $5.00 20

AF-07 $10.00 20 12 AF-36 $15.00 # # AF-07 $5.00 20 AF-36 $5.00 #

AF-08 g $15.00 12 12 AF-37 g $15.00 20 12 AF-08 $5.00 20 AF-37 $5.00 20

AF-09 g $15.00 12 12 AF-38 * * * AF-09 $5.00 20 AF-38 * *

AF-10 g $12.00 12 12 AF-39 * * * AF-10 $5.00 20 AF-39 * *

AF-11 $10.00 X X AF-40 $10.00 20 12 AF-11 $10.00 20 AF-40 $5.00 20

AF-12 $25.00 20 12 AF-41 $12.00 20 12 AF-12 $5.00 20 AF-41 $5.00 20

AF-13 $20.00 # # AF-42 * * * AF-13 $5.00 # AF-42 * *

AF-14 $15.00 # # AF-43 g $15.00 15 15 AF-14 $5.00 # AF-43 $5.00 15

AF-15 g $10.00 20 12 AF-44 $15.00 15 15 AF-15 $5.00 20 AF-44 $5.00 15

AF-16 g $15.00 20 12 AF-45 $20.00 # # AF-16 $5.00 20 AF-45 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AF-46 $8.00 20 20 AF-75 * * * AF-46 $5.00 20 AF-75 * *

AF-47 $10.00 15 15 AF-76 * * * AF-47 $5.00 15 AF-76 * *

AF-48 $10.00 15 15 AF-77 * * * AF-48 $5.00 15 AF-77 * *

AF-49 $12.00 15 15 AF-78 * * * AF-49 $5.00 15 AF-78 * *

AF-50 $12.00 15 15 AF-79 * * * AF-50 $5.00 15 AF-79 * *

AF-51 $15.00 15 15 AF-80 * * * AF-51 $5.00 15 AF-80 * *

AF-52 $15.00 15 15 AF-81 * * * AF-52 $5.00 15 AF-81 * *

AF-53 $18.00 # # AF-82 * * * AF-53 $5.00 # AF-82 * *

AF-54 $15.00 # # AF-83 * * * AF-54 $5.00 # AF-83 * *

AF-55 $18.00 # # AF-84 * * * AF-55 $5.00 # AF-84 * *

AF-56 $15.00 # # AF-85 * * * AF-56 $5.00 # AF-85 * *

AF-57 N/C N/C N/C AF-86 NADA # # AF-57 N/C N/C AF-86 NADA #

AF-58 $15.00 # # AF-87 * * * AF-58 $5.00 # AF-87 * *

AF-59 $10.00 20 12 AF-88 $15.00 20 12 AF-59 $5.00 20 AF-88 $5.00 20

AF-60 * * * AF-89 * * * AF-60 * * AF-89 * *

AF-61 $15.00 20 12 AF-90 * * * AF-61 $5.00 20 AF-90 * *

AF-62 $18.00 # # AF-91 * * * AF-62 $5.00 # AF-91 * *

AF-63 g $15.00 50 50 AF-92 $15.00 20 12 AF-63 N/C N/C AF-92 $5.00 20

AF-64 g $15.00 20 12 AF-93 * * * AF-64 $5.00 20 AF-93 * *

AF-65 g $10.00 50 50 AF-94 $10.00 # # AF-65 N/C N/C AF-94 $10.00 #

AF-66 $15.00 # # AF-95 $15.00 20 12 AF-66 $5.00 # AF-95 $5.00 20

AF-67 $15.00 20 12 AF-96 $15.00 20 12 AF-67 $5.00 20 AF-96 $5.00 20

AF-68 $18.00 # # AF-97 $15.00 20 12 AF-68 $5.00 # AF-97 $5.00 20

AF-69 $15.00 20 12 AF-98 $15.00 20 12 AF-69 NADA 20 AF-98 $5.00 20

AF-70 * * * AF-99 $15.00 20 12 AF-70 * * AF-99 $5.00 20

AF-71 * * * AG-01 $15.00 20 12 AF-71 * * AG-01 $5.00 20

AF-72 * * * AG-02 $15.00 # # AF-72 * * AG-02 $5.00 #

AF-73 * * * AG-03 $15.00 20 12 AF-73 * * AG-03 $10.00 20

AF-74 * * * AG-04 $12.00 20 12 AF-74 * * AG-04 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AG-05 $15.00 20 12 AG-34 $15.00 # # AG-05 $5.00 20 AG-34 $5.00 #

AG-06 $15.00 20 12 AG-35 $15.00 20 12 AG-06 $5.00 20 AG-35 $5.00 20

AG-07 NADA # # AG-36 NADA # # AG-07 NADA # AG-36 NADA #

AG-08 $10.00 # # AG-37 $15.00 20 12 AG-08 $5.00 # AG-37 $5.00 20

AG-09 $12.00 # # AG-38 $7.00 20 12 AG-09 $5.00 # AG-38 $5.00 20

AG-10 $12.00 # # AG-39 $8.00 # # AG-10 $12.00 # AG-39 $10.00 #

AG-11 NADA # # AG-40 $12.00 20 12 AG-11 NADA # AG-40 $5.00 20

AG-12 $15.00 # # AG-41 $10.00 20 12 AG-12 $5.00 # AG-41 $5.00 20

AG-13 $15.00 # # AG-42 $12.00 20 12 AG-13 $15.00 # AG-42 $5.00 20

AG-14 $12.00 15 15 AG-43 $15.00 20 12 AG-14 $5.00 15 AG-43 $5.00 20

AG-15 $15.00 # # AG-44 $12.00 20 12 AG-15 $5.00 # AG-44 $5.00 20

AG-16 $15.00 20 12 AG-45 $15.00 20 12 AG-16 $5.00 20 AG-45 * *

AG-17 $15.00 20 12 AG-46 $15.00 20 12 AG-17 $5.00 20 AG-46 * *

AG-18 $15.00 # # AG-47 $10.00 20 12 AG-18 $15.00 # AG-47 $5.00 20

AG-19 $15.00 20 12 AG-48 $15.00 20 12 AG-19 $5.00 20 AG-48 $5.00 20

AG-20 $10.00 # # AG-49 $18.00 * * AG-20 $10.00 # AG-49 $5.00 *

AG-21 $15.00 20 12 AG-50 $8.00 20 12 AG-21 $5.00 20 AG-50 $5.00 20

AG-22 $15.00 20 12 AG-51 * * * AG-22 $5.00 20 AG-51 * *

AG-23 $15.00 # # AG-52 $15.00 20 N/C AG-23 $15.00 # AG-52 N/C N/C

AG-24 $15.00 20 12 AG-53 $15.00 20 12 AG-24 $5.00 20 AG-53 $5.00 20

AG-25 $15.00 20 12 AG-54 $15.00 20 12 AG-25 $5.00 20 AG-54 $5.00 20

AG-26 $15.00 20 12 AG-55 $15.00 20 12 AG-26 $5.00 20 AG-55 $5.00 20

AG-27 $15.00 20 12 AG-56 $10.00 20 12 AG-27 $5.00 20 AG-56 $5.00 20

AG-28 $15.00 # # AG-57 * * * AG-28 $15.00 # AG-57 * *

AG-29 $3.00 20 12 AG-58 $10.00 20 12 AG-29 $5.00 20 AG-58 $5.00 20

AG-30 $15.00 20 12 AG-59 $17.00 # # AG-30 $5.00 20 AG-59 $5.00 #

AG-31 $15.00 20 12 AG-60 $15.00 20 12 AG-31 $5.00 20 AG-60 $5.00 20

AG-32 $15.00 20 12 AG-61 $10.00 # # AG-32 $5.00 20 AG-61 $10.00 #

AG-33 $15.00 20 12 AG-62 $10.00 20 12 AG-33 $5.00 20 AG-62 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AG-63 $10.00 20 12 AG-92 $12.00 # # AG-63 $5.00 20 AG-92 $12.00 #

AG-64 $15.00 # # AG-93 $12.00 # # AG-64 $5.00 # AG-93 $12.00 #

AG-65 $15.00 AG-94 $20.00 20 12 AG-65 $10.00 * AG-94 $5.00 20

AG-66 AG-95 $20.00 # # AG-66 * * AG-95 $20.00 #

AG-67 $15.00 20 12 AG-96 $15.00 # # AG-67 $5.00 20 AG-96 $15.00 #

AG-68 $15.00 15 15 AG-97 $15.00 15 15 AG-68 $5.00 15 AG-97 $5.00 15

AG-69 N/C N/C N/C AG-98 $10.00 # # AG-69 N/C N/C AG-98 $15.00 #

AG-70 AG-99 $15.00 # # AG-70 * * AG-99 $15.00 #

AG-71 $15.00 # # AH-01 g $15.00 20 12 AG-71 $5.00 # AH-01 $5.00 20

AG-72 $15.00 # # AH-02 g $12.00 15 15 AG-72 $5.00 # AH-02 $5.00 15

AG-73 $10.00 # # AH-03 $15.00 20 12 AG-73 $10.00 # AH-03 $5.00 20

AG-74 $15.00 20 12 AH-04 $15.00 15 15 AG-74 $5.00 20 AH-04 $5.00 15

AG-75 $20.00 20 12 AH-05 $10.00 15 15 AG-75 $5.00 20 AH-05 $5.00 15

AG-76 $15.00 # # AH-06 $10.00 # # AG-76 $15.00 # AH-06 $5.00 #

AG-77 $10.00 # # AH-07 $15.00 # # AG-77 $18.00 # AH-07 $5.00 #

AG-78 N/C AH-08 $15.00 # # AG-78 N/C AH-08 $5.00 #

AG-79 $10.00 # # AH-09 s,x $15.00 20 12 AG-79 $10.00 # AH-09 $5.00 20

AG-80 $15.00 20 12 AH-10 $15.00 15 15 AG-80 $5.00 20 AH-10 $5.00 15

AG-81 $10.00 20 12 AH-11 $10.00 20 12 AG-81 $5.00 20 AH-11 $10.00 20

AG-82 $15.00 # # AH-12 $17.00 # # AG-82 $15.00 # AH-12 $5.00 #

AG-83 $15.00 # # AH-13 $18.00 15 15 AG-83 $15.00 # AH-13 $5.00 15

AG-84 $15.00 # # AH-14 $15.00 15 15 AG-84 $15.00 # AH-14 $5.00 15

AG-85 $15.00 20 12 AH-15 $10.00 # # AG-85 $5.00 20 AH-15 $10.00 #

AG-86 $20.00 # # AH-16 $18.00 # # AG-86 $20.00 # AH-16 $18.00 #

AG-87 $15.00 20 12 AH-17 $15.00 # # AG-87 $5.00 20 AH-17 $5.00 20

AG-88 $15.00 20 12 AH-18 $10.00 # # AG-88 $5.00 20 AH-18 $10.00 #

AG-89 N/C N/C N/C AH-19 $15.00 # # AG-89 N/C N/C AH-19 $15.00 #

AG-90 $15.00 20 12 AH-20 $15.00 # # AG-90 $5.00 20 AH-20 $15.00 #

AG-91 $15.00 20 12 AH-21 $15.00 20 12 AG-91 $5.00 20 AH-21 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AH-22 $12.00 # # AH-51 $8.00 # # AH-22 $5.00 # AH-51 $8.00 #

AH-23 $15.00 # # AH-52 $12.00 # # AH-23 $15.00 # AH-52 $12.00 #

AH-24 $15.00 # # AH-53 * * * AH-24 $5.00 # AH-53 * *

AH-25 $20.00 # # AH-54 $10.00 # # AH-25 $5.00 # AH-54 NADA #

AH-26 $12.00 # # AH-55 g $10.00 20 12 AH-26 $5.00 # AH-55 $5.00 20

AH-27 $15.00 # # AH-56 $2.00 # # AH-27 $5.00 # AH-56 NADA #

AH-28 $8.00 # # AH-57 * * * AH-28 $5.00 # AH-57 * *

AH-29 $12.00 20 12 AH-58 $10.00 # # AH-29 $5.00 20 AH-58 $10.00 #

AH-30 $20.00 # # AH-59 $15.00 20 12 AH-30 $5.00 # AH-59 $5.00 20

AH-31 $15.00 20 12 AH-60 $7.00 20 12 AH-31 $5.00 20 AH-60 $5.00 20

AH-32 $18.00 # # AH-61 $10.00 20 12 AH-32 $5.00 # AH-61 $5.00 20

AH-33 $12.00 # # AH-62 $5.00 20 12 AH-33 $5.00 # AH-62 $5.00 20

AH-34 $12.00 # # AH-63 $5.00 20 12 AH-34 $12.00 # AH-63 $5.00 20

AH-35 $12.00 # # AH-64 NADA 20 12 AH-35 $12.00 # AH-64 $5.00 20

AH-36 NADA # # AH-65 NADA 20 12 AH-36 NADA # AH-65 $5.00 20

AH-37 $15.00 # # AH-66 $5.00 20 12 AH-37 $5.00 # AH-66 $5.00 20

AH-38 $15.00 # # AH-67 NADA 20 12 AH-38 $15.00 # # $5.00 20

AH-39 $15.00 20 12 AH-68 $5.00 20 12 AH-39 $5.00 20 AH-68 $5.00 20

AH-40 $12.00 20 12 AH-69 $5.00 20 12 AH-40 $5.00 20 AH-69 $5.00 20

AH-41 $20.00 15 15 AH-70 $7.00 20 12 AH-41 $5.00 15 AH-70 $5.00 20

AH-42 $18.00 20 12 AH-71 $5.00 20 12 AH-42 $5.00 20 AH-71 $5.00 20

AH-43 $8.00 # # AH-72 $7.00 20 12 AH-43 $8.00 # AH-72 $5.00 20

AH-44 $10.00 20 12 AH-73 $20.00 # # AH-44 $5.00 20 AH-73 $5.00 #

AH-45 $12.00 20 12 AH-74 $8.00 20 12 AH-45 $5.00 20 AH-74 $5.00 20

AH-46 $8.00 # # AH-75 $8.00 20 12 AH-46 $8.00 # AH-75 $5.00 20

AH-47 $14.00 # # AH-76 $15.00 20 12 AH-47 50% # AH-76 $5.00 20

AH-48 $10.00 20 12 AH-77 $10.00 20 12 AH-48 $5.00 20 AH-77 $5.00 20

AH-49 $12.00 # # AH-78 $10.00 20 12 AH-49 $12.00 # AH-78 $5.00 20

AH-50 $8.00 # # AH-79 $20.00 20 12 AH-50 $8.00 # AH-79 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AH-80 $15.00 20 12 AI-10 $12.00 # # AH-80 $5.00 20 AI-10 $5.00 #

AH-81 $12.00 20 12 AI-11 $10.00 # # AH-81 $5.00 20 AI-11 $5.00 #

AH-82 $12.00 20 12 AI-12 $15.00 20 12 AH-82 $5.00 20 AI-12 $5.00 20

AH-83 * * * AI-13 $15.00 # # AH-83 * * AI-13 $5.00 #

AH-84 $12.00 # # AI-14 $10.00 # # AH-84 $5.00 # AI-14 $5.00 #

AH-85 $12.00 # # AI-15 $15.00 # # AH-85 $5.00 # AI-15 $5.00 #

AH-86 $12.00 # # AI-16 $15.00 # # AH-86 $5.00 # AI-16 $5.00 #

AH-87 $18.00 20 12 AI-17 $15.00 # # AH-87 $5.00 20 AI-17 $5.00 #

AH-88 $12.00 # # AI-18 $15.00 # # AH-88 $12.00 # AI-18 $5.00 #

AH-89 $10.00 # # AI-19 $15.00 # # AH-89 $10.00 # AI-19 $5.00 #

AH-90 $15.00 20 12 AI-20 $20.00 # # AH-90 $5.00 20 AI-20 $5.00 #

AH-91 $12.00 # # AI-21 $10.00 # # AH-91 $5.00 # AI-21 $5.00 #

AH-92 $12.00 # # AI-22 $15.00 # # AH-92 $5.00 # AI-22 $5.00 20

AH-93 N/C AI-23 $12.00 # # AH-93 N/C AI-23 $5.00 #

AH-94 $15.00 # # AI-24 $20.00 20 12 AH-94 $15.00 # AI-24 $5.00 20

AH-95 $10.00 # # AI-25 $12.00 # # AH-95 $10.00 # AI-25 $5.00 #

AH-96 $15.00 # # AI-26 $17.00 # # AH-96 $15.00 # AI-26 $5.00 #

AH-97 $15.00 20 12 AI-27 $18.00 # # AH-97 $5.00 20 AI-27 $5.00 #

AH-98 g $10.00 20 12 AI-28 $12.00 # # AH-98 $5.00 20 AI-28 $5.00 #

AH-99 $7.00 20 12 AI-29 $10.00 # # AH-99 $7.00 20 AI-29 $5.00 #

AI-01 g $18.00 20 12 AI-30 * * * AI-01 $5.00 20 AI-30 * *

AI-02 $10.00 # # AI-31 $15.00 20 12 AI-02 $10.00 # AI-31 $5.00 20

AI-03 $15.00 # # AI-32 $18.00 20 12 AI-03 $15.00 # AI-32 $5.00 20

AI-04 g $15.00 20 12 AI-33 $10.00 20 12 AI-04 $5.00 20 AI-33 $5.00 20

AI-05 N/C AI-34 $12.00 # # AI-05 N/C AI-34 $15.00 #

AI-06 $15.00 20 12 AI-35 $10.00 # # AI-06 $5.00 20 AI-35 $10.00 #

AI-07 $10.00 / $15.00

# # AI-36 $15.00 20 12 AI-07 NADA # AI-36 $5.00 20

AI-08 $12.00 # # AI-37 $10.00 20 12 AI-08 $5.00 # AI-37 $5.00 20

AI-09 N/C N/C N/C AI-38 $20.00 20 12 AI-09 N/C N/C AI-38 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AI-39 $15.00 20 12 AI-68 $18.00 # # AI-39 $5.00 20 AI-68 $8.00 #

AI-40 $10.00 20 12 AI-69 $12.00 # # AI-40 $5.00 20 AI-69 $12.00 #

AI-41 $10.00 20 12 AI-70 $12.00 20 12 AI-41 $5.00 20 AI-70 $5.00 20

AI-42 $15.00 # # AI-71 * * * AI-42 $15.00 # AI-71 * *

AI-43 $15.00 # # AI-72 * * * AI-43 $15.00 # AI-72 * *

AI-44 $15.00 # # AI-73 * * * AI-44 $15.00 # # * *

AI-45 $10.00 20 12 AI-74 * * * AI-45 $5.00 20 AI-74 * *

AI-46 $10.00 20 12 AI-75 * * * AI-46 $5.00 20 AI-75 * *

AI-47 $15.00 # # AI-76 * * * AI-47 $15.00 # AI-76 * *

AI-48 $10.00 # # AI-77 * * * AI-48 $5.00 # AI-77 * *

AI-49 $8.00 # # AI-78 * * * AI-49 $8.00 # AI-78 * *

AI-50 $10.00 # # AI-79 * * * AI-50 $7.00 # AI-79 * *

AI-51 * * * AI-80 * * * AI-51 * * AI-80 * *

AI-52 * * * AI-81 * * * AI-52 * * AI-81 * *

AI-53 $10.00 # # AI-82 * * * AI-53 $5.00 # AI-82 * *

AI-54 * * * AI-83 * * * AI-54 * * AI-83 * *

AI-55 * * * AI-84 $7.00 # # AI-55 * * AI-84 $5.00 #

AI-56 * * * AI-85 * * * AI-56 * * AI-85 * *

AI-57 * * * AI-86 * * * AI-57 * * AI-86 * *

AI-58 * * * AI-87 $12.00 20 12 AI-58 * * AI-87 $5.00 20

AI-59 $15.00 # # AI-88 $15.00 # # AI-59 $15.00 # AI-88 $15.00 #

AI-60 * * * AI-89 $10.00 # # AI-60 * * AI-89 $10.00 #

AI-61 * * * AI-90 * * * AI-61 * * AI-90 * *

AI-62 $12.00 # # AI-91 $15.00 20 12 AI-62 $12.00 # AI-91 $5.00 20

AI-63 * * * AI-92 $15.00 20 12 AI-63 * * AI-92 $5.00 20

AI-64 $15.00 # # AI-93 $15.00 20 12 AI-64 $15.00 # AI-93 $5.00 20

AI-65 $12.00 # # AI-94 $8.00 # # AI-65 $12.00 # AI-94 $8.00 #

AI-66 $15.00 20 12 AI-95 $10.00 # # AI-66 $5.00 20 AI-95 $10.00 #

AI-67 $15.00 20 12 AI-96 $20.00 20 12 AI-67 $5.00 20 AI-96 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AI-97 * * * AL-27 $12.00 20 12 AI-97 * * AL-27 $5.00 20

AI-98 * * * AL-28 $15.00 20 12 AI-98 * * AL-28 $5.00 20

AI-99 $10.00 20 12 AL-29 $12.00 20 12 AI-99 $5.00 20 AL-29 $5.00 20

AL-01 $15.00 # # AL-30 $12.00 20 12 AL-01 $15.00 # AL-30 $5.00 20

AL-02 $15.00 20 12 AL-31 $10.00 20 12 AL-02 $5.00 20 AL-31 $5.00 20

AL-03 $12.00 20 12 AL-32 $10.00 20 12 AL-03 $5.00 20 AL-32 $5.00 20

AL-04 $12.00 20 12 AL-33 $10.00 20 12 AL-04 $5.00 20 AL-33 $5.00 20

AL-05 $15.00 15 15 AL-34 $10.00 20 12 AL-05 $5.00 15 AL-34 $5.00 20

AL-06 $15.00 15 15 AL-35 $15.00 20 12 AL-06 $5.00 15 AL-35 $5.00 20

AL-07 $10.00 15 15 AL-36 $15.00 # # AL-07 $5.00 15 AL-36 $5.00 #

AL-08 $15.00 # # AL-37 $8.00 # # AL-08 $5.00 # AL-37 $5.00 #

AL-09 $15.00 15 15 AL-38 $8.00 # # AL-09 $5.00 15 AL-38 $5.00 #

AL-10 $10.00 15 15 AL-39 $10.00 # # AL-10 $5.00 15 AL-39 $5.00 #

AL-11 $12.00 15 15 AL-40 $10.00 # # AL-11 $5.00 15 AL-40 $5.00 #

AL-12 $12.00 15 15 AL-41 $12.00 # # AL-12 $5.00 15 AL-41 $5.00 #

AL-13 $15.00 15 15 AL-42 $10.00 15 15 AL-13 $5.00 15 AL-42 $5.00 15

AL-14 $15.00 15 15 AL-43 $12.00 # # AL-14 $5.00 15 AL-43 $5.00 #

AL-15 $15.00 15 15 AL-44 $15.00 15 15 AL-15 $5.00 15 AL-44 $5.00 15

AL-16 $15.00 # # AL-45 $15.00 # # AL-16 $5.00 # AL-45 $5.00 #

AL-17 $15.00 15 15 AL-46 $15.00 # # AL-17 $5.00 15 AL-46 $5.00 #

AL-18 $15.00 # # AL-47 $15.00 15 15 AL-18 $5.00 # AL-47 $5.00 15

AL-19 $15.00 # # AL-48 $15.00 # # AL-19 $5.00 # AL-48 $5.00 #

AL-20 $15.00 15 15 AL-49 $15.00 # # AL-20 $5.00 15 AL-49 $5.00 #

AL-21 $15.00 15 15 AL-50 $10.00 # # AL-21 $5.00 15 AL-50 $5.00 #

AL-22 $15.00 15 15 AL-51 $10.00 # # AL-22 $5.00 15 AL-51 $5.00 #

AL-23 $15.00 20 12 AL-52 $12.00 # # AL-23 $5.00 20 AL-52 $5.00 #

AL-24 $15.00 20 12 AL-53 $12.00 # # AL-24 N/C N/C AL-53 $5.00 #

AL-25 y y y AL-54 $15.00 15 15 AL-25 y y AL-54 $5.00 15

AL-26 $10.00 20 12 AL-55 $15.00 # # AL-26 $5.00 20 AL-55 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AL-56 $15.00 # # AL-85 $12.00 20 12 AL-56 $5.00 # AL-85 $5.00 20

AL-57 $15.00 15 15 AL-86 $15.00 20 12 AL-57 $7.00 15 AL-86 $5.00 20

AL-58 $15.00 15 15 AL-87 $10.00 # # AL-58 $5.00 15 AL-87 $5.00 #

AL-59 $15.00 15 15 AL-88 * * * AL-59 $7.00 15 AL-88 * *

AL-60 $15.00 15 15 AL-89 $15.00 # # AL-60 $5.00 15 AL-89 $7.00 #

AL-61 $15.00 15 15 AL-90 * * * AL-61 $7.00 15 AL-90 * *

AL-62 $15.00 15 15 AL-91 $15.00 # # AL-62 $7.00 15 AL-91 $7.00 #

AL-63 $15.00 15 15 AL-92 * * * AL-63 $7.00 15 AL-92 * *

AL-64 $15.00 15 15 AL-93 $15.00 # # AL-64 $7.00 15 AL-93 $7.00 #

AL-65 $15.00 15 15 AL-94 $15.00 15 15 AL-65 $5.00 15 AL-94 $7.00 15

AL-66 $15.00 15 15 AL-95 $15.00 15 15 AL-66 $7.00 15 AL-95 $7.00 15

AL-67 $12.00 15 15 AL-96 $10.00 15 15 AL-67 $5.00 15 AL-96 $7.00 15

AL-68 $15.00 20 12 AL-97 $10.00 15 15 AL-68 $5.00 20 AL-97 $7.00 15

AL-69 $18.00 20 12 AL-98 $10.00 15 15 AL-69 $5.00 20 AL-98 $7.00 15

AL-70 $18.00 # # AL-99 * * * AL-70 $5.00 # AL-99 * *

AL-71 $15.00 20 12 AK-01 $12.00 # # AL-71 $5.00 20 AK-01 $12.00 #

AL-72 * * * AK-02 $5.00 # # AL-72 * * AK-02 $5.00 #

AL-73 $15.00 20 12 AK-03 $5.00 # # AL-73 $5.00 20 AK-03 $5.00 #

AL-74 $15.00 15 15 AK-04 $18.00 # # AL-74 $7.00 15 AK-04 $18.00 #

AL-75 $15.00 # # AK-05 * * * AL-75 $7.00 # AK-05 * *

AL-76 $15.00 20 12 AK-06 * * * AL-76 $5.00 20 AK-06 * *

AL-77 $12.00 20 12 AK-07 * * * AL-77 $5.00 20 AK-07 * *

AL-78 * * * AK-08 $10.00 20 12 AL-78 * * AK-08 $5.00 20

AL-79 * * * AK-09 * * * AL-79 * * AK-09 * *

AL-80 $15.00 20 12 AK-10 * * * AL-80 $5.00 20 AK-10 * *

AL-81 $15.00 20 12 AK-11 $10.00 # # AL-81 $5.00 20 AK-11 $5.00 #

AL-82 $15.00 20 12 AK-12 $12.00 # # AL-82 $5.00 20 AK-12 $5.00 #

AL-83 $15.00 20 12 AK-13 $15.00 # # AL-83 $5.00 20 AK-13 $7.00 #

AL-84 $10.00 20 12 AK-14 $10.00 20 12 AL-84 $5.00 20 AK-14 $5.00 20

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AK-15 $20.00 # # AK-43 * * * AK-15 $5.00 # AK-43 * *

AK-16 $15.00 # # AK-44 g $15.00 15 15 AK-16 $5.00 # AK-44 $7.00 15

AK-17 $15.00 # # AK-45 $15.00 # # AK-17 $5.00 # AK-45 $7.00 #

AK-18 $10.00 20 12 AK-46 $15.00 20 12 AK-18 $5.00 20 AK-46 $5.00 20

AK-19 $15.00 20 12 AK-47 $15.00 20 12 AK-19 $5.00 20 AK-47 $5.00 20

AK-20 $10.00 20 12 AK-48 $18.00 20 20 AK-20 $5.00 20 AK-48 $5.00 20

AK-21 $10.00 20 12 AK-49 * * * AK-21 $5.00 20 AK-49 * *

AK-22 $15.00 20 12 AK-50 * * * AK-22 $5.00 20 AK-50 * *

AK-23 $15.00 20 12 AK-51 $15.00 # # AK-23 $5.00 20 AK-51 $5.00 #

AK-24 $15.00 20 12 AK-52 $16.00 # # AK-24 $5.00 20 AK-52 $5.00 #

AK-25 $15.00 # # AK-53 $18.00 20 12 AK-25 $5.00 # AK-53 $5.00 20.

AK-26 $20.00 20 12 AK-54 * * * AK-26 $5.00 20 AK-54 * *

AK-27 $15.00 # # AK-55 * * * AK-27 $5.00 # AK-55 * *

AK-28 $15.00 # # AK-56 $15.00 # # AK-28 $5.00 # AK-56 $5.00 #

AK-29 $10.00 # # AK-57 $10.00 # # AK-29 $5.00 # AK-57 $5.00 #

AK-30 $15.00 # # AK-58 $12.00 # # AK-30 $5.00 # AK-58 $5.00 #

AK-31 $20.00 # # AK-59 $10.00 20 12 AK-31 $5.00 # AK-59 $5.00 20

AK-32 $17.00 # # AK-60 $10.00 20 12 AK-32 $5.00 # AK-60 $5.00 20

AK-33 $15.00 # # AK-61 * * * AK-33 $5.00 # AK-61 * *

AK-34 $18.00 15 15 AK-62 NADA 15 15 AK-34 $5.00 15 AK-62 NADA 15

AK-35 $18.00 # # AK-63 $15.00 15 15 AK-35 $5.00 # AK-63 $5.00 15

AK-36 $18.00 # # AK-64 $15.00 15 15 AK-36 $5.00 # AK-64 $15.00 15

AK-37 $18.00 # # AK-65 * * * AK-37 $5.00 # AK-65 * *

AK-38 $15.00 # # AK-66 $15.00 # # AK-38 $5.00 # AK-66 $5.00 #

AK-39 $15.00 # # AK-67 $15.00 15 15 AK-39 $5.00 # AK-67 $5.00 15

AK-40 $15.00 # # AK-68 * * * AK-40 $5.00 # AK-68 * *

AK-41 * * * AK-69 * * * AK-41 * * AK-69 * *

AK-42 $12.00 20 12 AK-70 * * * AK-42 $5.00 20 AK-70 * *

AK-43 * * * AK-71 * * * AK-43 * * AK-71 * *

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AK-72 $12.00 15 15 * * * * AK-72 $5.00 15 * * *

AK-73 * * * * * * * AK-73 * * * * *

AK-74 * * * * * * * AK-74 * * * * *

AK-75 $8.00 15 15 * * * * AK-75 $5.00 15 * * *

AK-76 * * * * * * * AK-76 * * * * *

AK-77 * * * * * * * AK-77 * * * * *

AK-78 * * * * * * * AK-78 * * * * *

AK-79 * * * * * * * AK-79 * * * * *

AK-80 * * * * * * * AK-80 * * * * *

AK-81 * * * * * * * AK-81 * * * * *

AK-82 * * * * * * * AK-82 * * * * *

AK-83 * * * * * * * AK-83 * * * * *

AK-84 * * * * * * * AK-84 * * * * *

AK-85 * * * * * * * AK-85 * * * * *

AK-86 $15.00 20 12 * * * * AK-86 $5.00 20 * * *

AK-87 $15.00 # # * * * * AK-87 $5.00 # * * *

AK-88 $15.00 20 12 * * * * AK-88 $5.00 20 * * *

AK-89 * * * * * * * AK-89 * * * * *

AK-90 * * * * * * * AK-90 * * * * *

AK-91 * * * * * * * AK-91 * * * * *

AK-92 * * * * * * * AK-92 * * * * *

AK-93 * * * * * * * AK-93 * * * * *

AK-94 $12.00 20 12 * * * * AK-94 $5.00 20 * * *

AK-95 $15.00 20 12 * * * * AK-95 $5.00 20 * * *

AK-96 * * * * * * * AK-96 * * * * *

AK-97 * * * * * * * AK-97 * * * * *

AK-98 * * * * * * * AK-98 * * * * *

AK-99 * * * * * * * AK-99 * * * * *

* * * * * * * * * * * *

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AM-01 $15.00 # # AM-30 $10.00 # # AM-01 $5.00 # AM-30 NADA #

AM-02 * * * AM-31 $15.00 15 15 AM-02 * * AM-31 $15.00 15

AM-03 * * * AM-32 $15.00 15 15 AM-03 * * AM-32 $5.00 15

AM-04 $5.00 # # AM-33 $15.00 # # AM-04 NADA # AM-33 $5.00 #

AM-05 $20.00 15 15 AM-34 $10.00 # # AM-05 $5.00 15 AM-34 $5.00 #

AM-06 $10.00 # # AM-35 $12.00 # # AM-06 NADA # AM-35 $5.00 #

AM-07 $12.00 # # AM-36 $12.00 15 15 AM-07 $5.00 # AM-36 $5.00 15

AM-08 $10.00 # # AM-37 $10.00 15 15 AM-08 $10.00 # AM-37 $5.00 15

AM-09 X x x AM-38 $15.00 20 12 AM-09 x x AM-38 $5.00 15

AM-10 $15.00 15 15 AM-39 $15.00 20 12 AM-10 $5.00 15 AM-39 $5.00 15

AM-11 $12.00 # # AM-40 $15.00 15 15 AM-11 $5.00 # AM-40 $5.00 15

AM-12 $15.00 15 15 AM-41 $15.00 15 15 AM-12 $15.00 15 AM-41 $7.00 15

AM-13 $12.00 15 15 AM-42 $10.00 15 15 AM-13 $5.00 15 AM-42 $7.00 15

AM-14 $18.00 # # AM-43 $12.00 15 15 AM-14 $5.00 # AM-43 $5.00 15

AM-15 $15.00 15 15 AM-44 $7.00 15 15 AM-15 $5.00 15 AM-44 $5.00 15

AM-16 $15.00 # # AM-45 $10.00 15 15 AM-16 $7.00 # AM-45 $5.00 15

AM-17 $15.00 * * AM-46 * * * AM-17 $5.00 * AM-46 * *

AM-18 $15.00 * * AM-47 * * * AM-18 $5.00 * AM-47 * *

AM-19 $15.00 * * AM-48 * * * AM-19 $5.00 * AM-48 * *

AM-20 $15.00 * * AM-49 $15.00 15 15 AM-20 $5.00 * AM-49 $5.00 15

AM-21 $7.00 15 15 AM-50 $18.00 15 15 AM-21 $5.00 15 AM-50 $5.00 15

AM-22 * * * AM-51 $7.00 # # AM-22 * * AM-51 $5.00 #

AM-23 * * * AM-52 $7.00 # # AM-23 * * AM-52 $5.00 #

AM-24 $12.00 20 12 AM-53 $18.00 15 15 AM-24 $5.00 15 AM-53 $5.00 15

AM-25 $12.00 20 12 AM-54 $12.00 15 15 AM-25 $5.00 15 AM-54 $5.00 15

AM-26 $12.00 20 12 AM-55 $10.00 # # AM-26 $5.00 15 AM-55 $5.00 #

AM-27 $18.00 20 12 AM-56 $15.00 15 15 AM-27 $5.00 15 AM-56 $12.00 15

AM-28 * * * AM-57 $15.00 15 15 AM-28 * * AM-57 $5.00 15

AM-29 $12.00 * * AM-58 $15.00 15 15 AM-29 $5.00 * AM-58 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AM-59 $10.00 # # AM-88 &,$ $6.00 20 20 AM-59 $5.00 # AM-88 $10.00 20

AM-60 $10.00 # # AM-89 * * * AM-60 $5.00 # AM-89 * *

AM-61 * * * AM-90 $15.00 15 15 AM-61 $5.00 15 AM-90 * *

AM-62 $12.00 15 15 AM-91 $12 15 15 AM-62 $5.00 15 AM-91 $5.00 15

AM-63 $12.00 15 15 AM-92 $12 15 15 AM-63 $5.00 15 AM-92 $5.00 15

AM-64 $15.00 * * AM-93 $15 15 15 AM-64 $5.00 * AM-93 $5.00 15

AM-65 $12.00 15 15 AM-94 $15.00 # # AM-65 $5.00 15 AM-94 $15.00 #

AM-66 $12.00 15 15 AM-95 $15.00 # # AM-66 $5.00 15 AM-95 $5.00 #

AM-67 $3.00 # # AM-96 $15.00 # # AM-67 $5.00 # AM-96 $15.00 #

AM-68 * * * AM-97 $8.00 # # AM-68 * * AM-97 $8.00 #

AM-69 * * * AM-98 $8.00 # # AM-69 * * AM-98 $8.00 #

AM-70 * * * AM-99 $10.00 # # AM-70 * * AM-99 $5.00 #

AM-71 * * * AJ-01 NADA e e AM-71 * * AJ-01 NADA e

AM-72 $7.00 15 15 AJ-02 r $20.00 # # AM-72 $5.00 15 AJ-02 $20.00 #

AM-73 $15.00 15 15 AJ-03 $20.00 * * AM-73 $5.00 15 AJ-03 $20.00 *

AM-74 $12.00 15 15 AJ-04 $20.00 * * AM-74 $5.00 15 AJ-04 $20.00 *

AM-75 $15.00 15 15 AJ-05 $20.00 * * AM-75 $15.00 15 AJ-05 $20.00 *

AM-76 $18.00 15 15 AJ-06 N/C * * AM-76 $5.00 15 AJ-06 N/C *

AM-77 * * * AJ-07 s $10.00 * * AM-77 * * AJ-07 $5.00 *

AM-78 $15.00 15 15 AJ-08 $11.00 # # AM-78 $5.00 15 AJ-08 $11.00 #

AM-79 * * * AJ-09 20% * * AM-79 * * AJ-09 20% *

AM-80 $15.00 # # AJ-10 $15.00 * * AM-80 $5.00 # AJ-10 $5.00 *

AM-81 $15.00 # # AJ-11 j $15.00 20 15 AM-81 $5.00 # AJ-11 $5.00 20

AM-82 * * * AJ-12 $15.00 * * AM-82 * * AJ-12 $5.00 *

AM-83 * * * AJ-13 * * * AM-83 * * AJ-13 * *

AM-84 $20.00 15 15 AJ-14 $15.00 * * AM-84 $15.00 15 AJ-14 $5.00 *

AM-85 $10.00 15 15 AJ-15 $11.00 * * AM-85 $5.00 15 AJ-15 $5.00 *

AM-86 $10.00 15 15 AJ-16 $3.00 * * AM-86 $5.00 15 AJ-16 $3.00 *

AM-87 $15.00 15 15 AJ-17 $15.00 # # AM-87 $5.00 15 AJ-17 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AJ-18 $15.00 # # AJ-47 $10.00 # # AJ-18 $5.00 # AJ-47 $5.00 #

AJ-19 $15.00 * * AJ-48 $15.00 * * AJ-19 $5.00 * AJ-48 $5.00 *

AJ-20 $15.00 * * AJ-49 * * * AJ-20 $5.00 * AJ-49 * *

AJ-21 $15.00 * * AJ-50 $15.00 * * AJ-21 $5.00 * AJ-50 $5.00 *

AJ-22 $15.00 * * AJ-51 $15.00 * * AJ-22 $5.00 * AJ-51 $5.00 *

AJ-23 $15.00 * * AJ-52 $15.00 * * AJ-23 $5.00 * AJ-52 $12.00 *

AJ-24 $15.00 * * AJ-53 * * * AJ-24 $5.00 * AJ-53 * *

AJ-25 $10.00 # # AJ-54 $15.00 * * AJ-25 $10.00 * AJ-54 $5.00 *

AJ-26 $15.00 * * AJ-55 j $15.00 20 15 AJ-26 $5.00 * AJ-55 $5.00 20

AJ-27 $12.00 * * AJ-56 $12.00 # # AJ-27 $5.00 * AJ-56 $12.00 #

AJ-28 $11.00 * * AJ-57 y $12.00 * * AJ-28 $5.00 * AJ-57 $5.00 *

AJ-29 $15.00 * * AJ-58 $12.00 * * AJ-29 $5.00 * AJ-58 $5.00 *

AJ-30 $25.00 * * AJ-59 $15.00 * * AJ-30 $5.00 * AJ-59 $15.00 *

AJ-31 $12.00 * * AJ-60 $11.00 # # AJ-31 $5.00 * AJ-60 $5.00 #

AJ-32 $15.00 * * AJ-61 * * * AJ-32 $5.00 * AJ-61 * *

AJ-33 $15.00 * * AJ-62 $15.00 * * AJ-33 $5.00 * AJ-62 $5.00 *

AJ-34 * * * AJ-63 $12.00 * * AJ-34 * * AJ-63 $5.00 *

AJ-35 $12.00 * * AJ-64 z $11.00 * * AJ-35 $5.00 * AJ-64 $5.00 *

AJ-36 $15.00 * * AJ-65 * * * AJ-36 $5.00 * AJ-65 * *

AJ-37 $15.00 * * AJ-66 * * * AJ-37 $5.00 * AJ-66 * *

AJ-38 $15.00 # # AJ-67 $20.00 * * AJ-38 $15.00 # AJ-67 $5.00 *

AJ-39 $15.00 # # AJ-68 $15.00 * * AJ-39 $12.00 # AJ-68 $5.00 *

AJ-40 $15.00 # # AJ-69 * * * AJ-40 $15.00 # AJ-69 * *

AJ-41 $15.00 * * AJ-70 $15.00 * * AJ-41 $5.00 * AJ-70 $5.00 *

AJ-42 $15.00 * * AJ-71 $15.00 * * AJ-42 $5.00 * AJ-71 $5.00 *

AJ-43 $15.00 15 15 AJ-72 $10.00 * * AJ-43 $5.00 15 AJ-72 $5.00 *

AJ-44 * * * AJ-73 $15.00 * * AJ-44 * * AJ-73 $5.00 *

AJ-45 $15.00 * * AJ-74 * * * AJ-45 $5.00 * AJ-74 * *

AJ-46 $15.00 * * AJ-75 $15.00 * * AJ-46 $5.00 * AJ-75 $5.00 *

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AJ-76 $15.00 * * * * * * AJ-76 $5.00 * * * *

AJ-77 * * * * * * * AJ-77 * * * * *

AJ-78 $15.00 * * * * * * AJ-78 $15.00 * * * *

AJ-79 * * * * * * * AJ-79 * * * * *

AJ-80 $15.00 * * * * * * AJ-80 $5.00 * * * *

AJ-81 $10.00 * * * * * * AJ-81 $5.00 * * * *

AJ-82 NADA * * * * * * AJ-82 NADA * * * *

AJ-83 $15.00 * * * * * * AJ-83 $15.00 * * * *

AJ-84 * * * * * * * AJ-84 * * * * *

AJ-85 $15.00 * * * * * * AJ-85 $5.00 * * * *

AJ-86 $6.00 * * * * * * AJ-86 $5.00 * * * *

AJ-87 $7.00 # # * * * * AJ-87 $7.00 # * * *

AJ-88 $12.00 * * * * * * AJ-88 $5.00 * * * *

AJ-89 $12.00 * * * * * * AJ-89 $5.00 * * * *

AJ-90 * * * * * * * AJ-90 * * * * *

AJ-91 $17.00 * * * * * * AJ-91 $17.00 * * * *

AJ-92 * * * * * * * AJ-92 * * * * *

AJ-93 $15.00 * * * * * * AJ-93 $15.00 * * * *

AJ-94 $11.00 * * * * * * AJ-94 $5.00 * * * *

AJ-95 $15.00 * * * * * * AJ-95 $5.00 * * * *

AJ-96 $15.00 * * * * * * AJ-96 $5.00 * * * *

AJ-97 $15.00 * * * * * * AJ-97 $5.00 * * * *

AJ-98 $15.00 * * * * * * AJ-98 $5.00 * * * *

AJ-99 $12.00 * * * * * * AJ-99 $5.00 * * * *

* * * * * * * * * * * * * *

* * * * * * * * * * * * * *

* * * * * * * * * * * * * *

* * * * * * * * * * * * * *

* * * * * * * * * * * * * *

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AN-01 $10.00 # # AN-30 * * * AN-01 $10.00 # AN-30 * *

AN-02 $12.00 # # AN-31 $15.00 # # AN-02 $5.00 # AN-31 $15.00 #

AN-03 $12.00 # # AN-32 $20.00 # # AN-03 $12.00 # AN-32 $20.00 #

AN-04 $15.00 # # AN-33 $10.00 # # AN-04 $15.00 # AN-33 $10.00 #

AN-05 $15.00 # # AN-34 $10.00 # # AN-05 $15.00 # AN-34 $10.00 #

AN-06 $15.00 15 15 AN-35 $15.00 # # AN-06 $5.00 15 AN-35 $18.00 #

AN-07 $15.00 15 15 AN-36 $15.00 # # AN-07 $5.00 15 AN-36 $15.00 #

AN-08 $10.00 # # AN-37 $10.00 # # AN-08 $10.00 # AN-37 $10.00 #

AN-09 $10.00 # # AN-38 $12.00 # # AN-09 $10.00 # AN-38 $12.00 #

AN-10 $10.00 # # AN-39 $18.00 # # AN-10 $10.00 # AN-39 $18.00 #

AN-11 $10.00 # # AN-40 $20.00 # # AN-11 $10.00 # AN-40 $20.00 #

AN-12 $10.00 # # AN-41 $15.00 # # AN-12 $10.00 # AN-41 $15.00 #

AN-13 $15.00 # # AN-43 $15.00 # # AN-13 $15.00 # AN-42 $15.00 #

AN-14 $15.00 # # AN-43 $15.00 # # AN-14 $15.00 # AN-43 $15.00 #

AN-15 $15.00 # # AN-44 $10.00 # # AN-15 $15.00 # AN-44 $10.00 #

AN-16 * * * AN-45 * * * AN-16 * * AN-45 * *

AN-17 * * * AN-46 $15.00 # # AN-17 * * AN-46 $15.00 #

AN-18 * * * AN-47 $30.00 # # AN-18 * * AN-47 NADA #

AN-19 * * * AN-48 $15.00 # # AN-19 * * AN-48 NADA #

AN-20 $10.00 # # AN-49 $18.00 # # AN-20 $5.00 # AN-49 $18.00 #

AN-21 * * * AN-50 $12.00 # # AN-21 * * AN-50 $12.00 #

AN-22 $12.00 # # AN-51 $15.00 15 15 AN-22 $12.00 # AN-51 $5.00 15

AN-23 * * * AN-52 $15.00 15 15 AN-23 * * AN-52 $5.00 15

AN-24 $15.00 # # AN-53 $15.00 15 15 AN-24 $15.00 # AN-53 $5.00 15

AN-25 * * * AN-54 $20.00 # # AN-25 * * AN-54 $20.00 #

AN-26 $18.00 # # AN-55 $15.00 # # AN-26 $18.00 # AN-55 $15.00 #

AN-27 $10.00 # # AN-56 $10.00 # # AN-27 $10.00 # AN-56 $10.00 #

AN-28 $12.00 # # AN-57 $20.00 # # AN-28 $12.00 # AN-57 $20.00 #

AN-29 $17.00 # # AN-58 $8.00 # # AN-29 $5.00 # AN-58 $8.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AN-59 $15.00 # # AN-88 $18.00 # # AN-59 $15.00 # AN-88 $18.00 #

AN-60 $10.00 # # AN-89 $15.00 # # AN-60 $10.00 # AN-89 $15.00 #

AN-61 $15.00 # # AN-90 $12.00 # # AN-61 $15.00 # AN-90 $12.00 #

AN-62 $18.00 # # AN-91 $12.00 # # AN-62 $18.00 # AN-91 $12.00 #

AN-63 NADA # # AN-92 $10.00 # # AN-63 NADA # AN-92 $10.00 #

AN-64 $15.00 15 15 AN-93 $15.00 # # AN-64 $15.00 15 AN-93 $15.00 #

AN-65 $18.00 15 15 AN-94 $15.00 # # AN-65 $18.00 15 AN-94 $15.00 #

AN-66 $15.00 # # AN-95 $12.00 # # AN-66 $15.00 # AN-95 $12.00 #

AN-67 $18.00 # # AN-96 * * * AN-67 $18.00 # AN-96 * *

AN-68 $12.00 # # AN-97 * * * AN-68 $12.00 # AN-97 * *

AN-69 $12.00 # # AN-98 $18.00 # # AN-69 $12.00 # AN-98 $18.00 #

AN-70 $15.00 # # AN-99 $18.00 # # AN-70 $15.00 # AN-99 $18.00 #

AN-71 * * * * * * * AN-71 * * * * *

AN-72 $15.00 # # * * * * AN-72 $15.00 # * * *

AN-73 $18.00 # # * * * * AN-73 $18.00 # * * *

AN-74 $15.00 # # * * * * AN-74 $15.00 # * * *

AN-75 $15.00 # # * * * * AN-75 $15.00 # * * *

AN-76 $10.00 # # * * * * AN-76 $10.00 # * * *

AN-77 $20.00 # # * * * * AN-77 $20.00 # * * *

AN-78 $20.00 # # * * * * AN-78 $20.00 # * * *

AN-79 $15.00 # # * * * * AN-79 $15.00 # * * *

AN-80 $15.00 # # * * * * AN-80 $15.00 # * * *

AN-81 $17.00 # # * * * * AN-81 $17.00 # * * *

AN-82 $18.00 # # * * * * AN-82 $18.00 # * * *

AN-83 $15.00 # # * * * * AN-83 $15.00 # * * *

AN-84 $12.00 # # * * * * AN-84 $12.00 # * * *

AN-85 $15.00 # # * * * * AN-85 $15.00 # * * *

AN-86 $15.00 # # * * * * AN-86 $15.00 # * * *

AN-87 $15.00 # # * * * * AN-87 $15.00 # * * *

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AP-01 * * * AP-30 $15.00 * * AP-01 * * AP-30 $5.00

AP-02 $15.00 * * AP-31 20% * * AP-02 $5.00 * AP-31 20%

AP-03 $15.00 * * AP-32 $15.00 * * AP-03 $5.00 * AP-32 $5.00 *

AP-04 $15.00 * * AP-33 $15.00 * * AP-04 $5.00 * AP-33 $15.00 *

AP-05 $15.00 * * AP-34 * * * AP-05 $5.00 * AP-34 * *

AP-06 $20.00 * * AP-35 * * * AP-06 $5.00 * AP-35 * *

AP-07 $15.00 * * AP-36 * * AP-07 $5.00 * AP-36 * *

AP-08 & $11.00 * * AP-37 $15.00 # # AP-08 $5.00 * AP-37 $5.00 #

AP-09 $15.00 * * AP-38 $10.00 # # AP-09 $5.00 * AP-38 $5.00 #

AP-10 $11.00 * * AP-39 $12.00 # # AP-10 $5.00 * AP-39 $5.00 #

AP-11 $15.00 * * AP-40 $18.00 # # AP-11 $5.00 * AP-40 $5.00 #

AP-12 $10.00 # # AP-41 $15.00 # # AP-12 $10.00 # AP-41 $7.00 #

AP-13 $15.00 * * AP-42 NADA # # AP-13 $5.00 * AP-42 N/C *

AP-14 $15.00 * * AP-43 $15.00 # # AP-14 $5.00 * AP-43 $5.00 #

AP-15 $15.00 * * AP-44 $12.00 # # AP-15 $5.00 * AP-44 $5.00 #

AP-16 $15.00 * * AP-45 $15.00 # # AP-16 $5.00 * AP-45 $5.00 #

AP-17 $15.00 * * AP-46 $15.00 15 15 AP-17 $5.00 * AP-46 NADA 15

AP-18 * * * AP-47 $15.00 # # AP-18 * * AP-47 $5.00 #

AP-19 $15.00 # # AP-48 $15.00 # # AP-19 $5.00 # AP-48 $5.00 #

AP-20 $15.00 * * AP-49 $15.00 # # AP-20 $5.00 * AP-49 $5.00 #

AP-21 $18.00 # # AP-50 $15.00 # # AP-21 $15.00 # AP-50 $7.00 #

AP-22 $15.00 # # AP-51 $15.00 # # AP-22 $15.00 # AP-51 $5.00 #

AP-23 $15.00 # # AP-52 $15.00 # # AP-23 $15.00 # AP-52 $5.00 #

AP-24 $18.00 # # AP-53 $10.00 # # AP-24 $15.00 # AP-53 $5.00 #

AP-25 $15.00 * * AP-54 $20.00 # # AP-25 $5.00 * AP-54 $5.00 #

AP-26 $12.00 * * AP-55 $15.00 # # AP-26 $5.00 * AP-55 $5.00 #

AP-27 * * * AP-56 $15.00 # # AP-27 * * AP-56 $5.00 #

AP-28 $12.00 * * AP-57 $12.00 # # AP-28 $5.00 * AP-57 $5.00 #

AP-29 $15.00 * * AP-58 $18.00 # # AP-29 $5.00 * AP-58 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

AP-59 $15.00 # # AP-88 $12.00 # # AP-59 $5.00 # AP-88 $5.00 #

AP-60 $15.00 # # AP-89 $15.00 # # AP-60 $5.00 # AP-89 $15.00 #

AP-61 $20.00 # # AP-90 $18.00 # # AP-61 $5.00 # AP-90 $5.00 #

AP-62 $20.00 # # AP-91 $15.00 # # AP-62 $5.00 # AP-91 $5.00 #

AP-63 $15.00 # # AP-92 $15.00 # # AP-63 $5.00 # AP-92 $5.00 #

AP-64 $15.00 # # AP-93 * * * AP-64 $15.00 # AP-93 * *

AP-65 $12.00 # # AP-94 * * * AP-65 $12.00 # AP-94 * *

AP-66 $15.00 # # AP-95 * * * AP-66 $5.00 # AP-95 * *

AP-67 $20.00 # # AP-96 * * * AP-67 $5.00 # AP-96 * *

AP-68 $18.00 # # AP-97 * * * AP-68 $5.00 # AP-97 * *

AP-69 $15.00 # # AP-98 * * * AP-69 $5.00 # AP-98 * *

AP-70 $15.00 # # AP-99 $20.00 # # AP-70 $5.00 # AP-99 $5.00 #

AP-71 $15.00 # # * * * * AP-71 $5.00 # * * *

AP-72 $15.00 # # * * * * AP-72 $5.00 # * * *

AP-73 $15.00 # # * * * * AP-73 $5.00 # * * *

AP-74 20% # # * * * * AP-74 N/C * * * *

AP-75 $15.00 # * * * * * AP-75 $5.00 # * * *

AP-76 $12.00 # * * * * * AP-76 $5.00 # * * *

AP-77 $15.00 # * * * * * AP-77 $5.00 # * * *

AP-78 $18.00 # * * * * * AP-78 $5.00 # * * *

AP-79 $12.00 # * * * * * AP-79 $5.00 # * * *

AP-80 $15.00 # * * * * * AP-80 $5.00 # * * *

AP-81 $15.00 # * * * * * AP-81 $5.00 # * * *

AP-82 $15.00 # # * * * * AP-82 NADA # * * *

AP-83 $15.00 # # * * * * AP-83 NADA # * * *

AP-84 $15.00 # # * * * * AP-84 $5.00 # * * *

AP-85 * * * * * * * AP-85 * * * * *

AP-86 $12.00 # # * * * * AP-86 $12.00 # * * *

AP-87 $15.00 # # * * * * AP-87 $15.00 # * * *

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CÓDIGOS DE CUBIERTAS / COPAGOS

Departamento de Comunicación Técnica, División de Mercadeo y Desarrollo de Productos 32 06/30/2014

VISITAS SIQUIÁTRICAS, VISITAS COLATERALES Y TERAPIAS DE GRUPO

NOTAS: El número de visitas aplica por persona asegurada. N/C No cubre * Código sin asignar (a) Aplica periodo de espera. (b) Las visitas colaterales están limitadas a 5 visitas; si el paciente es mayor de 19 años y a 12 si el

paciente es menor de 19 años. (c) 50 Visitas por combinación de visitas al siquiatra, visitas colaterales y terapias de grupo. (d) Visitas por la combinación de psicoterapia, visitas colaterales y terapias de grupo. (e) Servicios cubiertos de acuerdo a necesidad médica justificada a través del Programa de Manejo de

Condiciones Mentales. (f) Visitas colaterales limitadas a 5 visitas si el paciente es mayor de 18 años y a 20 visitas si es menor de

18 años. (g) El límite en visitas a la oficina del siquiatra aplica sólo para el tratamiento de drogadicción y

alcoholismo, las demás condiciones estarán cubiertas de acuerdo a la necesidad médica justificada. (h) Visitas 1 a la 5 NADA

Visitas 6-7-8 15% Visitas 9-10 30% Visitas 11-12 45%

(i) Las visitas colaterales pagarán el deducible de especialista especificado en la tarjeta del asegurado. (k) Sin límite. (l) 10 Visitas por semestre académico. (m) 40 Visitas en combinación de visitas al siquiatra y terapia de grupo. (n) Cubre 15 visitas adicionales por motivo de rehabilitación por drogadicción y alcoholismo sujeto a

precertificación. (o) Si la tarjeta de identificación del asegurado (a) incluye la Y, las visitas siquiátricas en la oficina para el

tratamiento de condiciones mentales se cubrirán de acuerdo a la necesidad médica justificada. El límite incluido en la Tabla corresponde solamente a las visitas colaterales, terapia de grupo y tratamiento para drogadicción y alcoholismo.

(p) Las visitas individuales para el tratamiento de condiciones mentales por siquiatra, sicólogo o

trabajadores sociales estarán cubiertas de acuerdo a la necesidad médica justificada.

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(q) Las visitas individuales para el tratamiento de abuso de sustancias, terapias de grupo para el

tratamiento de condiciones mentales y abuso de sustancias, y visitas colaterales para el tratamiento de condiciones mentales y abuso de sustancias (incluyendo servicios de sicólogos o trabajadores sociales, estarán cubiertas hasta un máximo de 20 por año.

(r) Las visitas colaterales no pagan deducible. (s) $5.00 de deducible para visitas colaterales. (t) No incluye los servicios provistos por los sicólogos clínicos contratados en la red de Triple-S Salud.

(u) No cubre visitas colaterales. (v) No cubre visitas por drogadicción y alcoholismo. (w) $12.00 de deducible para visitas colaterales. Todos los servicios por condiciones mentales y/o

drogadicción y alcoholismo estarán cubiertos de acuerdo a la necesidad médica justificada, pero deberán ser precertificados por FHC Options, siempre y cuando no sean de emergencia. De lo contrario, no se cubrirán.

(x) Aplica al Programa Medicare Advantage (y) $10.00 de deducible para visitas colaterales. (z) $7.00 de deducible para visitas colaterales. (&) $15.00 de deducible para visitas colaterales

% Visitas siquiátricas y colaterales y terapias de grupo por drogadicción y alcoholismo hasta 20 por año

póliza. & Las visitas individuales y visitas colaterales para el tratamiento de condiciones mentales por siquiatras,

sicólogos o trabajadores sociales están cubiertas de acuerdo a la necesidad médica justificada; cuando el asegurado visite un proveedor no participante, el rembolso será a base de la tarifa contratada.

$ Las 20 visitas individuales y 20 visitas colaterales para el tratamiento de abuso de sustancias.

Cuando el asegurado visite un proveedor no participante, el rembolso será a base de la tarifa contratada.

# Servicios cubiertos de acuerdo a la necesidad médica justificada. € Todo servicio por condiciones mentales y/o drogadiccion y alcoholismo, incluyendo visitas al siquiatra,

sicologo, colaterales y terapia de grupo, estaran cubiertos segun necesidad medica justificada, pero deben ser precertificados por FHC.

¥ Las visitas no usadas, pasaran al próximo año póliza.

() Versión de Cubiertas de Reforma de Salud Federal que incluyen beneficios que se considerarán como Servicios Preventivos

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Grupo Triple-S

VISITAS SIQUIÁTRICAS Y

COLATERALES

TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS

B1 $2.00 # # B1 NADA #

B2 $10.00 # # B2 $10.00 #

B3 $10.00 20 15 B3 $5.00 20

B4 $10.00 20 15 B4 $5.00 20

B5 $10.00 # # B5 NADA #

B6 $10.00 # # B6 NADA #

B7 $10.00 # # B7 NADA #

B8 $10.00 # # B8 NADA #

B9 $2.00 # # B9 NADA #

B10 $5.00 # # B10 NADA #

B11 $5.00 # # B11 NADA #

B12 $10.00 # # B12 NADA #

B13 $10.00 # # B13 NADA #

B14 $10.00 # # B14 NADA #

B15 $2.00 # # B15 NADA #

B16 $5.00 # # B16 NADA #

B17 $10.00 # # B17 $10.00 #

B18 $10.00 # # B18 NADA #

B19 $10.00 # # B19 NADA #

B20 $10.00 # # B20 NADA #

B21 $10.00 # # B21 NADA #

B22 $10.00 # # B22 NADA #

B23 $10.00 # # B23 NADA #

B24 $5.00 # # B24 NADA #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B25 g $15.00 15 15 B50 g $15.00 15 15 B25 $5.00 15 B50 $5.00 15

B26 g $15.00 15 15 B51 g $15.00 15 15 B26 $5.00 15 B51 $5.00 15

B27 g $15.00 15 15 B52 g $15.00 15 15 B27 $5.00 15 B52 $5.00 15

B28 g $15.00 15 15 B53 g $15.00 15 15 B28 $5.00 15 B53 $5.00 15

B29 g $15.00 15 15 B54 g $15.00 15 15 B29 $5.00 15 B54 $5.00 15

B30 g $15.00 15 15 B55 g $15.00 15 15 B30 $5.00 15 B55 $5.00 15

B31 g $15.00 15 15 B56 g $15.00 15 15 B31 $5.00 15 B56 $5.00 15

B32 g $15.00 15 15 B57 g $15.00 15 15 B32 $5.00 15 B57 $5.00 15

B33 g $15.00 15 15 B58 g $15.00 15 15 B33 $5.00 15 B58 $5.00 15

B34 g $15.00 15 15 B59 g $15.00 15 15 B34 $5.00 15 B59 $5.00 15

B35 g $15.00 15 15 B60 g $15.00 15 15 B35 $5.00 15 B60 $5.00 15

B36 g $15.00 15 15 B61 g $15.00 15 15 B36 $5.00 15 B61 $5.00 15

B37 g $15.00 15 15 B62 g $15.00 15 15 B37 $5.00 15 B62 $5.00 15

B38 g $15.00 15 15 B63 g $15.00 15 15 B38 $5.00 15 B63 $5.00 15

B39 g $15.00 15 15 B64 g $15.00 15 15 B39 $5.00 15 B64 $5.00 15

B40 g $15.00 15 15 B65 g $15.00 15 15 B40 $5.00 15 B65 $5.00 15

B41 g $15.00 15 15 B66 g $15.00 15 15 B41 $5.00 15 B66 $5.00 15

B42 g $15.00 15 15 B67 g $15.00 15 15 B42 $5.00 15 B67 $5.00 15

B43 g $15.00 15 15 B68 g $15.00 15 15 B43 $5.00 15 B68 $5.00 15

B44 g $15.00 15 15 B69 g $15.00 15 15 B44 $5.00 15 B69 $5.00 15

B45 g $15.00 15 15 B70 g $15.00 15 15 B45 $5.00 15 B70 $5.00 15

B46 g $15.00 15 15 B71 g $15.00 15 15 B46 $5.00 15 B71 $5.00 15

B47 g $15.00 15 15 B72 g $15.00 15 15 B47 $5.00 15 B72 $5.00 15

B48 g $15.00 15 15 B73 g $15.00 15 15 B48 $5.00 15 B73 $5.00 15

B49 g $15.00 15 15 B74 g $15.00 15 15 B49 $5.00 15 B74 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B75 g $15.00 15 15 B100 g $15.00 15 15 B75 $5.00 15 B100 $5.00 15

B76 g $15.00 15 15 B101 g $15.00 15 15 B76 $5.00 15 B101 $5.00 15

B77 g $15.00 15 15 B102 g $15.00 15 15 B77 $5.00 15 B102 $5.00 15

B78 g $15.00 15 15 B103 g $15.00 15 15 B78 $5.00 15 B103 $5.00 15

B79 g $15.00 15 15 B104 g $15.00 15 15 B79 $5.00 15 B104 $5.00 15

B80 g $15.00 15 15 B105 g $15.00 15 15 B80 $5.00 15 B105 $5.00 15

B81 g $15.00 15 15 B106 g $15.00 15 15 B81 $5.00 15 B106 $5.00 15

B82 g $15.00 15 15 B107 g $15.00 15 15 B82 $5.00 15 B107 $5.00 15

B83 g $15.00 15 15 B108 g $15.00 15 15 B83 $5.00 15 B108 $5.00 15

B84 g $15.00 15 15 B109 g $15.00 15 15 B84 $5.00 15 B109 $5.00 15

B85 g $15.00 15 15 B110 g $15.00 15 15 B85 $5.00 15 B110 $5.00 15

B86 g $15.00 15 15 B111 g $15.00 15 15 B86 $5.00 15 B111 $5.00 15

B87 g $15.00 15 15 B112 g $15.00 15 15 B87 $5.00 15 B112 $5.00 15

B88 g $15.00 15 15 B113 g $15.00 15 15 B88 $5.00 15 B113 $5.00 15

B89 g $15.00 15 15 B114 g $15.00 15 15 B89 $5.00 15 B114 $5.00 15

B90 g $15.00 15 15 B115 g $15.00 15 15 B90 $5.00 15 B115 $5.00 15

B91 g $15.00 15 15 B116 g $15.00 15 15 B91 $5.00 15 B116 $5.00 15

B92 g $15.00 15 15 B117 g $15.00 15 15 B92 $5.00 15 B117 $5.00 15

B93 g $15.00 15 15 B118 g $15.00 15 15 B93 $5.00 15 B118 $5.00 15

B94 g $15.00 15 15 B119 g $15.00 15 15 B94 $5.00 15 B119 $5.00 15

B95 g $15.00 15 15 B120 g $15.00 15 15 B95 $5.00 15 B120 $5.00 15

B96 g $15.00 15 15 B121 g $15.00 15 15 B96 $5.00 15 B121 $5.00 15

B97 g $15.00 15 15 B122 g $15.00 15 15 B97 $5.00 15 B122 $5.00 15

B98 g $15.00 15 15 B123 g $15.00 15 15 B98 $5.00 15 B123 $5.00 15

B99 g $15.00 15 15 B124 g $15.00 15 15 B99 $5.00 15 B124 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B125 g $15.00 15 15 B150 g $15.00 15 15 B125 $5.00 15 B150 $5.00 15

B126 g $15.00 15 15 B151 g $15.00 15 15 B126 $5.00 15 B151 $5.00 15

B127 g $15.00 15 15 B152 g $15.00 15 15 B127 $5.00 15 B152 $5.00 15

B128 g $15.00 15 15 B153 g $15.00 15 15 B128 $5.00 15 B153 $5.00 15

B129 g $15.00 15 15 B154 g $15.00 15 15 B129 $5.00 15 B154 $5.00 15

B130 g $15.00 15 15 B155 g $15.00 15 15 B130 $5.00 15 B155 $5.00 15

B131 g $15.00 15 15 B156 g $15.00 15 15 B131 $5.00 15 B156 $5.00 15

B132 g $15.00 15 15 B157 g $15.00 15 15 B132 $5.00 15 B157 $5.00 15

B133 g $15.00 15 15 B158 g $15.00 15 15 B133 $5.00 15 B158 $5.00 15

B134 g $15.00 15 15 B159 g $15.00 15 15 B134 $5.00 15 B159 $5.00 15

B135 g $15.00 15 15 B160 g $15.00 15 15 B135 $5.00 15 B160 $5.00 15

B136 g $15.00 15 15 B161 g $15.00 15 15 B136 $5.00 15 B161 $5.00 15

B137 g $15.00 15 15 B162 g $15.00 15 15 B137 $5.00 15 B162 $5.00 15

B138 g $15.00 15 15 B163 g $15.00 15 15 B138 $5.00 15 B163 $5.00 15

B139 g $15.00 15 15 B164 g $15.00 15 15 B139 $5.00 15 B164 $5.00 15

B140 g $15.00 15 15 B165 g $15.00 15 15 B140 $5.00 15 B165 $5.00 15

B141 g $15.00 15 15 B166 g $15.00 15 15 B141 $5.00 15 B166 $5.00 15

B142 g $15.00 15 15 B167 g $15.00 15 15 B142 $5.00 15 B167 $5.00 15

B143 g $15.00 15 15 B168 g $15.00 15 15 B143 $5.00 15 B168 $5.00 15

B144 g $15.00 15 15 B169 g $15.00 15 15 B144 $5.00 15 B169 $5.00 15

B145 g $15.00 15 15 B170 g $15.00 15 15 B145 $5.00 15 B170 $5.00 15

B146 g $15.00 15 15 B171 g $15.00 15 15 B146 $5.00 15 B171 $5.00 15

B147 g $15.00 15 15 B172 g $15.00 15 15 B147 $5.00 15 B172 $5.00 15

B148 g $15.00 15 15 B173 g $15.00 15 15 B148 $5.00 15 B173 $5.00 15

B149 g $15.00 15 15 B174 g $15.00 15 15 B149 $5.00 15 B174 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B175 g $15.00 15 15 B200 g $15.00 15 15 B175 $5.00 15 B200 $5.00 15

B176 g $15.00 15 15 B201 g $15.00 15 15 B176 $5.00 15 B201 $5.00 15

B177 g $15.00 15 15 B202 g $15.00 15 15 B177 $5.00 15 B202 $5.00 15

B178 g $15.00 15 15 B203 g $15.00 15 15 B178 $5.00 15 B203 $5.00 15

B179 g $15.00 15 15 B204 g $15.00 15 15 B179 $5.00 15 B204 $5.00 15

B180 g $15.00 15 15 B205 g $15.00 15 15 B180 $5.00 15 B205 $5.00 15

B181 g $15.00 15 15 B206 g $15.00 15 15 B181 $5.00 15 B206 $5.00 15

B182 g $15.00 15 15 B207 g $15.00 15 15 B182 $5.00 15 B207 $5.00 15

B183 g $15.00 15 15 B208 g $15.00 15 15 B183 $5.00 15 B208 $5.00 15

B184 g $15.00 15 15 B209 g $15.00 15 15 B184 $5.00 15 B209 $5.00 15

B185 g $15.00 15 15 B210 g $15.00 15 15 B185 $5.00 15 B210 $5.00 15

B186 g $15.00 15 15 B211 g $15.00 15 15 B186 $5.00 15 B211 $5.00 15

B187 g $15.00 15 15 B212 g $15.00 15 15 B187 $5.00 15 B212 $5.00 15

B188 g $15.00 15 15 B213 g $15.00 15 15 B188 $5.00 15 B213 $5.00 15

B189 g $15.00 15 15 B214 g $15.00 15 15 B189 $5.00 15 B214 $5.00 15

B190 g $15.00 15 15 B215 g $15.00 15 15 B190 $5.00 15 B215 $5.00 15

B191 g $15.00 15 15 B216 g $15.00 15 15 B191 $5.00 15 B216 $5.00 15

B192 g $15.00 15 15 B217 g $15.00 15 15 B192 $5.00 15 B217 $5.00 15

B193 g $15.00 15 15 B218 g $15.00 15 15 B193 $5.00 15 B218 $5.00 15

B194 g $15.00 15 15 B219 g $15.00 15 15 B194 $5.00 15 B219 $5.00 15

B195 g $15.00 15 15 B220 g $15.00 15 15 B195 $5.00 15 B220 $5.00 15

B196 g $15.00 15 15 B221 g $15.00 15 15 B196 $5.00 15 B221 $5.00 15

B197 g $15.00 15 15 B222 g $15.00 15 15 B197 $5.00 15 B222 $5.00 15

B198 g $15.00 15 15 B223 g $15.00 15 15 B198 $5.00 15 B223 $5.00 15

B199 g $15.00 15 15 B224 g $15.00 15 15 B199 $5.00 15 B224 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B225 g $15.00 15 15 B250 g $15.00 15 15 B225 $5.00 15 B250 $5.00 15

B226 g $15.00 15 15 B251 g $15.00 15 15 B226 $5.00 15 B251 $5.00 15

B227 g $15.00 15 15 B252 g $15.00 15 15 B227 $5.00 15 B252 $5.00 15

B228 g $15.00 15 15 B253 g $15.00 15 15 B228 $5.00 15 B253 $5.00 15

B229 g $15.00 15 15 B254 g $15.00 15 15 B229 $5.00 15 B254 $5.00 15

B230 g $15.00 15 15 B255 g $15.00 15 15 B230 $5.00 15 B255 $5.00 15

B231 g $15.00 15 15 B256 g $15.00 15 15 B231 $5.00 15 B256 $5.00 15

B232 g $15.00 15 15 B257 g $15.00 15 15 B232 $5.00 15 B257 $5.00 15

B233 g $15.00 15 15 B258 g $15.00 15 15 B233 $5.00 15 B258 $5.00 15

B234 g $15.00 15 15 B259 g $15.00 15 15 B234 $5.00 15 B259 $5.00 15

B235 g $15.00 15 15 B250 g $15.00 20 15 B235 $5.00 15 B250 $5.00 15

B236 g $15.00 15 15 B251 g $15.00 20 15 B236 $5.00 15 B251 $5.00 15

B237 g $15.00 15 15 B252 g $15.00 20 15 B237 $5.00 15 B252 $5.00 15

B238 g $15.00 15 15 B253 g $15.00 20 15 B238 $5.00 15 B253 $5.00 15

B239 g $15.00 15 15 B254 g $15.00 20 15 B239 $5.00 15 B254 $5.00 15

B240 g $15.00 15 15 B255 g $15.00 20 15 B240 $5.00 15 B255 $5.00 15

B241 g $15.00 15 15 B256 g $15.00 20 15 B241 $5.00 15 B256 $5.00 15

B242 g $15.00 15 15 B257 g $15.00 20 15 B242 $5.00 15 B257 $5.00 15

B243 g $15.00 15 15 B258 g $15.00 20 15 B243 $5.00 15 B258 $5.00 15

B244 g $15.00 15 15 B259 g $15.00 20 15 B244 $5.00 15 B259 $5.00 15

B245 g $15.00 15 15 B260 g $15.00 20 12 B245 $5.00 15 B260 $5.00 15

B246 g $15.00 15 15 B261 g $15.00 20 12 B246 $5.00 15 B261 $5.00 15

B247 g $15.00 15 15 B262 g $15.00 20 12 B247 $5.00 15 B262 $5.00 15

B248 g $15.00 15 15 B263 g $15.00 20 12 B248 $5.00 15 B263 $5.00 15

B249 g $15.00 15 15 B264 g $15.00 20 12 B249 $5.00 15 B264 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B265 g $15.00 20 15 B290 g $15.00 20 15 B265 $5.00 15 B290 $5.00 15

B266 g $15.00 20 15 B291 g $15.00 20 15 B266 $5.00 15 B291 $5.00 15

B267 g $15.00 20 15 B292 g $15.00 20 15 B267 $5.00 15 B292 $5.00 15

B268 g $15.00 20 15 B293 g $15.00 20 15 B268 $5.00 15 B293 $5.00 15

B269 g $15.00 20 15 B294 g $15.00 20 15 B269 $5.00 15 B294 $5.00 15

B270 g $15.00 20 15 B295 g $15.00 20 15 B270 $5.00 15 B295 $5.00 15

B271 g $15.00 20 15 B296 g $15.00 20 15 B271 $5.00 15 B296 $5.00 15

B272 g $15.00 20 15 B297 g $15.00 20 15 B272 $5.00 15 B297 $5.00 15

B273 g $15.00 20 15 B298 g $15.00 20 15 B273 $5.00 15 B298 $5.00 15

B274 g $15.00 20 15 B299 g $15.00 20 15 B274 $5.00 15 B299 $5.00 15

B275 g $15.00 20 15 B300 g $15.00 20 15 B275 $5.00 15 B300 $5.00 15

B276 g $15.00 20 15 B301 g $15.00 20 15 B276 $5.00 15 B301 $5.00 15

B277 g $15.00 20 15 B302 g $15.00 20 15 B277 $5.00 15 B302 $5.00 15

B278 g $15.00 20 15 B303 g $15.00 20 15 B278 $5.00 15 B303 $5.00 15

B279 g $15.00 20 15 B304 g $15.00 20 15 B279 $5.00 15 B304 $5.00 15

B280 g $15.00 20 15 B305 g $15.00 20 15 B280 $5.00 15 B305 $5.00 15

B281 g $15.00 20 15 B306 g $15.00 20 15 B281 $5.00 15 B306 $5.00 15

B282 g $15.00 20 15 B307 g $15.00 20 15 B282 $5.00 15 B307 $5.00 15

B283 g $15.00 20 15 B308 g $15.00 20 15 B283 $5.00 15 B308 $5.00 15

B284 g $15.00 20 15 B309 g $15.00 20 15 B284 $5.00 15 B309 $5.00 15

B285 g $15.00 20 15 B310 g $15.00 20 15 B285 $5.00 15 B310 $5.00 15

B286 g $15.00 20 15 B311 g $15.00 20 15 B286 $5.00 15 B311 $5.00 15

B287 g $15.00 20 15 B312 g $15.00 20 15 B287 $5.00 15 B312 $5.00 15

B288 g $15.00 20 15 B313 g $15.00 20 15 B288 $5.00 15 B313 $5.00 15

B289 g $15.00 20 15 B314 g $15.00 20 15 B289 $5.00 15 B314 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B315 g $15.00 20 15 B340 g $15.00 20 15 B315 $5.00 15 B340 $5.00 15

B316 g $15.00 20 15 B341 g $15.00 20 15 B316 $5.00 15 B341 $5.00 15

B317 g $15.00 20 15 B342 g $15.00 20 15 B317 $5.00 15 B342 $5.00 15

B318 g $15.00 20 15 B343 g $15.00 20 15 B318 $5.00 15 B343 $5.00 15

B319 g $15.00 20 15 B344 g $15.00 20 15 B319 $5.00 15 B344 $5.00 15

B320 g $15.00 20 15 B345 g $15.00 20 15 B320 $5.00 15 B345 $5.00 15

B321 g $15.00 20 15 B346 g $15.00 20 15 B321 $5.00 15 B346 $5.00 15

B322 g $15.00 20 15 B347 g $15.00 20 15 B322 $5.00 15 B347 $5.00 15

B323 g $15.00 20 15 B348 g $15.00 20 15 B323 $5.00 15 B348 $5.00 15

B324 g $15.00 20 15 B349 g $15.00 20 15 B324 $5.00 15 B349 $5.00 15

B325 g $15.00 20 15 B350 g $15.00 20 15 B325 $5.00 15 B350 $5.00 15

B326 g $15.00 20 15 B351 g $15.00 20 15 B326 $5.00 15 B351 $5.00 15

B327 g $15.00 20 15 B352 g $15.00 20 15 B327 $5.00 15 B352 $5.00 15

B328 g $15.00 20 15 B353 g $15.00 20 15 B328 $5.00 15 B353 $5.00 15

B329 g $15.00 20 15 B354 g $15.00 20 15 B329 $5.00 15 B354 $5.00 15

B330 g $15.00 20 15 B355 g $15.00 20 15 B330 $5.00 15 B355 $5.00 15

B331 g $15.00 20 15 B356 g $15.00 20 15 B331 $5.00 15 B356 $5.00 15

B332 g $15.00 20 15 B357 g $15.00 20 15 B332 $5.00 15 B357 $5.00 15

B333 g $15.00 20 15 B358 g $15.00 20 15 B333 $5.00 15 B358 $5.00 15

B334 g $15.00 20 15 B359 g $15.00 20 15 B334 $5.00 15 B359 $5.00 15

B335 g $15.00 20 15 B361 g $15.00 20 15 B335 $5.00 15 B361 $5.00 15

B336 g $15.00 20 15 B362 g $15.00 20 15 B336 $5.00 15 B362 $5.00 15

B337 g $15.00 20 15 B363 g $15.00 20 15 B337 $5.00 15 B363 $5.00 15

B338 g $15.00 20 15 B364 g $15.00 20 15 B338 $5.00 15 B364 $5.00 15

B339 g $15.00 20 15 B365 g $15.00 20 15 B339 $5.00 15 B365 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B366 g $15.00 20 15 B391 g $15.00 20 15 B366 $5.00 15 B391 $5.00 15

B367 g $15.00 20 15 B392 g $15.00 20 15 B367 $5.00 15 B392 $5.00 15

B368 g $15.00 20 15 B393 g $15.00 20 15 B368 $5.00 15 B393 $5.00 15

B369 g $15.00 20 15 B394 g $15.00 20 15 B369 $5.00 15 B394 $5.00 15

B370 g $15.00 20 15 B395 g $15.00 20 15 B370 $5.00 15 B395 $5.00 15

B371 g $15.00 20 15 B396 g $15.00 20 15 B371 $5.00 15 B396 $5.00 15

B372 g $15.00 20 15 B397 g $15.00 20 15 B372 $5.00 15 B397 $5.00 15

B373 g $15.00 20 15 B398 g $15.00 20 15 B373 $5.00 15 B398 $5.00 15

B374 g $15.00 20 15 B399 g $15.00 20 15 B374 $5.00 15 B399 $5.00 15

B375 g $15.00 20 15 B400 g $15.00 20 15 B375 $5.00 15 B400 $5.00 15

B376 g $15.00 20 15 B401 g $15.00 20 15 B376 $5.00 15 B401 $5.00 15

B377 g $15.00 20 15 B402 g $15.00 20 15 B377 $5.00 15 B402 $5.00 15

B378 g $15.00 20 15 B403 g $15.00 20 15 B378 $5.00 15 B403 $5.00 15

B379 g $15.00 20 15 B404 g $15.00 20 15 B379 $5.00 15 B404 $5.00 15

B380 g $15.00 20 15 B405 g $15.00 20 15 B380 $5.00 15 B405 $5.00 15

B381 g $15.00 20 15 B406 g $15.00 20 15 B381 $5.00 15 B406 $5.00 15

B382 g $15.00 20 15 B407 g $15.00 20 15 B382 $5.00 15 B407 $5.00 15

B383 g $15.00 20 15 B408 g $15.00 20 15 B383 $5.00 15 B408 $5.00 15

B384 g $15.00 20 15 B409 g $15.00 20 15 B384 $5.00 15 B409 $5.00 15

B385 g $15.00 20 15 B410 g $15.00 20 15 B385 $5.00 15 B410 $5.00 15

B386 g $15.00 20 15 B411 g $15.00 20 15 B386 $5.00 15 B411 $5.00 15

B387 g $15.00 20 15 B412 g $15.00 20 15 B387 $5.00 15 B412 $5.00 15

B388 g $15.00 20 15 B413 g $15.00 20 15 B388 $5.00 15 B413 $5.00 15

B389 g $15.00 20 15 B414 g $15.00 20 15 B389 $5.00 15 B414 $5.00 15

B390 g $15.00 20 15 B415 g $15.00 20 15 B390 $5.00 15 B415 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B416 g $15.00 20 15 B441 g $15.00 15 15 B416 $5.00 15 B441 $5.00 15

B417 g $15.00 20 15 B442 g $15.00 15 15 B417 $5.00 15 B442 $5.00 15

B418 g $15.00 20 15 B443 g $15.00 15 15 B418 $5.00 15 B443 $5.00 15

B419 g $15.00 20 15 B444 g $15.00 15 15 B419 $5.00 15 B444 $5.00 15

B420 g $15.00 20 15 B445 g $15.00 15 15 B420 $5.00 15 B445 $5.00 15

B421 g $15.00 20 15 B446 g $15.00 15 15 B421 $5.00 15 B446 $5.00 15

B422 g $15.00 20 15 B447 g $15.00 15 15 B422 $5.00 15 B447 $5.00 15

B423 g $15.00 20 15 B448 g $15.00 15 15 B423 $5.00 15 B448 $5.00 15

B424 g $15.00 20 15 B449 g $15.00 15 15 B424 $5.00 15 B449 $5.00 15

B425 g $15.00 20 15 B450 g $15.00 15 15 B425 $5.00 15 B450 $5.00 15

B426 g $15.00 20 15 B451 g $15.00 15 15 B426 $5.00 15 B451 $5.00 15

B427 g $15.00 20 15 B452 g $15.00 15 15 B427 $5.00 15 B452 $5.00 15

B428 g $15.00 20 15 B453 g $15.00 15 15 B428 $5.00 15 B453 $5.00 15

B429 g $15.00 20 15 B454 g $15.00 15 15 B429 $5.00 15 B454 $5.00 15

B430 g $15.00 20 15 B455 g $15.00 15 15 B430 $5.00 15 B455 $5.00 15

B431 g $15.00 20 15 B456 g $15.00 15 15 B431 $5.00 15 B456 $5.00 15

B432 g $15.00 20 15 B457 g $15.00 15 15 B432 $5.00 15 B457 $5.00 15

B433 g $15.00 20 15 B458 g $15.00 15 15 B433 $5.00 15 B458 $5.00 15

B434 g $15.00 20 15 B459 g $15.00 15 15 B434 $5.00 15 B459 $5.00 15

B435 g $15.00 20 15 B460 g $15.00 15 15 B435 $5.00 15 B460 $5.00 15

B436 g $15.00 20 15 B461 g $15.00 15 15 B436 $5.00 15 B461 $5.00 15

B437 g $15.00 15 15 B462 g $15.00 15 15 B437 $5.00 15 B462 $5.00 15

B438 g $15.00 15 15 B463 g $15.00 15 15 B438 $5.00 15 B463 $5.00 15

B439 g $15.00 15 15 B464 g $15.00 15 15 B439 $5.00 15 B464 $5.00 15

B440 g $15.00 15 15 B465 g $15.00 15 15 B440 $5.00 15 B465 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B466 g $15.00 15 15 B491 g $15.00 15 15 B466 $5.00 15 B491 $5.00 15

B467 g $15.00 15 15 B492 g $15.00 15 15 B467 $5.00 15 B492 $5.00 15

B468 g $15.00 15 15 B493 g $15.00 15 15 B468 $5.00 15 B493 $5.00 15

B469 g $15.00 15 15 B494 g $15.00 15 15 B469 $5.00 15 B494 $5.00 15

B470 g $15.00 15 15 B495 g $15.00 15 15 B470 $5.00 15 B495 $5.00 15

B471 g $15.00 15 15 B496 g $15.00 15 15 B471 $5.00 15 B496 $5.00 15

B472 g $15.00 15 15 B497 g $15.00 15 15 B472 $5.00 15 B497 $5.00 15

B473 g $15.00 15 15 B498 g $15.00 15 15 B473 $5.00 15 B498 $5.00 15

B474 g $15.00 15 15 B499 g $15.00 15 15 B474 $5.00 15 B499 $5.00 15

B475 g $15.00 15 15 B500 g $15.00 15 15 B475 $5.00 15 B500 $5.00 15

B476 g $15.00 15 15 B501 g $15.00 15 15 B476 $5.00 15 B501 $5.00 15

B477 g $15.00 15 15 B502 g $15.00 15 15 B477 $5.00 15 B502 $5.00 15

B478 g $15.00 15 15 B503 g $15.00 15 15 B478 $5.00 15 B503 $5.00 15

B479 g $15.00 15 15 B504 g $15.00 15 15 B479 $5.00 15 B504 $5.00 15

B480 g $15.00 15 15 B505 g $15.00 15 15 B480 $5.00 15 B505 $5.00 15

B481 g $15.00 15 15 B506 g $15.00 15 15 B481 $5.00 15 B506 $5.00 15

B482 g $15.00 15 15 B507 g $15.00 15 15 B482 $5.00 15 B507 $5.00 15

B483 g $15.00 15 15 B508 g $15.00 15 15 B483 $5.00 15 B508 $5.00 15

B484 g $15.00 15 15 B509 g $15.00 15 15 B484 $5.00 15 B509 $5.00 15

B485 g $15.00 15 15 B510 g $15.00 15 15 B485 $5.00 15 B510 $5.00 15

B486 g $15.00 15 15 B511 g $15.00 15 15 B486 $5.00 15 B511 $5.00 15

B487 g $15.00 15 15 B512 g $15.00 15 15 B487 $5.00 15 B512 $5.00 15

B488 g $15.00 15 15 B513 g $15.00 15 15 B488 $5.00 15 B513 $5.00 15

B489 g $15.00 15 15 B514 g $15.00 15 15 B489 $5.00 15 B514 $5.00 15

B490 g $15.00 15 15 B515 g $15.00 15 15 B490 $5.00 15 B515 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B516 g $15.00 15 15 B541 g $15.00 15 15 B516 $5.00 15 B541 $5.00 15

B517 g $15.00 15 15 B542 g $15.00 15 15 B517 $5.00 15 B542 $5.00 15

B518 g $15.00 15 15 B543 g $15.00 15 15 B518 $5.00 15 B543 $5.00 15

B519 g $15.00 15 15 B544 g $15.00 15 15 B519 $5.00 15 B544 $5.00 15

B520 g $15.00 15 15 B545 g $15.00 15 15 B520 $5.00 15 B545 $5.00 15

B521 g $15.00 15 15 B546 g $15.00 15 15 B521 $5.00 15 B546 $5.00 15

B522 g $15.00 15 15 B547 g $15.00 15 15 B522 $5.00 15 B547 $5.00 15

B523 g $15.00 15 15 B548 g $15.00 15 15 B523 $5.00 15 B548 $5.00 15

B524 g $15.00 15 15 B549 g $15.00 15 15 B524 $5.00 15 B549 $5.00 15

B525 g $15.00 15 15 B550 g $15.00 15 15 B525 $5.00 15 B550 $5.00 15

B526 g $15.00 15 15 B551 g $15.00 15 15 B526 $5.00 15 B551 $5.00 15

B527 g $15.00 15 15 B552 g $15.00 15 15 B527 $5.00 15 B552 $5.00 15

B528 g $15.00 15 15 B553 g $15.00 15 15 B528 $5.00 15 B553 $5.00 15

B529 g $15.00 15 15 B554 g $15.00 15 15 B529 $5.00 15 B554 $5.00 15

B530 g $15.00 15 15 B555 g $15.00 15 15 B530 $5.00 15 B555 $5.00 15

B531 g $15.00 15 15 B556 g $15.00 15 15 B531 $5.00 15 B556 $5.00 15

B532 g $15.00 15 15 B557 g $15.00 15 15 B532 $5.00 15 B557 $5.00 15

B533 g $15.00 15 15 B558 g $15.00 15 15 B533 $5.00 15 B558 $5.00 15

B534 g $15.00 15 15 B559 g $15.00 15 15 B534 $5.00 15 B559 $5.00 15

B535 g $15.00 15 15 B560 g $15.00 15 15 B535 $5.00 15 B560 $5.00 15

B536 g $15.00 15 15 B561 g $15.00 15 15 B536 $5.00 15 B561 $5.00 15

B537 g $15.00 15 15 B562 g $15.00 15 15 B537 $5.00 15 B562 $5.00 15

B538 g $15.00 15 15 B563 g $15.00 15 15 B538 $5.00 15 B563 $5.00 15

B539 g $15.00 15 15 B564 g $15.00 15 15 B539 $5.00 15 B564 $5.00 15

B540 g $15.00 15 15 B565 g $15.00 15 15 B540 $5.00 15 B565 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B566 g $15.00 15 15 B591 g $15.00 15 15 B566 $5.00 15 B591 $5.00 15

B567 g $15.00 15 15 B592 g $15.00 15 15 B567 $5.00 15 B592 $5.00 15

B568 g $15.00 15 15 B593 g $15.00 15 15 B568 $5.00 15 B593 $5.00 15

B569 g $15.00 15 15 B594 g $15.00 15 15 B569 $5.00 15 B594 $5.00 15

B570 g $15.00 15 15 B595 g $15.00 15 15 B570 $5.00 15 B595 $5.00 15

B571 g $15.00 15 15 B596 g $15.00 15 15 B571 $5.00 15 B596 $5.00 15

B572 g $15.00 15 15 B597 g $15.00 15 15 B572 $5.00 15 B597 $5.00 15

B573 g $15.00 15 15 B598 g $15.00 15 15 B573 $5.00 15 B598 $5.00 15

B574 g $15.00 15 15 B599 g $15.00 15 15 B574 $5.00 15 B599 $5.00 15

B575 g $15.00 15 15 B600 g $15.00 15 15 B575 $5.00 15 B600 $5.00 15

B576 g $15.00 15 15 B601 g $15.00 15 15 B576 $5.00 15 B601 $5.00 15

B577 g $15.00 15 15 B602 g $15.00 15 15 B577 $5.00 15 B602 $5.00 15

B578 g $15.00 15 15 B603 g $15.00 15 15 B578 $5.00 15 B603 $5.00 15

B579 g $15.00 15 15 B604 g $15.00 15 15 B579 $5.00 15 B604 $5.00 15

B580 g $15.00 15 15 B605 g $15.00 15 15 B580 $5.00 15 B605 $5.00 15

B581 g $15.00 15 15 B606 g $15.00 15 15 B581 $5.00 15 B606 $5.00 15

B582 g $15.00 15 15 B607 g $15.00 15 15 B582 $5.00 15 B607 $5.00 15

B583 g $15.00 15 15 B608 g $15.00 15 15 B583 $5.00 15 B608 $5.00 15

B584 g $15.00 15 15 B609 g $15.00 15 15 B584 $5.00 15 B609 $5.00 15

B585 g $15.00 15 15 B610 g $15.00 15 15 B585 $5.00 15 B610 $5.00 15

B586 g $15.00 15 15 B611 g $15.00 15 15 B586 $5.00 15 B611 $5.00 15

B587 g $15.00 15 15 B612 g $15.00 15 15 B587 $5.00 15 B612 $5.00 15

B588 g $15.00 15 15 B613 g $15.00 15 15 B588 $5.00 15 B613 $5.00 15

B589 g $15.00 15 15 B614 g $15.00 15 15 B589 $5.00 15 B614 $5.00 15

B590 g $15.00 15 15 B615 g $15.00 15 15 B590 $5.00 15 B615 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B616 g $15.00 15 15 B641 g $15.00 15 15 B616 $5.00 15 B641 $5.00 15

B617 g $15.00 15 15 B642 g $15.00 15 15 B617 $5.00 15 B642 $5.00 15

B618 g $15.00 15 15 B643 g $15.00 15 15 B618 $5.00 15 B643 $5.00 15

B619 g $15.00 15 15 B644 g $15.00 15 15 B619 $5.00 15 B644 $5.00 15

B620 g $15.00 15 15 B645 g $15.00 15 15 B620 $5.00 15 B645 $5.00 15

B621 g $15.00 15 15 B646 g $15.00 15 15 B621 $5.00 15 B646 $5.00 15

B622 g $15.00 15 15 B647 g $15.00 15 15 B622 $5.00 15 B647 $5.00 15

B623 g $15.00 15 15 B648 g $15.00 15 15 B623 $5.00 15 B648 $5.00 15

B624 g $15.00 15 15 B649 g $15.00 15 15 B624 $5.00 15 B649 $5.00 15

B625 g $15.00 15 15 B650 g $15.00 15 15 B625 $5.00 15 B650 $5.00 15

B626 g $15.00 15 15 B651 g $15.00 15 15 B626 $5.00 15 B651 $5.00 15

B627 g $15.00 15 15 B652 g $15.00 15 15 B627 $5.00 15 B652 $5.00 15

B628 g $15.00 15 15 B653 g $15.00 15 15 B628 $5.00 15 B653 $5.00 15

B629 g $15.00 15 15 B654 g $15.00 15 15 B629 $5.00 15 B654 $5.00 15

B630 g $15.00 15 15 B655 g $15.00 15 15 B630 $5.00 15 B655 $5.00 15

B631 g $15.00 15 15 B656 g $15.00 15 15 B631 $5.00 15 B656 $5.00 15

B632 g $15.00 15 15 B657 g $15.00 15 15 B632 $5.00 15 B657 $5.00 15

B633 g $15.00 15 15 B658 g $15.00 15 15 B633 $5.00 15 B658 $5.00 15

B634 g $15.00 15 15 B659 g $15.00 15 15 B634 $5.00 15 B659 $5.00 15

B635 g $15.00 15 15 B660 g $15.00 15 15 B635 $5.00 15 B660 $5.00 15

B636 g $15.00 15 15 B661 g $15.00 15 15 B636 $5.00 15 B661 $5.00 15

B637 g $15.00 15 15 B662 g $15.00 15 15 B637 $5.00 15 B662 $5.00 15

B638 g $15.00 15 15 B663 g $15.00 15 15 B638 $5.00 15 B663 $5.00 15

B639 g $15.00 15 15 B664 g $15.00 15 15 B639 $5.00 15 B664 $5.00 15

B640 g $15.00 15 15 B665 g $15.00 15 15 B640 $5.00 15 B665 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B666 g $15.00 15 15 B691 g $15.00 15 15 B666 $5.00 15 B691 $5.00 15

B667 g $15.00 15 15 B692 g $15.00 15 15 B667 $5.00 15 B692 $5.00 15

B668 g $15.00 15 15 B693 g $15.00 15 15 B668 $5.00 15 B693 $5.00 15

B669 g $15.00 15 15 B694 g $15.00 15 15 B669 $5.00 15 B694 $5.00 15

B670 g $15.00 15 15 B695 g $15.00 15 15 B670 $5.00 15 B695 $5.00 15

B671 g $15.00 15 15 B696 g $15.00 15 15 B671 $5.00 15 B696 $5.00 15

B672 g $15.00 15 15 B697 g $15.00 15 15 B672 $5.00 15 B697 $5.00 15

B673 g $15.00 15 15 B698 g $15.00 15 15 B673 $5.00 15 B698 $5.00 15

B674 g $15.00 15 15 B699 g $15.00 15 15 B674 $5.00 15 B699 $5.00 15

B675 g $15.00 15 15 B700 g $15.00 15 15 B675 $5.00 15 B700 $5.00 15

B676 g $15.00 15 15 B701 g $15.00 15 15 B676 $5.00 15 B701 $5.00 15

B677 g $15.00 15 15 B702 g $15.00 15 15 B677 $5.00 15 B702 $5.00 15

B678 g $15.00 15 15 B703 g $15.00 15 15 B678 $5.00 15 B703 $5.00 15

B679 g $15.00 15 15 B704 g $15.00 15 15 B679 $5.00 15 B704 $5.00 15

B680 g $15.00 15 15 B705 g $15.00 15 15 B680 $5.00 15 B705 $5.00 15

B681 g $15.00 15 15 B706 g $15.00 15 15 B681 $5.00 15 B706 $5.00 15

B682 g $15.00 15 15 B707 g $15.00 15 15 B682 $5.00 15 B707 $5.00 15

B683 g $15.00 15 15 B708 g $15.00 15 15 B683 $5.00 15 B708 $5.00 15

B684 g $15.00 15 15 B709 g $15.00 15 15 B684 $5.00 15 B709 $5.00 15

B685 g $15.00 15 15 B710 g $15.00 15 15 B685 $5.00 15 B710 $5.00 15

B686 g $15.00 15 15 B711 g $15.00 15 15 B686 $5.00 15 B711 $5.00 15

B687 g $15.00 15 15 B712 g $15.00 15 15 B687 $5.00 15 B712 $5.00 15

B688 g $15.00 15 15 B713 g $15.00 15 15 B688 $5.00 15 B713 $5.00 15

B689 g $15.00 15 15 B714 g $15.00 15 15 B689 $5.00 15 B714 $5.00 15

B690 g $15.00 15 15 B715 g $15.00 15 15 B690 $5.00 15 B715 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B716 g $15.00 15 15 B741 g $15.00 15 15 B716 $5.00 15 B741 $5.00 15

B717 g $15.00 15 15 B742 g $15.00 15 15 B717 $5.00 15 B742 $5.00 15

B718 g $15.00 15 15 B743 g $15.00 15 15 B718 $5.00 15 B743 $5.00 15

B719 g $15.00 15 15 B744 g $15.00 15 15 B719 $5.00 15 B744 $5.00 15

B720 g $15.00 15 15 B745 g $15.00 15 15 B720 $5.00 15 B745 $5.00 15

B721 g $15.00 15 15 B746 g $15.00 15 15 B721 $5.00 15 B746 $5.00 15

B722 g $15.00 15 15 B747 g $15.00 15 15 B722 $5.00 15 B747 $5.00 15

B723 g $15.00 15 15 B748 g $15.00 15 15 B723 $5.00 15 B748 $5.00 15

B724 g $15.00 15 15 B749 g $15.00 15 15 B724 $5.00 15 B749 $5.00 15

B725 g $15.00 15 15 B750 g $15.00 15 15 B725 $5.00 15 B750 $5.00 15

B726 g $15.00 15 15 B751 g $15.00 15 15 B726 $5.00 15 B751 $5.00 15

B727 g $15.00 15 15 B752 g $15.00 15 15 B727 $5.00 15 B752 $5.00 15

B728 g $15.00 15 15 B753 g $15.00 15 15 B728 $5.00 15 B753 $5.00 15

B729 g $15.00 15 15 B754 g $15.00 15 15 B729 $5.00 15 B754 $5.00 15

B730 g $15.00 15 15 B755 g $15.00 15 15 B730 $5.00 15 B755 $5.00 15

B731 g $15.00 15 15 B756 g $15.00 15 15 B731 $5.00 15 B756 $5.00 15

B732 g $15.00 15 15 B757 g $15.00 15 15 B732 $5.00 15 B757 $5.00 15

B733 g $15.00 15 15 B758 g $15.00 15 15 B733 $5.00 15 B758 $5.00 15

B734 g $15.00 15 15 B759 g $15.00 15 15 B734 $5.00 15 B759 $5.00 15

B735 g $15.00 15 15 B760 g $15.00 15 15 B735 $5.00 15 B760 $5.00 15

B736 g $15.00 15 15 B761 g $15.00 15 15 B736 $5.00 15 B761 $5.00 15

B737 g $15.00 15 15 B762 g $15.00 15 15 B737 $5.00 15 B762 $5.00 15

B738 g $15.00 15 15 B763 g $15.00 15 15 B738 $5.00 15 B763 $5.00 15

B739 g $15.00 15 15 B764 g $15.00 15 15 B739 $5.00 15 B764 $5.00 15

B740 g $15.00 15 15 B765 g $15.00 15 15 B740 $5.00 15 B765 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B766 g $15.00 15 15 B791 g $15.00 15 15 B766 $5.00 15 B791 $5.00 15

B767 g $15.00 15 15 B792 g $15.00 15 15 B767 $5.00 15 B792 $5.00 15

B768 g $15.00 15 15 B793 g $15.00 15 15 B768 $5.00 15 B793 $5.00 15

B769 g $15.00 15 15 B794 g $15.00 15 15 B769 $5.00 15 B794 $5.00 15

B770 g $15.00 15 15 B795 g $15.00 15 15 B770 $5.00 15 B795 $5.00 15

B771 g $15.00 15 15 B796 g $15.00 15 15 B771 $5.00 15 B796 $5.00 15

B772 g $15.00 15 15 B797 g $15.00 15 15 B772 $5.00 15 B797 $5.00 15

B773 g $15.00 15 15 B798 g $15.00 15 15 B773 $5.00 15 B798 $5.00 15

B774 g $15.00 15 15 B799 g $15.00 15 15 B774 $5.00 15 B799 $5.00 15

B775 g $15.00 15 15 B800 g $15.00 15 15 B775 $5.00 15 B800 $5.00 15

B776 g $15.00 15 15 B801 g $15.00 15 15 B776 $5.00 15 B801 $5.00 15

B777 g $15.00 15 15 B802 g $15.00 15 15 B777 $5.00 15 B802 $5.00 15

B778 g $15.00 15 15 B803 g $15.00 15 15 B778 $5.00 15 B803 $5.00 15

B779 g $15.00 15 15 B804 g $15.00 15 15 B779 $5.00 15 B804 $5.00 15

B780 g $15.00 15 15 B805 g $15.00 15 15 B780 $5.00 15 B805 $5.00 15

B781 g $15.00 15 15 B806 g $15.00 15 15 B781 $5.00 15 B806 $5.00 15

B782 g $15.00 15 15 B807 g $15.00 15 15 B782 $5.00 15 B807 $5.00 15

B783 g $15.00 15 15 B808 g $15.00 15 15 B783 $5.00 15 B808 $5.00 15

B784 g $15.00 15 15 B809 g $15.00 15 15 B784 $5.00 15 B809 $5.00 15

B785 g $15.00 15 15 B810 g $15.00 15 15 B785 $5.00 15 B810 $5.00 15

B786 g $15.00 15 15 B811 g $15.00 15 15 B786 $5.00 15 B811 $5.00 15

B787 g $15.00 15 15 B812 g $15.00 15 15 B787 $5.00 15 B812 $5.00 15

B788 g $15.00 15 15 B813 g $15.00 15 15 B788 $5.00 15 B813 $5.00 15

B789 g $15.00 15 15 B814 g $15.00 15 15 B789 $5.00 15 B814 $5.00 15

B790 g $15.00 15 15 B815 g $15.00 15 15 B790 $5.00 15 B815 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B816 g $15.00 15 15 B841 g $15.00 15 15 B816 $5.00 15 B841 $5.00 15

B817 g $15.00 15 15 B842 g $15.00 15 15 B817 $5.00 15 B842 $5.00 15

B818 g $15.00 15 15 B843 g $15.00 15 15 B818 $5.00 15 B843 $5.00 15

B819 g $15.00 15 15 B844 g $15.00 15 15 B819 $5.00 15 B844 $5.00 15

B820 g $15.00 15 15 B845 g $15.00 15 15 B820 $5.00 15 B845 $5.00 15

B821 g $15.00 15 15 B846 g $15.00 15 15 B821 $5.00 15 B846 $5.00 15

B822 g $15.00 15 15 B847 g $15.00 15 15 B822 $5.00 15 B847 $5.00 15

B823 g $15.00 15 15 B848 g $15.00 15 15 B823 $5.00 15 B848 $5.00 15

B824 g $15.00 15 15 B849 g $15.00 15 15 B824 $5.00 15 B849 $5.00 15

B825 g $15.00 15 15 B850 g $15.00 15 15 B825 $5.00 15 B850 $5.00 15

B826 g $15.00 15 15 B851 g $15.00 15 15 B826 $5.00 15 B851 $5.00 15

B827 g $15.00 15 15 B852 g $15.00 15 15 B827 $5.00 15 B852 $5.00 15

B828 g $15.00 15 15 B853 g $15.00 15 15 B828 $5.00 15 B853 $5.00 15

B829 g $15.00 15 15 B854 g $15.00 15 15 B829 $5.00 15 B854 $5.00 15

B830 g $15.00 15 15 B855 g $15.00 15 15 B830 $5.00 15 B855 $5.00 15

B831 g $15.00 15 15 B856 g $15.00 15 15 B831 $5.00 15 B856 $5.00 15

B832 g $15.00 15 15 B857 g $15.00 15 15 B832 $5.00 15 B857 $5.00 15

B833 g $15.00 15 15 B858 g $15.00 15 15 B833 $5.00 15 B858 $5.00 15

B834 g $15.00 15 15 B859 g $15.00 15 15 B834 $5.00 15 B859 $5.00 15

B835 g $15.00 15 15 B860 g $15.00 15 15 B835 $5.00 15 B860 $5.00 15

B836 g $15.00 15 15 B861 g $15.00 15 15 B836 $5.00 15 B861 $5.00 15

B837 g $15.00 15 15 B862 g $15.00 15 15 B837 $5.00 15 B862 $5.00 15

B838 g $15.00 15 15 B863 g $15.00 15 15 B838 $5.00 15 B863 $5.00 15

B839 g $15.00 15 15 B864 g $15.00 15 15 B839 $5.00 15 B864 $5.00 15

B840 g $15.00 15 15 B865 g $15.00 15 15 B840 $5.00 15 B865 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B866 g $15.00 15 15 B891 g $15.00 15 15 B866 $5.00 15 B891 $5.00 15

B867 g $15.00 15 15 B892 g $15.00 15 15 B867 $5.00 15 B892 $5.00 15

B868 g $15.00 15 15 B893 g $15.00 15 15 B868 $5.00 15 B893 $5.00 15

B869 g $15.00 15 15 B894 g $15.00 15 15 B869 $5.00 15 B894 $5.00 15

B870 g $15.00 15 15 B895 g $15.00 15 15 B870 $5.00 15 B895 $5.00 15

B871 g $15.00 15 15 B896 g $15.00 15 15 B871 $5.00 15 B896 $5.00 15

B872 g $15.00 15 15 B897 g $15.00 15 15 B872 $5.00 15 B897 $5.00 15

B873 g $15.00 15 15 B898 g $15.00 15 15 B873 $5.00 15 B898 $5.00 15

B874 g $15.00 15 15 B899 g $15.00 15 15 B874 $5.00 15 B899 $5.00 15

B875 g $15.00 15 15 B900 g $15.00 15 15 B875 $5.00 15 B900 $5.00 15

B876 g $15.00 15 15 B901 g $15.00 15 15 B876 $5.00 15 B901 $5.00 15

B877 g $15.00 15 15 B902 g $15.00 15 15 B877 $5.00 15 B902 $5.00 15

B878 g $15.00 15 15 B903 g $15.00 15 15 B878 $5.00 15 B903 $5.00 15

B879 g $15.00 15 15 B904 g $15.00 15 15 B879 $5.00 15 B904 $5.00 15

B880 g $15.00 15 15 B905 g $15.00 15 15 B880 $5.00 15 B905 $5.00 15

B881 g $15.00 15 15 B906 g $15.00 15 15 B881 $5.00 15 B906 $5.00 15

B882 g $15.00 15 15 B907 g $15.00 15 15 B882 $5.00 15 B907 $5.00 15

B883 g $15.00 15 15 B908 g $15.00 15 15 B883 $5.00 15 B908 $5.00 15

B884 g $15.00 15 15 B909 g $15.00 15 15 B884 $5.00 15 B909 $5.00 15

B885 g $15.00 15 15 B910 g $15.00 15 15 B885 $5.00 15 B910 $5.00 15

B886 g $15.00 15 15 B911 g $15.00 15 15 B886 $5.00 15 B911 $5.00 15

B887 g $15.00 15 15 B912 g $15.00 15 15 B887 $5.00 15 B912 $5.00 15

B888 g $15.00 15 15 B913 g $15.00 15 15 B888 $5.00 15 B913 $5.00 15

B889 g $15.00 15 15 B914 g $15.00 15 15 B889 $5.00 15 B914 $5.00 15

B890 g $15.00 15 15 B915 g $15.00 15 15 B890 $5.00 15 B915 $5.00 15

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B916 g $15.00 15 15 B941 g $15.00 15 15 B916 $5.00 15 B941 $5.00 15

B917 g $15.00 15 15 B942 g $15.00 15 15 B917 $5.00 15 B942 $5.00 15

B918 g $15.00 15 15 B943 g $15.00 15 15 B918 $5.00 15 B943 $5.00 15

B919 g $15.00 15 15 B944 g $15.00 15 15 B919 $5.00 15 B944 $5.00 15

B920 g $15.00 15 15 B945 g $15.00 15 15 B920 $5.00 15 B945 $5.00 15

B921 g $15.00 15 15 B946 g $15.00 15 15 B921 $5.00 15 B946 $5.00 15

B922 g $15.00 15 15 B947 g $15.00 15 15 B922 $5.00 15 B947 $5.00 15

B923 g $15.00 15 15 B948 g $15.00 15 15 B923 $5.00 15 B948 $5.00 15

B924 g $15.00 15 15 B949 g $15.00 15 15 B924 $5.00 15 B949 $5.00 15

B925 g $15.00 15 15 B950 g $15.00 15 15 B925 $5.00 15 B950 $5.00 15

B926 g $15.00 15 15 B951 g $15.00 15 15 B926 $5.00 15 B951 $5.00 15

B927 g $15.00 15 15 B952 g $15.00 15 15 B927 $5.00 15 B952 $5.00 15

B928 g $15.00 15 15 B953 g $15.00 15 15 B928 $5.00 15 B953 $5.00 15

B929 g $15.00 15 15 B954 g $15.00 15 15 B929 $5.00 15 B954 $5.00 15

B930 g $15.00 15 15 B955 g $15.00 15 15 B930 $5.00 15 B955 $5.00 15

B931 g $15.00 15 15 B956 g $15.00 15 15 B931 $5.00 15 B956 $5.00 15

B932 g $15.00 15 15 B957 g $15.00 15 15 B932 $5.00 15 B957 $5.00 15

B933 g $15.00 15 15 B958 g $15.00 15 15 B933 $5.00 15 B958 $5.00 15

B934 g $15.00 15 15 B959 g $15.00 15 15 B934 $5.00 15 B959 $5.00 15

B935 g $15.00 15 15 B960 g $15.00 15 15 B935 $5.00 15 B960 $5.00 15

B936 g $15.00 15 15 B961 g $15.00 15 15 B936 $5.00 15 B961 $5.00 15

B937 g $15.00 15 15 B962 g $15.00 15 15 B937 $5.00 15 B962 $5.00 15

B938 g $15.00 15 15 B963 g $15.00 15 15 B938 $5.00 15 B963 $5.00 15

B939 g $15.00 15 15 B964 g $15.00 15 15 B939 $5.00 15 B964 $5.00 15

B940 g $15.00 15 15 B965 g $15.00 15 15 B940 $5.00 15 B965 $5.00 15

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B966 g $15.00 15 15 B991 g $15.00 15 15 B966 $5.00 15 B991 $5.00 15

B967 g $15.00 15 15 B992 g $15.00 15 15 B967 $5.00 15 B992 $5.00 15

B968 g $15.00 15 15 B993 g $15.00 15 15 B968 $5.00 15 B993 $5.00 15

B969 g $15.00 15 15 B994 g $15.00 15 15 B969 $5.00 15 B994 $5.00 15

B970 g $15.00 15 15 B995 g $15.00 15 15 B970 $5.00 15 B995 $5.00 15

B971 g $15.00 15 15 B996 g $15.00 15 15 B971 $5.00 15 B996 $5.00 15

B972 g $15.00 15 15 B997 g $15.00 15 15 B972 $5.00 15 B997 $5.00 15

B973 g $15.00 15 15 B998 g $15.00 15 15 B973 $5.00 15 B998 $5.00 15

B974 g $15.00 15 15 B999 g $15.00 15 15 B974 $5.00 15 B999 $5.00 15

B975 g $15.00 15 15 B1000 $15.00 # # B975 $5.00 15 B1000 $5.00 #

B976 g $15.00 15 15 B1001 $15.00 # # B976 $5.00 15 B1001 $5.00 #

B977 g $15.00 15 15 B1002 $12.00 # # B977 $5.00 15 B1002 $5.00 #

B978 g $15.00 15 15 B1003 $15.00 # # B978 $5.00 15 B1003 $5.00 #

B979 g $15.00 15 15 B1004 $15.00 # # B979 $5.00 15 B1004 $5.00 #

B980 g $15.00 15 15 B1005 $15.00 # # B980 $5.00 15 B1005 $5.00 #

B981 g $15.00 15 15 B1006 $10.00 # # B981 $5.00 15 B1006 $5.00 #

B982 g $15.00 15 15 B1007 $12.00 # # B982 $5.00 15 B1007 $5.00 #

B983 g $15.00 15 15 B1008 $12.00 # # B983 $5.00 15 B1008 $5.00 #

B984 g $15.00 15 15 B1009 $15.00 # # B984 $5.00 15 B1009 $5.00 #

B985 g $15.00 15 15 B1010 $15.00 # # B985 $5.00 15 B1010 $5.00 #

B986 g $15.00 15 15 B1011 $15.00 # # B986 $5.00 15 B1011 $5.00 #

B987 g $15.00 15 15 B1012 $15.00 # # B987 $5.00 15 B1012 $5.00 #

B988 g $15.00 15 15 B1013 $15.00 # # B988 $5.00 15 B1013 $5.00 #

B989 g $15.00 15 15 B1014 $10.00 # # B989 $5.00 15 B1014 $5.00 #

B990 g $15.00 15 15 B1015 $10.00 # # B990 $5.00 15 B1015 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1016 $10.00 # # B1041 $12.00 # # B1016 $5.00 # B1041 $5.00 #

B1017 $10.00 # # B1042 $15.00 # # B1017 $5.00 # B1042 $5.00 #

B1018 $15.00 # # B1043 $15.00 # # B1018 $5.00 # B1043 $5.00 #

B1019 $15.00 # # B1044 $15.00 # # B1019 $5.00 # B1044 $5.00 #

B1020 $15.00 # # B1045 $15.00 # # B1020 $5.00 # B1045 $5.00 #

B1021 $15.00 # # B1046 $10.00 # # B1021 $5.00 # B1046 $5.00 #

B1022 $10.00 # # B1047 $15.00 # # B1022 $5.00 # B1047 $5.00 #

B1023 $15.00 # # B1048 $15.00 # # B1023 $5.00 # B1048 $5.00 #

B1024 $10.00 # # B1049 $15.00 # # B1024 $5.00 # B1049 $5.00 #

B1025 $10.00 # # B1050 $10.00 # # B1025 $5.00 # B1050 $5.00 #

B1026 $12.00 # # B1051 $12.00 # # B1026 $5.00 # B1051 $5.00 #

B1027 $15.00 # # B1052 $15.00 # # B1027 $5.00 # B1052 $5.00 #

B1028 $10.00 # # B1053 $15.00 # # B1028 $5.00 # B1053 $5.00 #

B1029 $10.00 # # B1054 $12.00 # # B1029 $5.00 # B1054 $5.00 #

B1030 $15.00 # # B1055 $15.00 # # B1030 $5.00 # B1055 $5.00 #

B1031 $15.00 # # B1056 $10.00 # # B1031 $5.00 # B1056 $5.00 #

B1032 $15.00 # # B1057 $10.00 # # B1032 $5.00 # B1057 $5.00 #

B1033 $10.00 # # B1058 $10.00 # # B1033 $5.00 # B1058 $5.00 #

B1034 $12.00 # # B1059 $15.00 # # B1034 $5.00 # B1059 $5.00 #

B1035 $15.00 # # B1060 $10.00 # # B1035 $5.00 # B1060 $5.00 #

B1036 $15.00 # # B1061 $12.00 # # B1036 $5.00 # B1061 $5.00 #

B1037 $15.00 # # B1062 $15.00 # # B1037 $5.00 # B1062 $5.00 #

B1038 $15.00 # # B1063 $10.00 # # B1038 $5.00 # B1063 $5.00 #

B1039 $15.00 # # B1064 $15.00 # # B1039 $5.00 # B1064 $5.00 #

B1040 $10.00 # # B1065 $8.00 # # B1040 $5.00 # B1065 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1066 $12.00 # # B1091 $15.00 # # B1066 $5.00 # B1091 $5.00 #

B1067 $15.00 # # B1092 $15.00 # # B1067 $5.00 # B1092 $5.00 #

B1068 $15.00 # # B1093 $15.00 # # B1068 $5.00 # B1093 $5.00 #

B1069 $10.00 # # B1094 $15.00 # # B1069 $5.00 # B1094 $5.00 #

B1070 $15.00 # # B1095 $12.00 # # B1070 $5.00 # B1095 $5.00 #

B1071 $15.00 # # B1096 $15.00 # # B1071 $5.00 # B1096 $5.00 #

B1072 $15.00 # # B1097 $10.00 # # B1072 $5.00 # B1097 $5.00 #

B1073 $15.00 # # B1098 $15.00 # # B1073 $5.00 # B1098 $5.00 #

B1074 $15.00 # # B1099 $15.00 # # B1074 $5.00 # B1099 $5.00 #

B1075 $15.00 # # B1100 $15.00 # # B1075 $5.00 # B1100 $5.00 #

B1076 $15.00 # # B1101 $15.00 # # B1076 $5.00 # B1101 $5.00 #

B1077 $15.00 # # B1102 $10.00 # # B1077 $5.00 # B1102 $5.00 #

B1078 $15.00 # # B1103 $15.00 # # B1078 $5.00 # B1103 $5.00 #

B1079 $12.00 # # B1104 $15.00 # # B1079 $5.00 # B1104 $5.00 #

B1080 $15.00 # # B1105 $12.00 # # B1080 $5.00 # B1105 $5.00 #

B1081 $15.00 # # B1106 $15.00 # # B1081 $5.00 # B1106 $5.00 #

B1082 $10.00 # # B1107 $15.00 # # B1082 $5.00 # B1107 $5.00 #

B1083 $15.00 # # B1108 $10.00 # # B1083 $5.00 # B1108 $5.00 #

B1084 $10.00 # # B1109 $12.00 # # B1084 $5.00 # B1109 $5.00 #

B1085 $15.00 # # B1110 $12.00 # # B1085 $5.00 # B1110 $5.00 #

B1086 $15.00 # # B1111 $10.00 # # B1086 $5.00 # B1111 $5.00 #

B1087 $15.00 # # B1112 $10.00 # # B1087 $5.00 # B1112 $5.00 #

B1088 $15.00 # # B1113 $15.00 # # B1088 $5.00 # B1113 $5.00 #

B1089 $15.00 # # B1114 $15.00 # # B1089 $5.00 # B1114 $5.00 #

B1090 $15.00 # # B1115 $12.00 # # B1090 $5.00 # B1115 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1116 $12.00 # # B1142 $10.00 # # B1116 $5.00 # B1142 $5.00 #

B1118 $15.00 # # B1143 $12.00 # # B1118 $5.00 # B1143 $5.00 #

B1119 $10.00 # # B1144 $8.00 # # B1119 $5.00 # B1144 $5.00 #

B1120 $15.00 # # B1145 $10.00 # # B1120 $5.00 # B1145 $5.00 #

B1121 $12.00 # # B1146 $15.00 # # B1121 $5.00 # B1146 $5.00 #

B1122 $15.00 # # B1147 $15.00 # # B1122 $5.00 # B1147 $5.00 #

B1123 $15.00 # # B1148 $15.00 # # B1123 $5.00 # B1148 $5.00 #

B1124 $15.00 # # B1149 $15.00 # # B1124 $5.00 # B1149 $5.00 #

B1125 $10.00 # # B1150 $15.00 # # B1125 $5.00 # B1150 $5.00 #

B1126 $15.00 # # B1151 $8.00 # # B1126 $5.00 # B1151 $5.00 #

B1127 $15.00 # # B1152 $15.00 # # B1127 $5.00 # B1152 $5.00 #

B1128 $15.00 # # B1153 $15.00 # # B1128 $5.00 # B1153 $5.00 #

B1129 $15.00 # # B1154 $12.00 # # B1129 $5.00 # B1154 $5.00 #

B1130 $15.00 # # B1155 $15.00 # # B1130 $5.00 # B1155 $5.00 #

B1131 $15.00 # # B1156 $15.00 # # B1131 $5.00 # B1156 $5.00 #

B1132 $15.00 # # B1157 $15.00 # # B1132 $5.00 # B1157 $5.00 #

B1133 $15.00 # # B1158 $8.00 # # B1133 $5.00 # B1158 $5.00 #

B1134 $15.00 # # B1159 $15.00 # # B1134 $5.00 # B1159 $5.00 #

B1135 $15.00 # # B1160 $15.00 # # B1135 $5.00 # B1160 $5.00 #

B1136 $15.00 # # B1161 $10.00 # # B1136 $5.00 # B1161 $5.00 #

B1137 $15.00 # # B1162 $15.00 # # B1137 $5.00 # B1162 $5.00 #

B1138 $10.00 # # B1163 $15.00 # # B1138 $5.00 # B1163 $5.00 #

B1139 $10.00 # # B1164 $10.00 # # B1139 $5.00 # B1164 $5.00 #

B1140 $10.00 # # B1165 $15.00 # # B1140 $5.00 # B1165 $5.00 #

B1141 $10.00 # # B1166 $10.00 # # B1141 $5.00 # B1166 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1167 $15.00 # # B1192 $15.00 # # B1167 $5.00 # B1192 $5.00 #

B1168 $15.00 # # B1193 $8.00 # # B1168 $5.00 # B1193 $5.00 #

B1169 $15.00 # # B1194 $10.00 # # B1169 $5.00 # B1194 $5.00 #

B1170 $15.00 # # B1195 $12.00 # # B1170 $5.00 # B1195 $5.00 #

B1171 $10.00 # # B1196 $15.00 # # B1171 $5.00 # B1196 $5.00 #

B1172 $12.00 # # B1197 $15.00 # # B1172 $5.00 # B1197 $5.00 #

B1173 $15.00 # # B1198 $15.00 # # B1173 $5.00 # B1198 $5.00 #

B1174 $15.00 # # B1199 $15.00 # # B1174 $5.00 # B1199 $5.00 #

B1175 $15.00 # # B1200 $8.00 # # B1175 $5.00 # B1200 $5.00 #

B1176 $15.00 # # B1201 $10.00 # # B1176 $5.00 # B1201 $5.00 #

B1177 $15.00 # # B1202 $15.00 # # B1177 $5.00 # B1202 $5.00 #

B1178 $8.00 # # B1203 $10.00 # # B1178 $5.00 # B1203 $5.00 #

B1179 $8.00 # # B1204 $15.00 # # B1179 $5.00 # B1204 $5.00 #

B1180 $10.00 # # B1205 $15.00 # # B1180 $5.00 # B1205 $5.00 #

B1181 $10.00 # # B1206 $15.00 # # B1181 $5.00 # B1206 $5.00 #

B1182 $12.00 # # B1207 $15.00 # # B1182 $5.00 # B1207 $5.00 #

B1183 $12.00 # # B1208 $15.00 # # B1183 $5.00 # B1208 $5.00 #

B1184 $15.00 # # B1209 $15.00 # # B1184 $5.00 # B1209 $5.00 #

B1185 $8.00 # # B1210 $15.00 # # B1185 $5.00 # B1210 $5.00 #

B1186 $10.00 # # B1211 $15.00 # # B1186 $5.00 # B1211 $5.00 #

B1187 $12.00 # # B1212 $15.00 # # B1187 $5.00 # B1212 $5.00 #

B1188 $15.00 # # B1213 $15.00 # # B1188 $5.00 # B1213 $5.00 #

B1189 $10.00 # # B1214 $15.00 # # B1189 $5.00 # B1214 $5.00 #

B1190 $10.00 # # B1215 $12.00 # # B1190 $5.00 # B1215 $5.00 #

B1191 $15.00 # # B1216 $15.00 # # B1191 $5.00 # B1216 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1217 $15.00 # # B1242 $15.00 # # B1217 $5.00 # B1242 $5.00 #

B1218 $15.00 # # B1243 $12.00 # # B1218 $5.00 # B1243 $5.00 #

B1219 $15.00 # # B1244 $8.00 # # B1219 $5.00 # B1244 $5.00 #

B1220 $10.00 # # B1245 $15.00 # # B1220 $5.00 # B1245 $5.00 #

B1221 $15.00 # # B1246 $15.00 # # B1221 $5.00 # B1246 $5.00 #

B1222 $15.00 # # B1247 $15.00 # # B1222 $5.00 # B1247 $5.00 #

B1223 $15.00 # # B1248 $15.00 # # B1223 $5.00 # B1248 $5.00 #

B1224 $15.00 # # B1249 $15.00 # # B1224 $5.00 # B1249 $5.00 #

B1225 $15.00 # # B1250 $10.00 # # B1225 $5.00 # B1250 $5.00 #

B1226 $15.00 # # B1251 $12.00 # # B1226 $5.00 # B1251 $5.00 #

B1227 $15.00 # # B1252 $15.00 # # B1227 $5.00 # B1252 $5.00 #

B1228 $15.00 # # B1253 $10.00 # # B1228 $5.00 # B1253 $5.00 #

B1229 $8.00 # # B1254 $12.00 # # B1229 $5.00 # B1254 $5.00 #

B1230 $10.00 # # B1255 $15.00 # # B1230 $5.00 # B1255 $5.00 #

B1231 $15.00 # # B1256 $15.00 # # B1231 $5.00 # B1256 $5.00 #

B1232 $15.00 # # B1257 $12.00 # # B1232 $5.00 # B1257 $5.00 #

B1233 $15.00 # # B1258 $15.00 # # B1233 $5.00 # B1258 $5.00 #

B1234 $15.00 # # B1259 $15.00 # # B1234 $5.00 # B1259 $5.00 #

B1235 $15.00 # # B1260 $10.00 # # B1235 $5.00 # B1260 $5.00 #

B1236 $15.00 # # B1261 $15.00 # # B1236 $5.00 # B1261 $5.00 #

B1237 $15.00 # # B1262 $10.00 # # B1237 $5.00 # B1262 $5.00 #

B1238 $12.00 # # B1263 $15.00 # # B1238 $5.00 # B1263 $5.00 #

B1239 $15.00 # # B1264 $10.00 # # B1239 $5.00 # B1264 $5.00 #

B1240 $12.00 # # B1265 $12.00 # # B1240 $5.00 # B1265 $5.00 #

B1241 $15.00 # # B1266 $15.00 # # B1241 $5.00 # B1266 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1267 $15.00 # # B1292 $15.00 # # B1267 $5.00 # B1292 $5.00 #

B1268 $12.00 # # B1293 $10.00 # # B1268 $5.00 # B1293 $5.00 #

B1269 $12.00 # # B1294 $15.00 # # B1269 $5.00 # B1294 $5.00 #

B1270 $8.00 # # B1295 $10.00 # # B1270 $5.00 # B1295 $5.00 #

B1271 $10.00 # # B1296 $15.00 # # B1271 $5.00 # B1296 $5.00 #

B1272 $10.00 # # B1297 $15.00 # # B1272 $5.00 # B1297 $5.00 #

B1273 $12.00 # # B1298 $10.00 # # B1273 $5.00 # B1298 $5.00 #

B1274 $15.00 # # B1299 $15.00 # # B1274 $5.00 # B1299 $5.00 #

B1275 $15.00 # # B1300 $10.00 # # B1275 $5.00 # B1300 $5.00 #

B1276 $10.00 # # B1301 $15.00 # # B1276 $5.00 # B1301 $5.00 #

B1277 $15.00 # # B1302 $15.00 # # B1277 $5.00 # B1302 $5.00 #

B1278 $15.00 # # B1303 $10.00 # # B1278 $5.00 # B1303 $5.00 #

B1279 $15.00 # # B1304 $10.00 # # B1279 $5.00 # B1304 $5.00 #

B1280 $15.00 # # B1305 $12.00 # # B1280 $5.00 # B1305 $5.00 #

B1281 $15.00 # # B1306 $10.00 # # B1281 $5.00 # B1306 $5.00 #

B1282 $15.00 # # B1307 $15.00 # # B1282 $5.00 # B1307 $5.00 #

B1283 $12.00 # # B1308 $10.00 # # B1283 $5.00 # B1308 $5.00 #

B1284 $15.00 # # B1309 $10.00 # # B1284 $5.00 # B1309 $5.00 #

B1285 $15.00 # # B1310 $15.00 # # B1285 $5.00 # B1310 $5.00 #

B1286 $10.00 # # B1311 $15.00 # # B1286 $5.00 # B1311 $5.00 #

B1287 $10.00 # # B1312 $15.00 # # B1287 $5.00 # B1312 $5.00 #

B1288 $12.00 # # B1313 $15.00 # # B1288 $5.00 # B1313 $5.00 #

B1289 $15.00 # # B1314 $15.00 # # B1289 $7.00 # B1314 $5.00 #

B1290 $15.00 # # B1315 $15.00 # # B1290 $7.00 # B1315 $5.00 #

B1291 $15.00 # # B1316 $12.00 # # B1291 $7.00 # B1316 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1317 $12.00 # # B1342 $10.00 # # B1317 $5.00 # B1342 $5.00 #

B1318 $15.00 # # B1343 $10.00 # # B1318 $5.00 # B1343 $5.00 #

B1319 $15.00 # # B1344 $15.00 # # B1319 $5.00 # B1344 $5.00 #

B1320 $15.00 # # B1345 $15.00 # # B1320 $5.00 # B1345 $5.00 #

B1321 $15.00 # # B1346 $15.00 # # B1321 $5.00 # B1346 $5.00 #

B1322 $15.00 # # B1347 $15.00 # # B1322 $5.00 # B1347 $5.00 #

B1323 $15.00 # # B1348 $12.00 # # B1323 $5.00 # B1348 $5.00 #

B1324 $15.00 # # B1349 $15.00 # # B1324 $5.00 # B1349 $5.00 #

B1325 $15.00 # # B1350 $15.00 # # B1325 $5.00 # B1350 $5.00 #

B1326 $15.00 # # B1351 $15.00 # # B1326 $5.00 # B1351 $5.00 #

B1327 $15.00 # # B1352 $15.00 # # B1327 $5.00 # B1352 $5.00 #

B1328 $15.00 # # B1353 $15.00 # # B1328 $5.00 # B1353 $5.00 #

B1329 $15.00 # # B1354 $15.00 # # B1329 $5.00 # B1354 $5.00 #

B1330 $15.00 # # B1355 $12.00 # # B1330 $5.00 # B1355 $5.00 #

B1331 $15.00 # # B1356 $15.00 # # B1331 $5.00 # B1356 $5.00 #

B1332 $15.00 # # B1357 $15.00 # # B1332 $5.00 # B1357 $5.00 #

B1333 $15.00 # # B1358 $15.00 # # B1333 $5.00 # B1358 $5.00 #

B1334 $15.00 # # B1359 $15.00 # # B1334 $5.00 # B1359 $5.00 #

B1335 $15.00 # # B1360 $12.00 # # B1335 $5.00 # B1360 $5.00 #

B1336 $15.00 # # B1361 $15.00 # # B1336 $5.00 # B1361 $5.00 #

B1337 $12.00 # # B1362 $15.00 # # B1337 $5.00 # B1362 $5.00 #

B1338 $12.00 # # B1363 $12.00 # # B1338 $5.00 # B1363 $5.00 #

B1339 $15.00 # # B1364 $15.00 # # B1339 $5.00 # B1364 $5.00 #

B1340 $15.00 # # B1365 $15.00 # # B1340 $5.00 # B1365 $5.00 #

B1341 $15.00 # # B1366 $15.00 # # B1341 $5.00 # B1366 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1367 $15.00 # # B1392 $15.00 # # B1367 $5.00 # B1392 $5.00 #

B1368 $15.00 # # B1393 $15.00 # # B1368 $5.00 # B1393 $5.00 #

B1369 $15.00 # # B1394 $15.00 # # B1369 $5.00 # B1394 $5.00 #

B1370 $10.00 # # B1395 $15.00 # # B1370 $5.00 # B1395 $5.00 #

B1371 $15.00 # # B1396 $15.00 # # B1371 $5.00 # B1396 $5.00 #

B1372 $15.00 # # B1397 $10.00 # # B1372 $5.00 # B1397 $5.00 #

B1373 $15.00 # # B1398 $15.00 # # B1373 $5.00 # B1398 $5.00 #

B1374 $15.00 # # B1399 $15.00 # # B1374 $5.00 # B1399 $5.00 #

B1375 $15.00 # # B1400 $12.00 # # B1375 $5.00 # B1400 $5.00 #

B1376 $15.00 # # B1401 $15.00 # # B1376 $5.00 # B1401 $5.00 #

B1377 $15.00 # # B1402 $15.00 # # B1377 $5.00 # B1402 $5.00 #

B1378 $15.00 # # B1403 $15.00 # # B1378 $5.00 # B1403 $5.00 #

B1379 $12.00 # # B1404 $15.00 # # B1379 $5.00 # B1404 $5.00 #

B1380 $10.00 # # B1405 $10.00 # # B1380 $5.00 # B1405 $5.00 #

B1381 $15.00 # # B1406 $15.00 # # B1381 $5.00 # B1406 $5.00 #

B1382 $10.00 # # B1407 $15.00 # # B1382 $5.00 # B1407 $5.00 #

B1383 $15.00 # # B1408 $10.00 # # B1383 $5.00 # B1408 $5.00 #

B1384 $15.00 # # B1409 $15.00 # # B1384 $5.00 # B1409 $5.00 #

B1385 $15.00 # # B1410 $15.00 # # B1385 $5.00 # B1410 $5.00 #

B1386 $15.00 # # B1411 $15.00 # # B1386 $5.00 # B1411 $5.00 #

B1387 $15.00 # # B1412 $12.00 # # B1387 $5.00 # B1412 $5.00 #

B1388 $15.00 # # B1413 $10.00 # # B1388 $5.00 # B1413 $5.00 #

B1389 $15.00 # # B1414 $15.00 # # B1389 $5.00 # B1414 $5.00 #

B1390 $10.00 # # B1415 $15.00 # # B1390 $5.00 # B1415 $5.00 #

B1391 $15.00 # # B1416 $12.00 # # B1391 $5.00 # B1416 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1417 $15.00 # # B1442 $15.00 # # B1417 $5.00 # B1442 $5.00 #

B1418 $10.00 # # B1443 $15.00 # # B1418 $5.00 # B1443 $5.00 #

B1419 $15.00 # # B1444 $15.00 # # B1419 $5.00 # B1444 $5.00 #

B1420 $10.00 # # B1445 $15.00 # # B1420 $5.00 # B1445 $5.00 #

B1421 $15.00 # # B1446 $15.00 # # B1421 $5.00 # B1446 $5.00 #

B1422 $15.00 # # B1447 $15.00 # # B1422 $5.00 # B1447 $5.00 #

B1423 $15.00 # # B1448 $15.00 # # B1423 $5.00 # B1448 $5.00 #

B1424 $12.00 # # B1449 $15.00 # # B1424 $5.00 # B1449 $5.00 #

B1425 $10.00 # # B1450 $15.00 # # B1425 $5.00 # B1450 $5.00 #

B1426 $15.00 # # B1451 $12.00 # # B1426 $5.00 # B1451 $5.00 #

B1427 $10.00 # # B1452 $15.00 # # B1427 $5.00 # B1452 $5.00 #

B1428 $15.00 # # B1453 $15.00 # # B1428 $5.00 # B1453 $5.00 #

B1429 $15.00 # # B1454 $15.00 # # B1429 $5.00 # B1454 $5.00 #

B1430 $15.00 # # B1455 $15.00 # # B1430 $5.00 # B1455 $5.00 #

B1431 $15.00 # # B1456 $12.00 # # B1431 $5.00 # B1456 $5.00 #

B1432 $15.00 # # B1457 $15.00 # # B1432 $5.00 # B1457 $5.00 #

B1433 $15.00 # # B1458 $15.00 # # B1433 $5.00 # B1458 $5.00 #

B1434 $15.00 # # B1459 $15.00 # # B1434 $5.00 # B1459 $5.00 #

B1435 $10.00 # # B1460 $15.00 # # B1435 $5.00 # B1460 $5.00 #

B1436 $15.00 # # B1461 $15.00 # # B1436 $5.00 # B1461 $5.00 #

B1437 $15.00 # # B1462 $15.00 # # B1437 $5.00 # B1462 $5.00 #

B1438 $15.00 # # B1463 $10.00 # # B1438 $5.00 # B1463 $5.00 #

B1439 $10.00 # # B1464 $15.00 # # B1439 $5.00 # B1464 $5.00 #

B1440 $15.00 # # B1465 $10.00 # # B1440 $5.00 # B1465 $5.00 #

B1441 $15.00 # # B1466 $15.00 # # B1441 $5.00 # B1466 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1467 $15.00 # # B1492 $10.00 # # B1467 $5.00 # B1492 $5.00 #

B1468 $10.00 # # B1493 $15.00 # # B1468 $5.00 # B1493 $5.00 #

B1469 $15.00 # # B1494 $10.00 # # B1469 $5.00 # B1494 $5.00 #

B1470 $15.00 # # B1495 $15.00 # # B1470 $5.00 # B1495 $5.00 #

B1471 $15.00 # # B1496 $12.00 # # B1471 $5.00 # B1496 $5.00 #

B1472 $15.00 # # B1497 $15.00 # # B1472 $5.00 # B1497 $5.00 #

B1473 $15.00 # # B1498 $15.00 # # B1473 $5.00 # B1498 $5.00 #

B1474 $15.00 # # B1499 $15.00 # # B1474 $5.00 # B1499 $5.00 #

B1475 $15.00 # # B1500 $15.00 # # B1475 $5.00 # B1500 $5.00 #

B1476 $15.00 # # B1501 $15.00 # # B1476 $5.00 # B1501 $5.00 #

B1477 $15.00 # # B1502 $15.00 # # B1477 $5.00 # B1502 $5.00 #

B1478 $15.00 # # B1503 $15.00 # # B1478 $5.00 # B1503 $5.00 #

B1479 $15.00 # # B1504 $15.00 # # B1479 $5.00 # B1504 $5.00 #

B1480 $15.00 # # B1505 $15.00 # # B1480 $5.00 # B1505 $5.00 #

B1481 $12.00 # # B1506 $15.00 # # B1481 $5.00 # B1506 $5.00 #

B1482 $15.00 # # B1507 $15.00 # # B1482 $5.00 # B1507 $5.00 #

B1483 $15.00 # # B1508 $15.00 # # B1483 $5.00 # B1508 $5.00 #

B1484 $10.00 # # B1509 $15.00 # # B1484 $5.00 # B1509 $5.00 #

B1485 $15.00 # # B1510 $15.00 # # B1485 $5.00 # B1510 $5.00 #

B1486 $15.00 # # B1511 $15.00 # # B1486 $5.00 # B1511 $5.00 #

B1487 $15.00 # # B1512 $10.00 # # B1487 $5.00 # B1512 $5.00 #

B1488 $15.00 # # B1513 $15.00 # # B1488 $5.00 # B1513 $5.00 #

B1489 $15.00 # # B1514 $10.00 # # B1489 $5.00 # B1514 $5.00 #

B1490 $15.00 # # B1515 $15.00 # # B1490 $5.00 # B1515 $5.00 #

B1491 $15.00 # # B1516 $15.00 # # B1491 $5.00 # B1516 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1517 $15.00 # # B1542 $15.00 # # B1517 $5.00 # B1542 $5.00 #

B1518 $15.00 # # B1543 $15.00 # # B1518 $5.00 # B1543 $5.00 #

B1519 $15.00 # # B1544 $15.00 # # B1519 $5.00 # B1544 $5.00 #

B1520 $15.00 # # B1545 $15.00 # # B1520 $5.00 # B1545 $5.00 #

B1521 $15.00 # # B1546 $15.00 # # B1521 $5.00 # B1546 $5.00 #

B1522 $15.00 # # B1547 $15.00 # # B1522 $5.00 # B1547 $5.00 #

B1523 $15.00 # # B1548 $15.00 # # B1523 $5.00 # B1548 $5.00 #

B1524 $10.00 # # B1549 $15.00 # # B1524 $5.00 # B1549 $5.00 #

B1525 $15.00 # # B1550 $15.00 # # B1525 $5.00 # B1550 $5.00 #

B1526 $15.00 # # B1551 $15.00 # # B1526 $5.00 # B1551 $5.00 #

B1527 $15.00 # # B1552 $15.00 # # B1527 $5.00 # B1552 $5.00 #

B1528 $15.00 # # B1553 $15.00 # # B1528 $5.00 # B1553 $5.00 #

B1529 $15.00 # # B1554 $15.00 # # B1529 $5.00 # B1554 $5.00 #

B1530 $12.00 # # B1555 $15.00 # # B1530 $5.00 # B1555 $5.00 #

B1531 $15.00 # # B1556 $15.00 # # B1531 $5.00 # B1556 $5.00 #

B1532 $8.00 # # B1557 $15.00 # # B1532 $5.00 # B1557 $5.00 #

B1533 $15.00 # # B1558 $15.00 # # B1533 $5.00 # B1558 $5.00 #

B1534 $15.00 # # B1559 $15.00 # # B1534 $5.00 # B1559 $5.00 #

B1535 $15.00 # # B1560 $15.00 # # B1535 $5.00 # B1560 $5.00 #

B1536 $15.00 # # B1561 $15.00 # # B1536 $5.00 # B1561 $5.00 #

B1537 $15.00 # # B1562 $15.00 # # B1537 $5.00 # B1562 $5.00 #

B1538 $8.00 # # B1563 $10.00 # # B1538 $5.00 # B1563 $5.00 #

B1539 $15.00 # # B1564 $15.00 # # B1539 $5.00 # B1564 $5.00 #

B1540 $10.00 # # B1565 $10.00 # # B1540 $5.00 # B1565 $5.00 #

B1541 $15.00 # # B1566 $15.00 # # B1541 $5.00 # B1566 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1567 $15.00 # # B1592 $15.00 # # B1567 $5.00 # B1592 $5.00 #

B1568 $15.00 # # B1593 $15.00 # # B1568 $5.00 # B1593 $5.00 #

B1569 $15.00 # # B1594 $15.00 # # B1569 $5.00 # B1594 $5.00 #

B1570 $15.00 # # B1595 $15.00 # # B1570 $5.00 # B1595 $5.00 #

B1571 $15.00 # # B1596 $15.00 # # B1571 $5.00 # B1596 $5.00 #

B1572 $15.00 # # B1597 $15.00 # # B1572 $5.00 # B1597 $5.00 #

B1573 $15.00 # # B1598 $10.00 # # B1573 $5.00 # B1598 $5.00 #

B1574 $15.00 # # B1599 $15.00 # # B1574 $7.00 # B1599 $5.00 #

B1575 $15.00 # # B1600 $15.00 # # B1575 $7.00 # B1600 $5.00 #

B1576 $15.00 # # B1601 $15.00 # # B1576 $7.00 # B1601 $5.00 #

B1577 $10.00 # # B1602 $15.00 # # B1577 $5.00 # B1602 $5.00 #

B1578 $12.00 # # B1603 $15.00 # # B1578 $5.00 # B1603 $5.00 #

B1579 $15.00 # # B1604 $15.00 # # B1579 $5.00 # B1604 $5.00 #

B1580 $15.00 # # B1605 $15.00 # # B1580 $5.00 # B1605 $5.00 #

B1581 $15.00 # # B1606 $10.00 # # B1581 $5.00 # B1606 N/C #

B1582 $10.00 # # B1607 $15.00 # # B1582 $5.00 # B1607 $5.00 #

B1583 $12.00 # # B1608 $15.00 # # B1583 $5.00 # B1608 $5.00 #

B1584 $15.00 # # B1609 $15.00 # # B1584 $5.00 # B1609 $5.00 #

B1585 $15.00 # # B1610 $10.00 # # B1585 $5.00 # B1610 $7.00 #

B1586 $10.00 # # B1611 $10.00 # # B1586 $5.00 # B1611 $7.00 #

B1587 $10.00 # # B1612 $10.00 # # B1587 $5.00 # B1612 $7.00 #

B1588 $15.00 # # B1613 $10.00 # # B1588 $5.00 # B1613 $7.00 #

B1589 $15.00 # # B1614 $10.00 # # B1589 $5.00 # B1614 $7.00 #

B1590 $10.00 # # B1615 $10.00 # # B1590 $5.00 # B1615 $7.00 #

B1591 $10.00 # # B1616 $10.00 # # B1591 $5.00 # B1616 $7.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1617 $10.00 # # B1642 $10.00 # # B1617 $7.00 # B1642 $7.00 #

B1618 $10.00 # # B1643 $10.00 # # B1618 $7.00 # B1643 $7.00 #

B1619 $10.00 # # B1644 $10.00 # # B1619 $7.00 # B1644 $7.00 #

B1620 $10.00 # # B1645 $10.00 # # B1620 $7.00 # B1645 $7.00 #

B1621 $10.00 # # B1646 $10.00 # # B1621 $7.00 # B1646 $7.00 #

B1622 $10.00 # # B1647 $10.00 # # B1622 $7.00 # B1647 $7.00 #

B1623 $10.00 # # B1648 $10.00 # # B1623 $7.00 # B1648 $7.00 #

B1624 $10.00 # # B1649 $15.00 # # B1624 $7.00 # B1649 $7.00 #

B1625 $10.00 # # B1650 $15.00 # # B1625 $7.00 # B1650 $7.00 #

B1626 $10.00 # # B1651 $15.00 # # B1626 $7.00 # B1651 $7.00 #

B1627 $10.00 # # B1652 $15.00 # # B1627 $7.00 # B1652 $7.00 #

B1628 $10.00 # # B1653 $15.00 # # B1628 $7.00 # B1653 $7.00 #

B1629 $10.00 # # B1654 $15.00 # # B1629 $7.00 # B1654 $7.00 #

B1630 $10.00 # # B1655 $15.00 # # B1630 $7.00 # B1655 $7.00 #

B1631 $10.00 # # B1656 $15.00 # # B1631 $7.00 # B1656 $7.00 #

B1632 $10.00 # # B1657 $15.00 # # B1632 $7.00 # B1657 $7.00 #

B1633 $10.00 # # B1658 $15.00 # # B1633 $7.00 # B1658 $7.00 #

B1634 $10.00 # # B1659 $15.00 # # B1634 $7.00 # B1659 $7.00 #

B1635 $10.00 # # B1660 $15.00 # # B1635 $7.00 # B1660 $7.00 #

B1636 $10.00 # # B1661 $15.00 # # B1636 $7.00 # B1661 $7.00 #

B1637 $10.00 # # B1662 $15.00 # # B1637 $7.00 # B1662 $7.00 #

B1638 $10.00 # # B1663 $15.00 # # B1638 $7.00 # B1663 $7.00 #

B1639 $10.00 # # B1664 $15.00 # # B1639 $7.00 # B1664 $7.00 #

B1640 $10.00 # # B1665 $15.00 # # B1640 $7.00 # B1665 $7.00 #

B1641 $10.00 # # B1666 $15.00 # # B1641 $7.00 # B1666 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1667 $15.00 # # B1692 $10.00 # # B1667 $7.00 # B1692 $7.00 #

B1668 $15.00 # # B1693 $10.00 # # B1668 $7.00 # B1693 $7.00 #

B1669 $15.00 # # B1694 $10.00 # # B1669 $7.00 # B1694 $7.00 #

B1670 $15.00 # # B1695 $10.00 # # B1670 $7.00 # B1695 $7.00 #

B1671 $15.00 # # B1696 $10.00 # # B1671 $7.00 # B1696 $7.00 #

B1672 $15.00 # # B1697 $10.00 # # B1672 $7.00 # B1697 $7.00 #

B1673 $15.00 # # B1698 $10.00 # # B1673 $7.00 # B1698 $7.00 #

B1674 $15.00 # # B1699 $10.00 # # B1674 $7.00 # B1699 $7.00 #

B1675 $15.00 # # B1700 $10.00 # # B1675 $7.00 # B1700 $7.00 #

B1676 $15.00 # # B1701 $10.00 # # B1676 $7.00 # B1701 $7.00 #

B1677 $15.00 # # B1702 $10.00 # # B1677 $7.00 # B1702 $7.00 #

B1678 $15.00 # # B1703 $10.00 # # B1678 $7.00 # B1703 $7.00 #

B1679 $15.00 # # B1704 $10.00 # # B1679 $7.00 # B1704 $7.00 #

B1680 $15.00 # # B1705 $15.00 # # B1680 $7.00 # B1705 $5.00 #

B1681 $15.00 # # B1706 $15.00 # # B1681 $7.00 # B1706 $5.00 #

B1682 $15.00 # # B1707 $10.00 # # B1682 $7.00 # B1707 $5.00 #

B1683 $15.00 # # B1708 $10.00 # # B1683 $7.00 # B1708 $5.00 #

B1684 $15.00 # # B1709 $15.00 # # B1684 $7.00 # B1709 $5.00 #

B1685 $15.00 # # B1710 $15.00 # # B1685 $7.00 # B1710 $5.00 #

B1686 $15.00 # # B1711 $20.00 # # B1686 $7.00 # B1711 $5.00 #

B1687 $15.00 # # B1712 $18.00 # # B1687 $7.00 # B1712 $5.00 #

B1688 $15.00 # # B1713 $15.00 # # B1688 $7.00 # B1713 $5.00 #

B1689 $15.00 # # B1714 $15.00 # # B1689 $7.00 # B1714 N/C #

B1690 $15.00 # # B1715 $15.00 # # B1690 $7.00 # B1715 $5.00 #

B1691 $10.00 # # B1716 $15.00 # # B1691 $7.00 # B1716 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1717 $15.00 # # B1742 $15.00 # # B1717 $5.00 # B1742 $5.00 #

B1718 $15.00 # # B1743 $15.00 # # B1718 $5.00 # B1743 $5.00 #

B1719 $7.00 # # B1744 $15.00 # # B1719 $5.00 # B1744 $5.00 #

B1720 $15.00 # # B1745 $15.00 # # B1720 $15.00 # B1745 $5.00 #

B1721 $15.00 # # B1746 $15.00 # # B1721 $5.00 # B1746 $5.00 #

B1722 $15.00 # # B1747 $10.00 # # B1722 $5.00 # B1747 $5.00 #

B1723 $15.00 # # B1748 $12.00 # # B1723 $5.00 # B1748 $5.00 #

B1724 $15.00 # # B1749 $15.00 # # B1724 $5.00 # B1749 $5.00 #

B1725 $15.00 # # B1750 $10.00 # # B1725 $5.00 # B1750 $5.00 #

B1726 $15.00 # # B1751 $15.00 # # B1726 $5.00 # B1751 $5.00 #

B1727 $15.00 # # B1752 $15.00 # # B1727 $5.00 # B1752 $5.00 #

B1728 $10.00 # # B1753 $15.00 # # B1728 $5.00 # B1753 $5.00 #

B1729 $15.00 # # B1754 $15.00 # # B1729 $5.00 # B1754 $5.00 #

B1730 $15.00 # # B1755 $15.00 # # B1730 $5.00 # B1755 $5.00 #

B1731 $10.00 # # B1756 $15.00 # # B1731 $5.00 # B1756 $5.00 #

B1732 $10.00 # # B1757 $15.00 # # B1732 $5.00 # B1757 $5.00 #

B1733 $15.00 # # B1758 $15.00 # # B1733 $5.00 # B1758 $5.00 #

B1734 $15.00 # # B1759 $15.00 # # B1734 $5.00 # B1759 $5.00 #

B1735 $15.00 # # B1760 $15.00 # # B1735 $5.00 # B1760 $5.00 #

B1736 $12.00 # # B1761 $10.00 # # B1736 $5.00 # B1761 $5.00 #

B1737 $15.00 # # B1762 $15.00 # # B1737 $5.00 # B1762 $7.00 #

B1738 $15.00 # # B1763 $15.00 # # B1738 $5.00 # B1763 $7.00 #

B1739 $15.00 # # B1764 $15.00 # # B1739 $5.00 # B1764 $7.00 #

B1740 $15.00 # # B1765 $15.00 # # B1740 $5.00 # B1765 $7.00 #

B1741 $15.00 # # B1766 $15.00 # # B1741 $5.00 # B1766 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1767 $15.00 # # B1792 $10.00 # # B1767 $7.00 # B1792 $7.00 #

B1768 $15.00 # # B1793 $10.00 # # B1768 $7.00 # B1793 $7.00 #

B1769 $15.00 # # B1794 $10.00 # # B1769 $7.00 # B1794 $7.00 #

B1770 $15.00 # # B1795 $10.00 # # B1770 $7.00 # B1795 $7.00 #

B1771 $15.00 # # B1796 $10.00 # # B1771 $7.00 # B1796 $7.00 #

B1772 $15.00 # # B1797 $10.00 # # B1772 $7.00 # B1797 $7.00 #

B1773 $15.00 # # B1798 $10.00 # # B1773 $7.00 # B1798 $7.00 #

B1774 $15.00 # # B1799 $10.00 # # B1774 $7.00 # B1799 $7.00 #

B1775 $15.00 # # B1800 $10.00 # # B1775 $7.00 # B1800 $7.00 #

B1776 $15.00 # # B1801 $10.00 # # B1776 $7.00 # B1801 $7.00 #

B1777 $15.00 # # B1802 $10.00 # # B1777 $7.00 # B1802 $7.00 #

B1778 $15.00 # # B1803 $10.00 # # B1778 $7.00 # B1803 $7.00 #

B1779 $15.00 # # B1804 $10.00 # # B1779 $7.00 # B1804 $7.00 #

B1780 $15.00 # # B1805 $10.00 # # B1780 $7.00 # B1805 $7.00 #

B1781 $15.00 # # B1806 $10.00 # # B1781 $7.00 # B1806 $7.00 #

B1782 $10.00 # # B1807 $10.00 # # B1782 $7.00 # B1807 $7.00 #

B1783 $10.00 # # B1808 $10.00 # # B1783 $7.00 # B1808 $7.00 #

B1784 $10.00 # # B1809 $10.00 # # B1784 $7.00 # B1809 $7.00 #

B1785 $10.00 # # B1810 $10.00 # # B1785 $7.00 # B1810 $7.00 #

B1786 $10.00 # # B1811 $10.00 # # B1786 $7.00 # B1811 $7.00 #

B1787 $10.00 # # B1812 $10.00 # # B1787 $7.00 # B1812 $7.00 #

B1788 $10.00 # # B1813 $10.00 # # B1788 $7.00 # B1813 $7.00 #

B1789 $10.00 # # B1814 $12.00 # # B1789 $7.00 # B1814 $5.00 #

B1790 $10.00 # # B1815 $15.00 # # B1790 $7.00 # B1815 $5.00 #

B1791 $10.00 # # B1816 $15.00 # # B1791 $7.00 # B1816 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1817 $10.00 # # B1842 $15.00 # # B1817 $5.00 # B1842 $5.00 #

B1818 $15.00 # # B1843 $10.00 # # B1818 $5.00 # B1843 $5.00 #

B1819 $15.00 # # B1844 $15.00 # # B1819 $5.00 # B1844 $5.00 #

B1820 $12.00 # # B1845 $15.00 # # B1820 $5.00 # B1845 $5.00 #

B1821 $12.00 # # B1846 $15.00 # # B1821 $5.00 # B1846 $5.00 #

B1822 $15.00 # # B1847 $15.00 # # B1822 $5.00 # B1847 $5.00 #

B1823 $15.00 # # B1848 $10.00 # # B1823 $5.00 # B1848 $5.00 #

B1824 $15.00 # # B1849 $15.00 # # B1824 $5.00 # B1849 $5.00 #

B1825 $10.00 # # B1850 $15.00 # # B1825 $5.00 # B1850 $5.00 #

B1826 $15.00 # # B1851 $15.00 # # B1826 $5.00 # B1851 $5.00 #

B1827 $15.00 # # B1852 $15.00 # # B1827 $7.00 # B1852 $5.00 #

B1828 $15.00 # # B1853 $15.00 # # B1828 $5.00 # B1853 $5.00 #

B1829 $15.00 # # B1854 $15.00 # # B1829 $5.00 # B1854 $5.00 #

B1830 $15.00 # # B1855 $10.00 # # B1830 $5.00 # B1855 $7.00 #

B1831 $15.00 # # B1856 $15.00 # # B1831 $5.00 # B1856 $5.00 #

B1832 $15.00 # # B1857 $15.00 # # B1832 $5.00 # B1857 $5.00 #

B1833 $15.00 # # B1858 $15.00 # # B1833 $5.00 # B1858 $5.00 #

B1834 $15.00 # # B1859 $15.00 # # B1834 $5.00 # B1859 $5.00 #

B1835 $10.00 # # B1860 $15.00 # # B1835 $5.00 # B1860 $5.00 #

B1836 $15.00 # # B1861 $15.00 # # B1836 $5.00 # B1861 $5.00 #

B1837 $15.00 # # B1862 $15.00 # # B1837 $5.00 # B1862 $5.00 #

B1838 $10.00 # # B1863 $15.00 # # B1838 N/C # B1863 $5.00 #

B1839 $15.00 # # B1864 $15.00 # # B1839 $5.00 # B1864 $5.00 #

B1840 $15.00 # # B1865 $15.00 # # B1840 $5.00 # B1865 $5.00 #

B1841 $12.00 # # B1866 $15.00 # # B1841 $5.00 # B1866 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1867 $15.00 # # B1892 $15.00 # # B1867 $5.00 # B1892 $5.00 #

B1868 $15.00 # # B1893 $15.00 # # B1868 $5.00 # B1893 $5.00 #

B1869 $15.00 # # B1894 $15.00 # # B1869 $5.00 # B1894 $5.00 #

B1870 $15.00 # # B1895 $15.00 # # B1870 $5.00 # B1895 $5.00 #

B1871 $15.00 # # B1896 $15.00 # # B1871 $5.00 # B1896 $5.00 #

B1872 $15.00 # # B1897 $15.00 # # B1872 $5.00 # B1897 $5.00 #

B1873 $15.00 # # B1898 $10.00 # # B1873 $5.00 # B1898 $5.00 #

B1874 $15.00 # # B1899 $15.00 # # B1874 $5.00 # B1899 $5.00 #

B1875 $10.00 # # B1900 $15.00 # # B1875 $5.00 # B1900 $5.00 #

B1876 $10.00 # # B1901 $15.00 # # B1876 $5.00 # B1901 $5.00 #

B1877 $15.00 # # B1902 $15.00 # # B1877 $5.00 # B1902 $5.00 #

B1878 $15.00 # # B1903 $10.00 # # B1878 $5.00 # B1903 $5.00 #

B1879 $12.00 # # B1904 $15.00 # # B1879 $5.00 # B1904 $5.00 #

B1880 $12.00 # # B1905 $15.00 # # B1880 $5.00 # B1905 $5.00 #

B1881 $10.00 # # B1906 $15.00 # # B1881 $5.00 # B1906 $5.00 #

B1882 $7.50 # # B1907 $12.00 # # B1882 $10.00 # B1907 $5.00 #

B1883 $15.00 # # B1908 $15.00 # # B1883 $5.00 # B1908 $5.00 #

B1884 $15.00 # # B1909 $15.00 # # B1884 $5.00 # B1909 $5.00 #

B1885 $15.00 # # B1910 $10.00 # # B1885 $5.00 # B1910 $5.00 #

B1886 $15.00 # # B1911 $15.00 # # B1886 $5.00 # B1911 $5.00 #

B1887 $10.00 # # B1912 $15.00 # # B1887 $5.00 # B1912 $5.00 #

B1888 $15.00 # # B1913 $12.00 # # B1888 $5.00 # B1913 $5.00 #

B1889 $12.00 # # B1914 $15.00 # # B1889 $5.00 # B1914 $5.00 #

B1890 $12.00 # # B1915 $10.00 # # B1890 $5.00 # B1915 $5.00 #

B1891 $15.00 # # B1916 $15.00 # # B1891 $5.00 # B1916 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1917 $15.00 # # B1943 $10.00 # # B1917 $5.00 # B1943 $5.00 #

B1918 $15.00 # # B1944 $15.00 # # B1918 $5.00 # B1944 $5.00 #

B1919 $15.00 # # B1945 $12.00 # # B1919 $5.00 # B1945 $5.00 #

B1920 $12.00 # # B1946 $12.00 # # B1920 $5.00 # B1946 $5.00 #

B1921 $15.00 # # B1947 $15.00 # # B1921 $5.00 # B1947 $5.00 #

B1922 $15.00 # # B1948 $15.00 # # B1922 $5.00 # B1948 $5.00 #

B1923 $15.00 # # B1949 $15.00 # # B1923 $5.00 # B1949 $5.00 #

B1924 $15.00 # # B1950 $15.00 # # B1924 $5.00 # B1950 $5.00 #

B1925 $15.00 # # B1951 $15.00 # # B1925 $5.00 # B1951 $5.00 #

B1926 $15.00 # # B1952 $10.00 # # B1926 $7.00 # B1952 $5.00 #

B1927 $15.00 # # B1953 $10.00 # # B1927 $5.00 # B1953 $5.00 #

B1929 $15.00 # # B1954 $15.00 # # B1929 $5.00 # B1954 $5.00 #

B1930 $15.00 # # B1955 $15.00 # # B1930 $5.00 # B1955 $7.00 #

B1931 $15.00 # # B1956 $15.00 # # B1931 $5.00 # B1956 $5.00 #

B1932 $15.00 # # B1957 $12.00 # # B1932 $5.00 # B1957 $5.00 #

B1933 $10.00 # # B1958 $12.00 # # B1933 $5.00 # B1958 $5.00 #

B1934 $15.00 # # B1959 $15.00 # # B1934 $5.00 # B1959 $5.00 #

B1935 $10.00 # # B1960 $15.00 # # B1935 $5.00 # B1960 $5.00 #

B1936 $15.00 # # B1961 $15.00 # # B1936 $5.00 # B1961 $5.00 #

B1937 $12.00 # # B1962 $15.00 # # B1937 $5.00 # B1962 $5.00 #

B1938 $10.00 # # B1963 $15.00 # # B1938 $5.00 # B1963 $5.00 #

B1939 $15.00 # # B1964 $10.00 # # B1939 $7.00 # B1964 $5.00 #

B1940 $15.00 # # B1965 $15.00 # # B1940 $5.00 # B1965 $5.00 #

B1941 $15.00 # # B1966 $15.00 # # B1941 $5.00 # B1966 $5.00 #

B1942 $12.00 # # B1967 $15.00 # # B1942 $5.00 # B1967 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B1968 $15.00 # # B1993 $15.00 # # B1968 $5.00 # B1993 $5.00 #

B1969 $15.00 # # B1994 $15.00 # # B1969 $5.00 # B1994 $5.00 #

B1970 $15.00 # # B1995 $12.00 # # B1970 $5.00 # B1995 $5.00 #

B1971 $12.00 # # B1996 $15.00 # # B1971 $5.00 # B1996 $5.00 #

B1972 $15.00 # # B1997 $12.00 # # B1972 $5.00 # B1997 $5.00 #

B1973 $12.00 # # B1998 $15.00 # # B1973 $5.00 # B1998 $5.00 #

B1974 $12.00 # # B1999 $10.00 # # B1974 $5.00 # B1999 $5.00 #

B1975 $10.00 # # B2000 $10.00 # # B1975 $5.00 # B2000 $5.00 #

B1976 $15.00 # # B2001 $15.00 # # B1976 $5.00 # B2001 $5.00 #

B1977 $15.00 # # B2002 $15.00 # # B1977 $5.00 # B2002 $5.00 #

B1978 $12.00 # # B2003 $10.00 # # B1978 $5.00 # B2003 $5.00 #

B1979 $15.00 # # B2004 $15.00 # # B1979 $5.00 # B2004 $5.00 #

B1980 $10.00 # # B2005 $15.00 # # B1980 $5.00 # B2005 $5.00 #

B1981 $15.00 # # B2006 $10.00 # # B1981 $5.00 # B2006 $5.00 #

B1982 $15.00 # # B2007 $15.00 # # B1982 $5.00 # B2007 $5.00 #

B1983 $15.00 # # B2008 $10.00 # # B1983 $5.00 # B2008 $5.00 #

B1984 $15.00 # # B2009 $10.00 # # B1984 $5.00 # B2009 $5.00 #

B1985 $10.00 # # B2010 $12.00 # # B1985 $5.00 # B2010 $5.00 #

B1986 $15.00 # # B2011 $15.00 # # B1986 $5.00 # B2011 $5.00 #

B1987 $10.00 # # B2012 $10.00 # # B1987 $5.00 # B2012 $5.00 #

B1988 $15.00 # # B2013 $15.00 # # B1988 $5.00 # B2013 $5.00 #

B1989 $10.00 # # B2014 $15.00 # # B1989 $5.00 # B2014 $5.00 #

B1990 $15.00 # # B2015 $10.00 # # B1990 $5.00 # B2015 $5.00 #

B1991 $15.00 # # B2016 $15.00 # # B1991 $5.00 # B2016 $5.00 #

B1992 $15.00 # # B2017 $15.00 # # B1992 $5.00 # B2017 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2018 $15.00 # # B2043 $15.00 # # B2018 $5.00 # B2043 $5.00 #

B2019 $12.00 # # B2044 $15.00 # # B2019 $5.00 # B2044 $5.00 #

B2020 $15.00 # # B2045 $15.00 # # B2020 $5.00 # B2045 $5.00 #

B2021 $15.00 # # B2046 $12.00 # # B2021 $5.00 # B2046 $5.00 #

B2022 $15.00 # # B2047 $15.00 # # B2022 $5.00 # B2047 $5.00 #

B2023 $15.00 # # B2048 $15.00 # # B2023 $5.00 # B2048 $5.00 #

B2024 $15.00 # # B2049 $15.00 # # B2024 $5.00 # B2049 $5.00 #

B2025 $15.00 # # B2050 $15.00 # # B2025 $5.00 # B2050 $5.00 #

B2026 $15.00 # # B2051 $15.00 # # B2026 $5.00 # B2051 $5.00 #

B2027 $15.00 # # B2052 $10.00 # # B2027 $5.00 # B2052 $5.00 #

B2028 $12.00 # # B2053 $15.00 # # B2028 $5.00 # B2053 $5.00 #

B2029 $15.00 # # B2054 $12.00 # # B2029 $5.00 # B2054 $5.00 #

B2030 $12.00 # # B2055 $15.00 # # B2030 $5.00 # B2055 $5.00 #

B2031 $15.00 # # B2056 $15.00 # # B2031 $5.00 # B2056 $5.00 #

B2032 $15.00 # # B2057 $10.00 # # B2032 $5.00 # B2057 $5.00 #

B2033 $15.00 # # B2058 $15.00 # # B2033 $5.00 # B2058 $5.00 #

B2034 $15.00 # # B2059 $15.00 # # B2034 $5.00 # B2059 $5.00 #

B2035 $15.00 # # B2060 $15.00 # # B2035 $5.00 # B2060 $5.00 #

B2036 $15.00 # # B2061 $15.00 # # B2036 $5.00 # B2061 $7.00 #

B2037 $15.00 # # B2062 $10.00 # # B2037 $5.00 # B2062 $5.00 #

B2038 $12.00 # # B2063 $15.00 # # B2038 $5.00 # B2063 $5.00 #

B2039 $12.00 # # B2064 $15.00 # # B2039 $5.00 # B2064 $5.00 #

B2040 $15.00 # # B2065 $15.00 # # B2040 $5.00 # B2065 $5.00 #

B2041 $15.00 # # B2066 $20.00 # # B2041 $5.00 # B2066 $5.00 #

B2042 $15.00 # # B2067 $15.00 # # B2042 $5.00 # B2067 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2068 $8.00 # # B2094 $15.00 # # B2068 $5.00 # B2094 $5.00 #

B2069 $15.00 # # B2095 $15.00 # # B2069 $5.00 # B2095 $5.00 #

B2070 $10.00 # # B2096 $15.00 # # B2070 $5.00 # B2096 $5.00 #

B2071 $10.00 # # B2097 $15.00 # # B2071 $5.00 # B2097 $5.00 #

B2072 $15.00 # # B2098 $15.00 # # B2072 $5.00 # B2098 $7.00 #

B2073 $20.00 # # B2099 $15.00 # # B2073 $5.00 # B2099 $7.00 #

B2074 $10.00 # # B2100 $15.00 # # B2074 $5.00 # B2100 $5.00 #

B2075 $15.00 # # B2101 $12.00 # # B2075 $5.00 # B2101 $5.00 #

B2076 $15.00 # # B2102 $15.00 # # B2076 $5.00 # B2102 $5.00 #

B2077 $15.00 # # B2103 $15.00 # # B2077 $5.00 # B2103 $5.00 #

B2079 $15.00 # # B2104 $10.00 # # B2079 $5.00 # B2104 $5.00 #

B2080 $15.00 # # B2105 $18.00 # # B2080 $5.00 # B2105 $5.00 #

B2081 $15.00 # # B2106 $18.00 # # B2081 $5.00 # B2106 $5.00 #

B2082 $15.00 # # B2107 $15.00 # # B2082 $5.00 # B2107 $5.00 #

B2083 $8.00 # # B2108 $12.00 # # B2083 $5.00 # B2108 $5.00 #

B2084 $12.00 # # B2109 $20.00 # # B2084 $5.00 # B2109 $5.00 #

B2085 $12.00 # # B2110 $15.00 # # B2085 $5.00 # B2110 $5.00 #

B2086 $20.00 # # B2111 $7.00 # # B2086 $5.00 # B2111 $7.00 #

B2087 $7.00 # # B2112 $15.00 # # B2087 $5.00 # B2112 $5.00 #

B2088 $15.00 # # B2113 $15.00 # # B2088 $5.00 # B2113 $5.00 #

B2089 $15.00 # # B2114 $15.00 # # B2089 $5.00 # B2114 $5.00 #

B2090 $15.00 # # B2115 $12.00 # # B2090 $5.00 # B2115 $5.00 #

B2091 $15.00 # # B2117 $20.00 # # B2091 $5.00 # B2117 $5.00 #

B2092 $15.00 # # B2118 $15.00 # # B2092 $5.00 # B2118 $5.00 #

B2093 $15.00 # # B2119 $15.00 # # B2093 $5.00 # B2119 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2120 $15.00 # # B2145 $18.00 # # B2120 $5.00 # B2145 $5.00 #

B2121 $15.00 # # B2146 $18.00 # # B2121 $5.00 # B2146 $5.00 #

B2122 $15.00 # # B2147 $15.00 # # B2122 $5.00 # B2147 $5.00 #

B2123 $10.00 # # B2148 $15.00 # # B2123 $5.00 # B2148 $5.00 #

B2124 $15.00 # # B2149 $15.00 # # B2124 $5.00 # B2149 $5.00 #

B2125 $10.00 # # B2150 $15.00 # # B2125 $5.00 # B2150 $5.00 #

B2126 $15.00 # # B2151 $15.00 # # B2126 $5.00 # B2151 $5.00 #

B2127 $15.00 # # B2152 $15.00 # # B2127 $5.00 # B2152 $5.00 #

B2128 $20.00 # # B2153 $20.00 # # B2128 $5.00 # B2153 $5.00 #

B2129 $15.00 # # B2154 $12.00 # # B2129 $5.00 # B2154 $12.00 #

B2130 $35.00 # # B2155 $10.00 # # B2130 $5.00 # B2155 $5.00 #

B2131 $15.00 # # B2156 $8.00 # # B2131 $5.00 # B2156 $5.00 #

B2132 $7.00 # # B2157 $15.00 # # B2132 $5.00 # B2157 $5.00 #

B2133 $15.00 # # B2158 $15.00 # # B2133 $5.00 # B2158 $5.00 #

B2134 $12.00 # # B2159 $15.00 # # B2134 $5.00 # B2159 $5.00 #

B2135 $12.00 # # B2160 $15.00 # # B2135 $5.00 # B2160 $5.00 #

B2136 $15.00 # # B2161 $20.00 # # B2136 $5.00 # B2161 $5.00 #

B2137 $18.00 # # B2162 $15.00 # # B2137 $18.00 # B2162 $5.00 #

B2138 $15.00 # # B2163 $15.00 # # B2138 $5.00 # B2163 $5.00 #

B2139 $15.00 # # B2164 $15.00 # # B2139 $5.00 # B2164 $5.00 #

B2140 $10.00 # # B2165 $10.00 # # B2140 $5.00 # B2165 $5.00 #

B2141 $18.00 # # B2166 $15.00 # # B2141 $5.00 # B2166 $5.00 #

B2142 $18.00 # # B2167 $12.00 # # B2142 $5.00 # B2167 $5.00 #

B2143 $18.00 # # B2168 $15.00 # # B2143 $5.00 # B2168 $5.00 #

B2144 $18.00 # # B2169 $15.00 # # B2144 $5.00 # B2169 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2170 $15.00 # # B2196 $15.00 # # B2170 $5.00 # B2196 $7.00 #

B2171 $15.00 # # B2197 $15.00 # # B2171 $5.00 # B2197 $5.00 #

B2172 $10.00 # # B2198 $15.00 # # B2172 $5.00 # B2198 $5.00 #

B2173 $15.00 # # B2199 $15.00 # # B2173 $5.00 # B2199 $5.00 #

B2175 $12.00 # # B2200 $15.00 # # B2175 $5.00 # B2200 $5.00 #

B2176 $10.00 # # B2201 $10.00 # # B2176 $5.00 # B2201 $5.00 #

B2177 $15.00 # # B2202 $15.00 # # B2177 $5.00 # B2202 $5.00 #

B2178 $15.00 # # B2203 $15.00 # # B2178 $5.00 # B2203 $5.00 #

B2179 $15.00 # # B2204 $12.00 # # B2179 $5.00 # B2204 $5.00 #

B2180 $10.00 # # B2205 $18.00 # # B2180 $5.00 # B2205 $5.00 #

B2181 $15.00 # # B2206 $10.00 # # B2181 $5.00 # B2206 $7.00 #

B2182 $15.00 # # B2207 $15.00 # # B2182 $5.00 # B2207 $5.00 #

B2183 $15.00 # # B2208 $15.00 # # B2183 $5.00 # B2208 $5.00 #

B2184 $15.00 # # B2209 $12.00 # # B2184 $5.00 # B2209 $5.00 #

B2185 $15.00 # # B2210 $15.00 # # B2185 $5.00 # B2210 $5.00 #

B2186 $15.00 # # B2211 $10.00 # # B2186 $5.00 # B2211 $5.00 #

B2187 $15.00 # # B2212 $15.00 # # B2187 $5.00 # B2212 $5.00 #

B2188 $15.00 # # B2213 $15.00 # # B2188 $5.00 # B2213 $5.00 #

B2189 $15.00 # # B2214 $15.00 # # B2189 $5.00 # B2214 $5.00 #

B2190 $15.00 # # B2215 $12.00 # # B2190 $5.00 # B2215 $5.00 #

B2191 $15.00 # # B2216 $15.00 # # B2191 $5.00 # B2216 $5.00 #

B2192 $10.00 # # B2217 $10.00 # # B2192 $5.00 # B2217 $5.00 #

B2193 $15.00 # # B2218 $10.00 # # B2193 $5.00 # B2218 $5.00 #

B2194 $15.00 # # B2219 $15.00 # # B2194 $5.00 # B2219 $5.00 #

B2195 $12.00 # # B2220 $10.00 # # B2195 $5.00 # B2220 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2221 $15.00 # # B2246 $15.00 # # B2221 $5.00 # B2246 $5.00 #

B2222 $15.00 # # B2247 $20.00 # # B2222 $5.00 # B2247 $5.00 #

B2223 $15.00 # # B2248 $15.00 # # B2223 $5.00 # B2248 $5.00 #

B2224 $15.00 # # B2249 $12.00 # # B2224 $5.00 # B2249 $5.00 #

B2225 $15.00 # # B2250 $15.00 # # B2225 $5.00 # B2250 $5.00 #

B2226 $15.00 # # B2251 $15.00 # # B2226 $5.00 # B2251 $5.00 #

B2227 $15.00 # # B2252 $15.00 # # B2227 $5.00 # B2252 $5.00 #

B2228 $15.00 # # B2253 $10.00 # # B2228 $5.00 # B2253 $5.00 #

B2229 $15.00 # # B2254 $15.00 # # B2229 $5.00 # B2254 $5.00 #

B2230 $15.00 # # B2255 $12.00 # # B2230 $5.00 # B2255 $5.00 #

B2231 $15.00 # # B2256 $12.00 # # B2231 $5.00 # B2256 $5.00 #

B2232 $15.00 # # B2257 $15.00 # # B2232 $5.00 # B2257 $5.00 #

B2233 $15.00 # # B2258 $8.00 # # B2233 $5.00 # B2258 $5.00 #

B2234 $15.00 # # B2259 $5.00 # # B2234 $5.00 # B2259 $5.00 #

B2235 $12.00 # # B2260 $10.00 # # B2235 $5.00 # B2260 $5.00 #

B2236 NADA # # B2261 $15.00 # # B2236 $5.00 # B2261 $5.00 #

B2237 $10.00 # # B2262 $18.00 # # B2237 $5.00 # B2262 $18.00 #

B2238 $15.00 # # B2263 $18.00 # # B2238 $5.00 # B2263 $5.00 #

B2239 $15.00 # # B2264 $15.00 # # B2239 $7.00 # B2264 $5.00 #

B2240 $15.00 # # B2265 $15.00 # # B2240 $7.00 # B2265 $5.00 #

B2241 $15.00 # # B2266 $15.00 # # B2241 $5.00 # B2266 $5.00 #

B2242 $15.00 # # B2267 $15.00 # # B2242 $5.00 # B2267 $5.00 #

B2243 $15.00 # # B2268 $10.00 # # B2243 $5.00 # B2268 $10.00 #

B2244 $15.00 # # B2269 $15.00 # # B2244 $5.00 # B2269 $5.00 #

B2245 $10.00 # # B2270 $15.00 # # B2245 $5.00 # B2270 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2271 $10.00 # # B2296 $20.00 # # B2271 $5.00 # B2296 $5.00 #

B2272 $15.00 # # B2297 $12.00 # # B2272 $15.00 # B2297 $5.00 #

B2273 $10.00 # # B2298 $12.00 # # B2273 $5.00 # B2298 $5.00 #

B2274 $15.00 # # B2299 $18.00 # # B2274 $5.00 # B2299 $5.00 #

B2275 $20.00 # # B2300 $20.00 # # B2275 $5.00 # B2300 $5.00 #

B2276 $20.00 # # B2301 $15.00 # # B2276 $5.00 # B2301 $5.00 #

B2277 $20.00 # # B2302 $10.00 # # B2277 $5.00 # B2302 $5.00 #

B2278 $20.00 # # B2303 $10.00 # # B2278 $5.00 # B2303 $5.00 #

B2279 $15.00 # # B2304 $15.00 # # B2279 $5.00 # B2304 $5.00 #

B2280 $15.00 # # B2305 $15.00 # # B2280 $5.00 # B2305 $5.00 #

B2281 $15.00 # # B2306 $15.00 # # B2281 $5.00 # B2306 $5.00 #

B2282 $12.00 # # B2307 $15.00 # # B2282 $5.00 # B2307 $5.00 #

B2283 $15.00 # # B2308 $15.00 # # B2283 $5.00 # B2308 $5.00 #

B2284 $12.00 # # B2309 $15.00 # # B2284 $5.00 # B2309 $5.00 #

B2285 $18.00 # # B2310 $15.00 # # B2285 $5.00 # B2310 $5.00 #

B2286 $15.00 # # B2311 $12.00 # # B2286 $5.00 # B2311 $5.00 #

B2287 $18.00 # # B2312 $12.00 # # B2287 $5.00 # B2312 $5.00 #

B2288 $15.00 # # B2313 $18.00 # # B2288 $5.00 # B2313 $5.00 #

B2289 $15.00 # # B2315 $15.00 # # B2289 $5.00 # B2315 $15.00 #

B2290 $17.00 # # B2316 $15.00 # # B2290 $5.00 # B2316 $15.00 #

B2291 $15.00 # # B2317 $15.00 # # B2291 $5.00 # B2317 $15.00 #

B2292 $15.00 # # B2318 $15.00 # # B2292 $5.00 # B2318 $5.00 #

B2293 $10.00 # # B2319 $15.00 # # B2293 $5.00 # B2319 $5.00 #

B2294 $18.00 # # B2320 $15.00 # # B2294 $5.00 # B2320 $5.00 #

B2295 $10.00 # # B2321 $15.00 # # B2295 $5.00 # B2321 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2322 $12.00 # # B2347 $15.00 # # B2322 $5.00 # B2347 $5.00 #

B2323 $15.00 # # B2348 $15.00 # # B2323 $5.00 # B2348 $5.00 #

B2324 $10.00 # # B2349 $10.00 # # B2324 $5.00 # B2349 $5.00 #

B2325 $10.00 # # B2350 $15.00 # # B2325 $5.00 # B2350 $5.00 #

B2326 $15.00 # # B2351 $12.00 # # B2326 $5.00 # B2351 $5.00 #

B2327 $10.00 # # B2352 $15.00 # # B2327 $10.00 # B2352 $5.00 #

B2328 $12.00 # # B2353 $15.00 # # B2328 $12.00 # B2353 $5.00 #

B2329 $15.00 # # B2354 $15.00 # # B2329 $5.00 # B2354 $5.00 #

B2330 $18.00 # # B2355 $15.00 # # B2330 $5.00 # B2355 $5.00 #

B2331 $15.00 # # B2356 $15.00 # # B2331 $5.00 # B2356 $5.00 #

B2332 $15.00 # # B2357 $15.00 # # B2332 $5.00 # B2357 $5.00 #

B2333 $15.00 # # B2358 $12.00 # # B2333 $5.00 # B2358 $5.00 #

B2334 $12.00 # # B2359 NADA # # B2334 $5.00 # B2359 $5.00 #

B2335 $12.00 # # B2360 $10.00 # # B2335 $5.00 # B2360 $5.00 #

B2336 $15.00 # # B2361 $15.00 # # B2336 $5.00 # B2361 $5.00 #

B2337 $15.00 # # B2362 $15.00 # # B2337 $5.00 # B2362 $5.00 #

B2338 $15.00 # # B2363 $6.00 # # B2338 $5.00 # B2363 $5.00 #

B2339 $12.00 # # B2364 $15.00 # # B2339 $5.00 # B2364 $5.00 #

B2340 $15.00 # # B2365 $10.00 # # B2340 $5.00 # B2365 $5.00 #

B2341 $12.00 # # B2366 $10.00 # # B2341 $5.00 # B2366 $5.00 #

B2342 $15.00 # # B2367 $12.00 # # B2342 $5.00 # B2367 $5.00 #

B2343 $12.00 # # B2368 $15.00 # # B2343 $5.00 # B2368 $15.00 #

B2344 $15.00 # # B2369 $15.00 # # B2344 $5.00 # B2369 $15.00 #

B2345 $12.00 # # B2370 $20.00 # # B2345 $5.00 # B2370 $20.00 #

B2346 $15.00 # # B2371 $12.00 # # B2346 $5.00 # B2371 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2372 $15.00 # # B2397 $15.00 # # B2372 $5.00 # B2397 $15.00 #

B2373 $20.00 # # B2398 $15.00 # # B2373 $5.00 # B2398 $5.00 #

B2374 $20.00 # # B2399 $12.00 # # B2374 $5.00 # B2399 $5.00 #

B2375 $12.00 # # B2400 $10.00 # # B2375 $5.00 # B2400 $5.00 #

B2376 $15.00 # # B2401 $15.00 # # B2376 $5.00 # B2401 $5.00 #

B2377 $18.00 # # B2402 $18.00 # # B2377 $5.00 # B2402 $5.00 #

B2378 $15.00 # # B2403 $15.00 # # B2378 $5.00 # B2403 $5.00 #

B2379 $15.00 # # B2404 $15.00 # # B2379 $5.00 # B2404 $15.00 #

B2380 $15.00 # # B2405 $20.00 # # B2380 $5.00 # B2405 $5.00 #

B2381 $15.00 # # B2406 $15.00 # # B2381 $5.00 # B2406 $5.00 #

B2382 $12.00 # # B2407 $10.00 # # B2382 $5.00 # B2407 $5.00 #

B2383 $12.00 # # B2408 $15.00 # # B2383 $5.00 # B2408 $5.00 #

B2384 $15.00 # # B2409 $15.00 # # B2384 $5.00 # B2409 $5.00 #

B2385 $15.00 # # B2410 $15.00 # # B2385 $5.00 # B2410 $7.00 #

B2386 $15.00 # # B2411 $8.00 # # B2386 $5.00 # B2411 $5.00 #

B2387 $12.00 # # B2412 $15.00 # # B2387 $12.00 # B2412 $5.00 #

B2388 $12.00 # # B2413 $15.00 # # B2388 $12.00 # B2413 $5.00 #

B2389 $20.00 # # B2414 $15.00 # # B2389 $5.00 # B2414 $5.00 #

B2390 $15.00 # # B2415 $15.00 # # B2390 $5.00 # B2415 $5.00 #

B2391 $15.00 # # B2416 $15.00 # # B2391 $15.00 # B2416 $5.00 #

B2392 $10.00 # # B2417 $15.00 # # B2392 $5.00 # B2417 $5.00 #

B2393 $10.00 # # B2418 $12.00 # # B2393 $5.00 # B2418 $5.00 #

B2394 $20.00 # # B2419 $10.00 # # B2394 $5.00 # B2419 $5.00 #

B2395 $20.00 # # B2420 $15.00 # # B2395 $5.00 # B2420 $5.00 #

B2396 $10.00 # # B2421 $40.00 # # B2396 $10.00 # B2421 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2422 $5.00 # # B2447 $15.00 # # B2422 $5.00 # B2447 $5.00 #

B2423 $5.00 # # B2448 $12.00 # # B2423 $5.00 # B2448 $5.00 #

B2424 $15.00 # # B2449 $12.00 # # B2424 $5.00 # B2449 $5.00 #

B2425 $12.00 # # B2450 $15.00 # # B2425 $5.00 # B2450 $5.00 #

B2426 $15.00 # # B2451 $10.00 # # B2426 $5.00 # B2451 $5.00 #

B2427 $15.00 # # B2452 $10.00 # # B2427 $5.00 # B2452 $5.00 #

B2428 $18.00 # # B2453 $10.00 # # B2428 $5.00 # B2453 $5.00 #

B2429 $18.00 # # B2454 $10.00 # # B2429 $5.00 # B2454 $5.00 #

B2430 $18.00 # # B2455 $20.00 # # B2430 $5.00 # B2455 $5.00 #

B2431 $18.00 # # B2456 $15.00 # # B2431 $5.00 # B2456 $5.00 #

B2432 $18.00 # # B2457 $15.00 # # B2432 $5.00 # B2457 $5.00 #

B2433 $18.00 # # B2458 $15.00 # # B2433 $5.00 # B2458 $5.00 #

B2434 $18.00 # # B2459 $15.00 # # B2434 $5.00 # B2459 $5.00 #

B2435 $18.00 # # B2460 $10.00 # # B2435 $5.00 # B2460 $5.00 #

B2436 $18.00 # # B2461 $18.00 # # B2436 $5.00 # B2461 $5.00 #

B2437 $18.00 # # B2462 $18.00 # # B2437 $5.00 # B2462 $5.00 #

B2438 $18.00 # # B2463 $15.00 # # B2438 $5.00 # B2463 $5.00 #

B2439 $18.00 # # B2464 $18.00 # # B2439 $5.00 # B2464 $5.00 #

B2440 $18.00 # # B2465 $18.00 # # B2440 $5.00 # B2465 $5.00 #

B2441 $18.00 # # B2466 $15.00 # # B2441 $5.00 # B2466 $5.00 #

B2442 $18.00 # # B2467 $15.00 # # B2442 $5.00 # B2467 $5.00 #

B2443 $18.00 # # B2468 $18.00 # # B2443 $5.00 # B2468 $5.00 #

B2444 $10.00 # # B2469 $20.00 # # B2444 $5.00 # B2469 $5.00 #

B2445 $10.00 # # B2470 $15.00 # # B2445 $5.00 # B2470 $5.00 #

B2446 $15.00 # # B2471 $15.00 # # B2446 $5.00 # B2471 $5.00 #

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B2472 $15.00 # # B2497 $18.00 # # B2472 $5.00 # B2497 $5.00 #

B2473 $15.00 # # B2498 $15.00 # # B2473 $5.00 # B2498 $5.00 #

B2474 $10.00 # # B2499 $12.00 # # B2474 $5.00 # B2499 $5.00 #

B2475 $10.00 # # B2500 $12.00 # # B2475 $5.00 # B2500 $5.00 #

B2476 $20.00 # # B2501 $15.00 # # B2476 $5.00 # B2501 $5.00 #

B2477 $10.00 # # B2502 $18.00 # # B2477 $5.00 # B2502 $5.00 #

B2478 NADA # # B2503 $20.00 # # B2478 $5.00 # B2503 $5.00 #

B2479 $6.00 # # B2504 $15.00 # # B2479 $5.00 # B2504 $5.00 #

B2480 $6.00 # # B2505 $10.00 # # B2480 $5.00 # B2505 $5.00 #

B2481 $15.00 # # B2506 $15.00 # # B2481 $7.00 # B2506 $15.00 #

B2482 $10.00 # # B2507 $15.00 # # B2482 $10.00 # B2507 $5.00 #

B2483 $15.00 # # B2508 $10.00 # # B2483 $15.00 # B2508 $5.00 #

B2484 $7.00 # # B2509 $10.00 # # B2484 $5.00 # B2509 $5.00 #

B2485 $15.00 # # B2510 $15.00 # # B2485 $5.00 # B2510 $5.00 #

B2486 $18.00 # # B2511 $15.00 # # B2486 $5.00 # B2511 $15.00 #

B2487 $18.00 # # B2512 $10.00 # # B2487 $5.00 # B2512 $5.00 #

B2488 $18.00 # # B2513 $15.00 # # B2488 $5.00 # B2513 $5.00 #

B2489 $18.00 # # B2514 $20.00 # # B2489 $5.00 # B2514 $5.00 #

B2490 $18.00 # # B2515 $15.00 # # B2490 $5.00 # B2515 $5.00 #

B2491 $10.00 # # B2516 $15.00 # # B2491 $5.00 # B2516 $5.00 #

B2492 $18.00 # # B2517 $15.00 # # B2492 $5.00 # B2517 $5.00 #

B2493 $18.00 # # B2518 $15.00 # # B2493 $5.00 # B2518 $5.00 #

B2494 $18.00 # # B2519 $15.00 # # B2494 $5.00 # B2519 $5.00 #

B2495 $12.00 # # B2520 $15.00 # # B2495 $5.00 # B2520 $5.00 #

B2496 $8.00 # # B2521 $15.00 # # B2496 $5.00 # B2521 $15.00 #

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B2522 $15.00 # # B2547 $15.00 # # B2522 $5.00 # B2547 $5.00 #

B2523 $10.00 # # B2548 $20.00 # # B2523 $5.00 # B2548 $5.00 #

B2524 $20.00 # # B2549 $20.00 # # B2524 $5.00 # B2549 $5.00 #

B2525 $15.00 # # B2550 $18.00 # # B2525 $5.00 # B2550 $5.00 #

B2526 $15.00 # # B2551 $15.00 # # B2526 $5.00 # B2551 $5.00 #

B2527 $15.00 # # B2552 $15.00 # # B2527 $5.00 # B2552 $5.00 #

B2528 $12.00 # # B2553 $7.00 # # B2528 $5.00 # B2553 $5.00 #

B2529 $12.00 # # B2554 $20.00 # # B2529 $5.00 # B2554 $5.00 #

B2530 $15.00 # # B2555 $15.00 # # B2530 $5.00 # B2555 $5.00 #

B2531 $12.00 # # B2556 $12.00 # # B2531 $5.00 # B2556 $5.00 #

B2532 $10.00 # # B2557 $15.00 # # B2532 $5.00 # B2557 $5.00 #

B2533 $15.00 # # B2558 $15.00 # # B2533 $5.00 # B2558 $5.00 #

B2534 $15.00 # # B2559 $15.00 # # B2534 $5.00 # B2559 $5.00 #

B2535 $15.00 # # B2560 $15.00 # # B2535 $15.00 # B2560 $5.00 #

B2536 $15.00 # # B2561 $15.00 # # B2536 $5.00 # B2561 $5.00 #

B2537 $12.00 # # B2562 $15.00 # # B2537 $5.00 # B2562 $7.00 #

B2538 $15.00 # # B2563 $12.00 # # B2538 $5.00 # B2563 $5.00 #

B2539 $10.00 # # B2564 $12.00 # # B2539 $5.00 # B2564 $5.00 #

B2540 $15.00 # # B2565 $17.00 # # B2540 $5.00 # B2565 $5.00 #

B2541 $15.00 # # B2566 $20.00 # # B2541 $5.00 # B2566 $5.00 #

B2542 $15.00 # # B2567 $15.00 # # B2542 $5.00 # B2567 $5.00 #

B2543 $15.00 # # B2568 $15.00 # # B2543 $5.00 # B2568 $7.00 #

B2544 $15.00 # # B2569 $10.00 # # B2544 $5.00 # B2569 $5.00 #

B2545 $15.00 # # B2570 $15.00 # # B2545 $5.00 # B2570 $5.00 #

B2546 $15.00 # # B2571 $10.00 # # B2546 $5.00 # B2571 $5.00 #

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B2572 $10.00 # # B2597 $15.00 # # B2572 $5.00 # B2597 $5.00 #

B2573 $12.00 # # B2598 $10.00 # # B2573 $5.00 # B2598 $5.00 #

B2574 $15.00 # # B2599 $15.00 # # B2574 $5.00 # B2599 $5.00 #

B2575 $15.00 # # B2600 $15.00 # # B2575 $5.00 # B2600 $5.00 #

B2576 $20.00 # # B2601 $15.00 # # B2576 $5.00 # B2601 $5.00 #

B2577 $15.00 # # B2602 $15.00 # # B2577 $5.00 # B2602 $5.00 #

B2578 $15.00 # # B2603 $10.00 # # B2578 $5.00 # B2603 $5.00 #

B2579 $15.00 # # B2604 $15.00 # # B2579 $5.00 # B2604 $5.00 #

B2580 $10.00 # # B2605 $15.00 # # B2580 $5.00 # B2605 $5.00 #

B2581 $15.00 # # B2606 $15.00 # # B2581 $5.00 # B2606 $5.00 #

B2582 $15.00 # # B2607 $15.00 # # B2582 $5.00 # B2607 $5.00 #

B2583 $15.00 # # B2608 $15.00 # # B2583 $5.00 # B2608 $5.00 #

B2584 $20.00 # # B2609 $15.00 # # B2584 $5.00 # B2609 $5.00 #

B2585 $15.00 # # B2610 $15.00 # # B2585 $5.00 # B2610 $5.00 #

B2586 $15.00 # # B2611 $15.00 # # B2586 $5.00 # B2611 $5.00 #

B2587 $8.00 # # B2612 $15.00 # # B2587 $5.00 # B2612 $5.00 #

B2588 $8.00 # # B2613 $15.00 # # B2588 $5.00 # B2613 $5.00 #

B2589 $15.00 # # B2614 $15.00 # # B2589 $5.00 # B2614 $5.00 #

B2590 $15.00 # # B2615 $15.00 # # B2590 $5.00 # B2615 $5.00 #

B2591 $15.00 # # B2616 $15.00 # # B2591 $7.00 # B2616 $5.00 #

B2592 $15.00 # # B2617 $15.00 # # B2592 $5.00 # B2617 $5.00 #

B2593 $15.00 # # B2618 $15.00 # # B2593 $7.00 # B2618 $5.00 #

B2594 $15.00 # # B2619 $15.00 # # B2594 $5.00 # B2619 $5.00 #

B2595 $10.00 # # B2620 $15.00 # # B2595 $5.00 # B2620 $5.00 #

B2596 $10.00 # # B2621 $15.00 # # B2596 $5.00 # B2621 $5.00 #

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B2622 $18.00 # # B2647 $15.00 # # B2622 $5.00 # B2647 $5.00 #

B2623 $15.00 # # B2648 $15.00 # # B2623 $5.00 # B2648 $5.00 #

B2624 $15.00 # # B2649 $12.00 # # B2624 $5.00 # B2649 $5.00 #

B2625 $15.00 # # B2650 $15.00 # # B2625 $5.00 # B2650 $15.00 #

B2626 $15.00 # # B2651 $15.00 # # B2626 $5.00 # B2651 $5.00 #

B2627 $15.00 # # B2652 $15.00 # # B2627 $5.00 # B2652 $5.00 #

B2628 $15.00 # # B2653 $15.00 # # B2628 $5.00 # B2653 $5.00 #

B2629 $15.00 # # B2654 $20.00 # # B2629 $5.00 # B2654 $5.00 #

B2630 $10.00 # # B2655 $15.00 # # B2630 $5.00 # B2655 $5.00 #

B2631 $10.00 # # B2656 $15.00 # # B2631 $5.00 # B2656 $5.00 #

B2632 $10.00 # # B2657 $15.00 # # B2632 $5.00 # B2657 $5.00 #

B2633 $15.00 # # B2658 $10.00 # # B2633 $5.00 # B2658 $5.00 #

B2634 $15.00 # # B2659 $15.00 # # B2634 $5.00 # B2659 $5.00 #

B2635 $12.00 # # B2660 NADA # # B2635 $5.00 # B2660 $5.00 #

B2636 $20.00 # # B2661 $15.00 # # B2636 $5.00 # B2661 $5.00 #

B2637 $15.00 # # B2662 $10.00 # # B2637 $5.00 # B2662 $5.00 #

B2638 $12.00 # # B2663 $12.00 # # B2638 $5.00 # B2663 $5.00 #

B2639 $12.00 # # B2664 $12.00 # # B2639 $5.00 # B2664 $5.00 #

B2640 $7.00 # # B2665 $10.00 # # B2640 $5.00 # B2665 $5.00 #

B2641 $15.00 # # B2666 $15.00 # # B2641 $5.00 # B2666 $5.00 #

B2642 $7.00 # # B2667 $15.00 # # B2642 $5.00 # B2667 $5.00 #

B2643 $15.00 # # B2668 $15.00 # # B2643 $5.00 # B2668 $5.00 #

B2644 $15.00 # # B2669 $15.00 # # B2644 $5.00 # B2669 $5.00 #

B2645 $15.00 # # B2670 $10.00 # # B2645 $5.00 # B2670 $5.00 #

B2646 $15.00 # # B2671 $10.00 # # B2646 $5.00 # B2671 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2672 $10.00 # # B2697 $17.00 # # B2672 $5.00 # B2697 $5.00 #

B2673 $15.00 # # B2698 $20.00 # # B2673 $5.00 # B2698 $5.00 #

B2674 $15.00 # # B2699 $15.00 # # B2674 $5.00 # B2699 $5.00 #

B2675 $15.00 # # B2700 $15.00 # # B2675 $5.00 # B2700 $5.00 #

B2676 $15.00 # # B2701 $15.00 # # B2676 $5.00 # B2701 $5.00 #

B2677 $10.00 # # B2702 $15.00 # # B2677 $5.00 # B2702 $5.00 #

B2678 $12.00 # # B2703 $15.00 # # B2678 $5.00 # B2703 $5.00 #

B2679 NADA # # B2704 $15.00 # # B2679 $5.00 # B2704 $5.00 #

B2680 $20.00 # # B2705 $15.00 # # B2680 $5.00 # B2705 $5.00 #

B2681 $15.00 # # B2706 $10.00 # # B2681 $5.00 # B2706 $5.00 #

B2682 $15.00 # # B2707 $15.00 # # B2682 $5.00 # B2707 $5.00 #

B2683 $18.00 # # B2708 $15.00 # # B2683 $5.00 # B2708 $5.00 #

B2684 $15.00 # # B2709 $18.00 # # B2684 $5.00 # B2709 $5.00 #

B2685 $15.00 # # B2710 $15.00 # # B2685 $5.00 # B2710 $5.00 #

B2686 $15.00 # # B2711 $18.00 # # B2686 $5.00 # B2711 $5.00 #

B2687 $15.00 # # B2712 $15.00 # # B2687 $5.00 # B2712 $5.00 #

B2688 $15.00 # # B2713 NADA # # B2688 $5.00 # B2713 $5.00 #

B2689 $12.00 # # B2714 $15.00 # # B2689 $5.00 # B2714 $5.00 #

B2690 $16.00 # # B2715 $15.00 # # B2690 $5.00 # B2715 $5.00 #

B2691 $15.00 # # B2716 $20.00 # # B2691 $5.00 # B2716 $10.00 #

B2692 $10.00 # # B2717 $12.00 # # B2692 $5.00 # B2717 $5.00 #

B2693 $12.00 # # B2718 $20.00 # # B2693 $5.00 # B2718 $20.00 #

B2694 $15.00 # # B2719 NADA # # B2694 $5.00 # B2719 $5.00 #

B2695 $15.00 # # B2720 $15.00 # # B2695 $5.00 # B2720 $5.00 #

B2696 $18.00 # # B2721 $15.00 # # B2696 $5.00 # B2721 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2722 $18.00 # # B2747 $15.00 # # B2722 $5.00 # B2747 $5.00 #

B2723 $15.00 # # B2748 $15.00 # # B2723 $5.00 # B2748 $5.00 #

B2724 $15.00 # # B2749 $12.00 # # B2724 $5.00 # B2749 $5.00 #

B2725 $12.00 # # B2750 $12.00 # # B2725 $5.00 # B2750 $12.00 #

B2726 $15.00 # # B2751 $15.00 # # B2726 $5.00 # B2751 $15.00 #

B2727 $18.00 # # B2752 $12.00 # # B2727 $5.00 # B2752 $12.00 #

B2728 $18.00 # # B2753 $15.00 # # B2728 $5.00 # B2753 $15.00 #

B2729 $10.00 # # B2754 $15.00 # # B2729 $5.00 # B2754 $5.00 #

B2730 $15.00 # # B2755 $10.00 # # B2730 $5.00 # B2755 $5.00 #

B2731 $10.00 # # B2756 $8.00 # # B2731 $5.00 # B2756 $5.00 #

B2732 $15.00 # # B2757 $3.00 # # B2732 $5.00 # B2757 $3.00 #

B2733 NADA # # B2758 $15.00 # # B2733 $5.00 # B2758 $5.00 #

B2734 NADA # # B2759 $15.00 # # B2734 $5.00 # B2759 $5.00 #

B2735 $15.00 # # B2760 $15.00 # # B2735 $5.00 # B2760 $5.00 #

B2736 $15.00 # # B2761 $15.00 # # B2736 $7.00 # B2761 $5.00 #

B2737 $15.00 # # B2762 $15.00 # # B2737 $5.00 # B2762 $5.00 #

B2738 $15.00 # # B2763 $15.00 # # B2738 $5.00 # B2763 $5.00 #

B2739 $15.00 # # B2764 $10.00 # # B2739 $5.00 # B2764 $5.00 #

B2740 $15.00 # # B2765 $15.00 # # B2740 $5.00 # B2765 $7.00 #

B2741 $15.00 # # B2766 $15.00 # # B2741 $5.00 # B2766 $15.00 #

B2742 $15.00 # # B2767 $15.00 # # B2742 $5.00 # B2767 $7.00 #

B2743 $15.00 # # B2768 $12.00 # # B2743 $5.00 # B2768 $5.00 #

B2744 NADA # # B2769 $15.00 # # B2744 NADA # B2769 $7.00 #

B2745 NADA # # B2770 $15.00 # # B2745 NADA # B2770 $7.00 #

B2746 NADA # # B2771 $15.00 # # B2746 NADA # B2771 $7.00 #

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B2772 $15.00 # # B2797 $35.00 # # B2772 $7.00 # B2797 $5.00 #

B2773 $20.00 # # B2798 $12.00 # # B2773 $10.00 # B2798 $5.00 #

B2774 $15.00 # # B2799 $15.00 # # B2774 $5.00 # B2799 $7.00 #

B2775 $10.00 # # B2800 $15.00 # # B2775 $5.00 # B2800 $7.00 #

B2776 $10.00 # # B2801 $15.00 # # B2776 $5.00 # B2801 $7.00 #

B2777 $10.00 # # B2802 $15.00 # # B2777 $5.00 # B2802 $7.00 #

B2778 $10.00 # # B2803 $15.00 # # B2778 $5.00 # B2803 $5.00 #

B2779 $15.00 # # B2804 $12.00 # # B2779 $5.00 # B2804 $5.00 #

B2780 $15.00 # # B2805 $12.00 # # B2780 $5.00 # B2805 $5.00 #

B2781 $15.00 # # B2806 $15.00 # # B2781 $5.00 # B2806 $5.00 #

B2782 $15.00 # # B2807 $12.00 # # B2782 $5.00 # B2807 $5.00 #

B2783 $15.00 # # B2808 $15.00 # # B2783 $7.00 # B2808 $7.00 #

B2784 $15.00 # # B2809 $15.00 # # B2784 $7.00 # B2809 $5.00 #

B2785 $15.00 # # B2810 $15.00 # # B2785 $7.00 # B2810 $5.00 #

B2786 $12.00 # # B2811 $15.00 # # B2786 $5.00 # B2811 $5.00 #

B2787 $15.00 # # B2812 $15.00 # # B2787 $5.00 # B2812 $5.00 #

B2788 $12.00 # # B2813 $15.00 # # B2788 $5.00 # B2813 $5.00 #

B2789 $15.00 # # B2814 $15.00 # # B2789 $5.00 # B2814 $5.00 #

B2790 $10.00 # # B2815 $15.00 # # B2790 $5.00 # B2815 $5.00 #

B2791 $10.00 # # B2816 $15.00 # # B2791 $5.00 # B2816 $5.00 #

B2792 $10.00 # # B2817 $15.00 # # B2792 $5.00 # B2817 $5.00 #

B2793 $15.00 # # B2818 $15.00 # # B2793 $5.00 # B2818 $5.00 #

B2794 $10.00 # # B2819 $15.00 # # B2794 $5.00 # B2819 $5.00 #

B2795 $15.00 # # B2820 $20.00 # # B2795 $7.00 # B2820 $5.00 #

B2796 $10.00 # # B2821 $20.00 # # B2796 $5.00 # B2821 $5.00 #

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B2822 $20.00 # # B2847 $15.00 # # B2822 $5.00 # B2847 $5.00 #

B2823 $10.00 # # B2848 $10.00 # # B2823 $5.00 # B2848 $5.00 #

B2824 $15.00 # # B2849 $15.00 # # B2824 $5.00 # B2849 $5.00 #

B2825 $18.00 # # B2850 $15.00 # # B2825 $5.00 # B2850 $5.00 #

B2826 $15.00 # # B2851 $15.00 # # B2826 $5.00 # B2851 $7.00 #

B2827 $15.00 # # B2852 $15.00 # # B2827 $5.00 # B2852 $5.00 #

B2828 $15.00 # # B2853 $15.00 # # B2828 $5.00 # B2853 $5.00 #

B2829 $15.00 # # B2854 $15.00 # # B2829 $15.00 # B2854 $5.00 #

B2830 $12.00 # # B2855 $10.00 # # B2830 $5.00 # B2855 $5.00 #

B2831 $12.00 # # B2856 $18.00 # # B2831 $5.00 # B2856 $5.00 #

B2832 $12.00 # # B2857 $18.00 # # B2832 $5.00 # B2857 $5.00 #

B2833 $15.00 # # B2858 $15.00 # # B2833 $5.00 # B2858 $5.00 #

B2834 $15.00 # # B2859 $10.00 # # B2834 $5.00 # B2859 $5.00 #

B2835 $15.00 # # B2860 $10.00 # # B2835 $5.00 # B2860 $5.00 #

B2836 $10.00 # # B2861 $15.00 # # B2836 $5.00 # B2861 $5.00 #

B2837 $10.00 # # B2862 $15.00 # # B2837 $5.00 # B2862 $5.00 #

B2838 $15.00 # # B2863 $15.00 # # B2838 $7.00 # B2863 $5.00 #

B2839 $12.00 # # B2864 $15.00 # # B2839 $5.00 # B2864 $5.00 #

B2840 $15.00 # # B2865 $15.00 # # B2840 $5.00 # B2865 $5.00 #

B2841 $15.00 # # B2866 $15.00 # # B2841 $5.00 # B2866 $5.00 #

B2842 $10.00 # # B2867 $10.00 # # B2842 $5.00 # B2867 $5.00 #

B2843 $15.00 # # B2868 $15.00 # # B2843 $5.00 # B2868 $5.00 #

B2844 $12.00 # # B2869 $18.00 # # B2844 $5.00 # B2869 $5.00 #

B2845 $15.00 # # B2870 $12.00 # # B2845 $5.00 # B2870 $5.00 #

B2846 $12.00 # # B2871 $15.00 # # B2846 $5.00 # B2871 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2872 $15.00 # # B2897 $15.00 # # B2872 $5.00 # B2897 $5.00 #

B2873 $15.00 # # B2898 $10.00 # # B2873 $5.00 # B2898 $5.00 #

B2874 $15.00 # # B2899 $15.00 # # B2874 $5.00 # B2899 $7.00 #

B2875 $18.00 # # B2900 $10.00 # # B2875 $5.00 # B2900 $5.00 #

B2876 $3.00 # # B2901 $15.00 # # B2876 $3.00 # B2901 $5.00 #

B2877 $3.00 # # B2902 $15.00 # # B2877 $3.00 # B2902 $5.00 #

B2878 $15.00 # # B2903 $15.00 # # B2878 $5.00 # B2903 $5.00 #

B2879 $12.00 # # B2904 $15.00 # # B2879 $5.00 # B2904 $5.00 #

B2880 $12.00 # # B2905 $15.00 # # B2880 $5.00 # B2905 $5.00 #

B2881 $12.00 # # B2906 $15.00 # # B2881 $5.00 # B2906 $5.00 #

B2882 $10.00 # # B2907 $12.00 # # B2882 $5.00 # B2907 $5.00 #

B2883 $10.00 # # B2908 $10.00 # # B2883 $5.00 # B2908 $5.00 #

B2884 $15.00 # # B2909 $18.00 # # B2884 $5.00 # B2909 $5.00 #

B2885 $10.00 # # B2910 $15.00 # # B2885 $5.00 # B2910 $5.00 #

B2886 $10.00 # # B2911 $15.00 # # B2886 $5.00 # B2911 $5.00 #

B2887 $15.00 # # B2912 $15.00 # # B2887 $5.00 # B2912 $5.00 #

B2888 $15.00 # # B2913 $15.00 # # B2888 $5.00 # B2913 $5.00 #

B2889 $15.00 # # B2914 $18.00 # # B2889 $5.00 # B2914 $5.00 #

B2890 $15.00 # # B2915 $15.00 # # B2890 $5.00 # B2915 $5.00 #

B2891 $10.00 # # B2916 $10.00 # # B2891 $5.00 # B2916 $5.00 #

B2892 $10.00 # # B2917 $15.00 # # B2892 $5.00 # B2917 $5.00 #

B2893 $10.00 # # B2918 $10.00 # # B2893 $5.00 # B2918 $5.00 #

B2894 $15.00 # # B2919 $15.00 # # B2894 $5.00 # B2919 $5.00 #

B2895 $15.00 # # B2920 $3.00 # # B2895 $5.00 # B2920 $3.00 #

B2896 $15.00 # # B2921 $15.00 # # B2896 $5.00 # B2921 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2922 $15.00 # # B2947 $15.00 # # B2922 $5.00 # B2947 $5.00 #

B2923 $15.00 # # B2948 $15.00 # # B2923 $5.00 # B2948 $5.00 #

B2924 $15.00 # # B2949 $15.00 # # B2924 $5.00 # B2949 $5.00 #

B2925 $15.00 # # B2950 $12.00 # # B2925 $5.00 # B2950 $5.00 #

B2926 $15.00 # # B2951 $15.00 # # B2926 $7.00 # B2951 $5.00 #

B2927 $15.00 # # B2952 $15.00 # # B2927 $5.00 # B2952 $5.00 #

B2928 $15.00 # # B2953 $15.00 # # B2928 $5.00 # B2953 $5.00 #

B2929 $15.00 # # B2954 $15.00 # # B2929 $5.00 # B2954 $5.00 #

B2930 $12.00 # # B2955 $10.00 # # B2930 $5.00 # B2955 $5.00 #

B2931 $15.00 # # B2956 $15.00 # # B2931 $5.00 # B2956 $5.00 #

B2932 $15.00 # # B2957 $15.00 # # B2932 $5.00 # B2957 $5.00 #

B2933 $15.00 # # B2958 $12.00 # # B2933 $5.00 # B2958 $5.00 #

B2934 $15.00 # # B2959 $12.00 # # B2934 $5.00 # B2959 $5.00 #

B2935 $15.00 # # B2960 $12.00 # # B2935 $5.00 # B2960 $5.00 #

B2936 $15.00 # # B2961 $10.00 # # B2936 $5.00 # B2961 $5.00 #

B2937 $10.00 # # B2962 $15.00 # # B2937 $5.00 # B2962 $5.00 #

B2938 $12.00 # # B2963 $15.00 # # B2938 $5.00 # B2963 $5.00 #

B2939 $10.00 # # B2964 $15.00 # # B2939 $5.00 # B2964 $5.00 #

B2940 $15.00 # # B2965 $12.00 # # B2940 $5.00 # B2965 $5.00 #

B2941 $15.00 # # B2966 $15.00 # # B2941 $5.00 # B2966 $5.00 #

B2942 $15.00 # # B2967 $15.00 # # B2942 $5.00 # B2967 $5.00 #

B2943 $15.00 # # B2968 $15.00 # # B2943 $5.00 # B2968 $5.00 #

B2944 $15.00 # # B2969 $15.00 # # B2944 $5.00 # B2969 $5.00 #

B2945 $15.00 # # B2970 $12.00 # # B2945 $5.00 # B2970 $5.00 #

B2946 $15.00 # # B2971 $10.00 # # B2946 $5.00 # B2971 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B2972 $15.00 # # B2997 $20.00 # # B2972 $5.00 # B2997 $5.00 #

B2973 $20.00 # # B2998 $15.00 # # B2973 $5.00 # B2998 $5.00 #

B2974 $15.00 # # B2999 $15.00 # # B2974 $5.00 # B2999 $7.00 #

B2975 $15.00 # # B3000 $15.00 # # B2975 $5.00 # B3000 $5.00 #

B2976 $15.00 # # B3001 $15.00 # # B2976 $5.00 # B3001 $5.00 #

B2977 $15.00 # # B3002 $15.00 # # B2977 $5.00 # B3002 $5.00 #

B2978 $10.00 # # B3003 $15.00 # # B2978 $5.00 # B3003 $5.00 #

B2979 $15.00 # # B3004 $15.00 # # B2979 $5.00 # B3004 $5.00 #

B2980 $15.00 # # B3005 $18.00 # # B2980 $5.00 # B3005 $5.00 #

B2981 $12.00 # # B3006 $18.00 # # B2981 # B3006 $5.00 #

B2982 $12.00 # # B3007 $15.00 # # B2982 # B3007 $5.00 #

B2983 $12.00 # # B3008 $15.00 # # B2983 $5.00 # B3008 $5.00 #

B2984 $10.00 # # B3009 $12.00 # # B2984 $5.00 # B3009 $5.00 #

B2985 $15.00 # # B3010 $8.00 # # B2985 $5.00 # B3010 $5.00 #

B2986 $15.00 # # B3011 $10.00 # # B2986 $5.00 # B3011 $5.00 #

B2987 $15.00 # # B3012 $12.00 # # B2987 $5.00 # B3012 $5.00 #

B2988 $15.00 # # B3013 $12.00 # # B2988 $5.00 # B3013 $5.00 #

B2989 $15.00 # # B3014 $15.00 # # B2989 $5.00 # B3014 $5.00 #

B2990 $15.00 # # B3015 NADA # # B2990 $5.00 # B3015 NADA #

B2991 $8.00 # # B3016 $15.00 # # B2991 $5.00 # B3016 $7.00 #

B2992 $12.00 # # B3017 $15.00 # # B2992 $5.00 # B3017 $5.00 #

B2993 $8.00 # # B3018 $15.00 # # B2993 $5.00 # B3018 $5.00 #

B2994 $18.00 # # B3019 $12.00 # # B2994 $5.00 # B3019 $5.00 #

B2995 $15.00 # # B3020 $12.00 # # B2995 $5.00 # B3020 $5.00 #

B2996 $12.00 # # B3021 $12.00 # # B2996 $5.00 # B3021 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3022 $12.00 # # B3047 $15.00 # # B3022 $5.00 # B3047 $5.00 #

B3023 $12.00 # # B3048 $15.00 # # B3023 $5.00 # B3048 $5.00 #

B3024 $12.00 # # B3049 $10.00 # # B3024 $5.00 # B3049 $5.00 #

B3025 $15.00 # # B3050 $15.00 # # B3025 $5.00 # B3050 $5.00 #

B3026 $15.00 # # B3051 $15.00 # # B3026 $5.00 # B3051 $5.00 #

B3027 $15.00 # # B3052 $15.00 # # B3027 $5.00 # B3052 $5.00 #

B3028 $15.00 # # B3053 $12.00 # # B3028 $5.00 # B3053 $5.00 #

B3029 $20.00 # # B3054 $15.00 # # B3029 $5.00 # B3054 $5.00 #

B3030 $15.00 # # B3055 $15.00 # # B3030 $5.00 # B3055 $5.00 #

B3031 NADA # # B3056 $15.00 # # B3031 $5.00 # B3056 $5.00 #

B3032 NADA # # B3057 $15.00 # # B3032 $5.00 # B3057 $5.00 #

B3033 $15.00 # # B3058 $10.00 # # B3033 $5.00 # B3058 $5.00 #

B3034 $10.00 # # B3059 $12.00 # # B3034 $5.00 # B3059 $5.00 #

B3035 $10.00 # # B3060 $15.00 # # B3035 $5.00 # B3060 $5.00 #

B3036 $20.00 # # B3061 $15.00 # # B3036 $5.00 # B3061 $5.00 #

B3037 $20.00 # # B3062 $20.00 # # B3037 $5.00 # B3062 $5.00 #

B3038 $15.00 # # B3063 $7.00 # # B3038 $5.00 # B3063 $5.00 #

B3039 $10.00 # # B3064 $7.00 # # B3039 $5.00 # B3064 $5.00 #

B3040 $10.00 # # B3065 $15.00 # # B3040 $5.00 # B3065 $5.00 #

B3041 $12.00 # # B3066 $15.00 # # B3041 $5.00 # B3066 $5.00 #

B3042 $12.00 # # B3067 $15.00 # # B3042 $5.00 # B3067 $5.00 #

B3043 $10.00 # # B3068 NADA # # B3043 $5.00 # B3068 NADA #

B3044 $10.00 # # B3069 $10.00 # # B3044 $5.00 # B3069 $10.00 #

B3045 $15.00 # # B3070 $10.00 # # B3045 $5.00 # B3070 $10.00 #

B3046 $15.00 # # B3071 $10.00 # # B3046 $5.00 # B3071 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3072 $10.00 # # B3097 $10.00 # # B3072 $5.00 # B3097 $5.00 #

B3073 $10.00 # # B3098 NADA # # B3073 $5.00 # B3098 NADA #

B3074 $15.00 # # B3099 NADA # # B3074 $5.00 # B3099 NADA #

B3075 $15.00 # # B3100 $15.00 # # B3075 $5.00 # B3100 $5.00 #

B3076 $7.00 # # B3101 $10.00 # # B3076 $7.00 # B3101 $5.00 #

B3077 $7.00 # # B3102 $10.00 # # B3077 $7.00 # B3102 $5.00 #

B3078 $10.00 # # B3103 $15.00 # # B3078 $5.00 # B3103 $5.00 #

B3079 $15.00 # # B3104 $15.00 # # B3079 $5.00 # B3104 $5.00 #

B3080 $17.00 # # B3105 $15.00 # # B3080 $5.00 # B3105 $5.00 #

B3081 $10.00 # # B3106 $15.00 # # B3081 NADA # B3106 $15.00 #

B3082 $7.00 # # B3107 $12.00 # # B3082 $5.00 # B3107 $5.00 #

B3083 $7.00 # # B3108 $7.00 # # B3083 $5.00 # B3108 $5.00 #

B3084 $15.00 # # B3109 $10.00 # # B3084 $5.00 # B3109 $5.00 #

B3085 $10.00 # # B3110 $15.00 # # B3085 $5.00 # B3110 $5.00 #

B3086 $6.00 # # B3111 $20.00 # # B3086 $5.00 # B3111 $5.00 #

B3087 $15.00 # # B3112 $20.00 # # B3087 $5.00 # B3112 $5.00 #

B3088 $15.00 # # B3113 $10.00 # # B3088 $5.00 # B3113 $5.00 #

B3089 $15.00 # # B3114 $5.00 # # B3089 $5.00 # B3114 $5.00 #

B3090 $5.00 # # B3115 $5.00 # # B3090 $5.00 # B3115 $5.00 #

B3091 $20.00 # # B3116 $15.00 # # B3091 $5.00 # B3116 $5.00 #

B3092 $15.00 # # B3117 $10.00 # # B3092 $5.00 # B3117 $5.00 #

B3093 $7.00 # # B3118 $10.00 # # B3093 $7.00 # B3118 $5.00 #

B3094 $7.00 # # B3119 $10.00 # # B3094 $5.00 # B3119 $5.00 #

B3095 NADA # # B3120 $15.00 # # B3095 NADA # B3120 $15.00 #

B3096 NADA # # B3121 NADA # # B3096 NADA # B3121 NADA #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3122 $10.00 # # B3147 $15.00 # # B3122 $5.00 # B3147 $15.00 #

B3123 $7.00 # # B3148 $10.00 # # B3123 $5.00 # B3148 $10.00 #

B3124 $7.00 # # B3149 $10.00 # # B3124 NADA # B3149 $5.00 #

B3125 $20.00 # # B3150 $12.00 # # B3125 $10.00 # B3150 $5.00 #

B3126 $12.00 # # B3151 $12.00 # # B3126 $5.00 # B3151 $5.00 #

B3127 NADA # # B3152 $15.00 # # B3127 $5.00 # B3152 NADA #

B3128 $15.00 # # B3153 $15.00 # # B3128 $5.00 # B3153 $5.00 #

B3129 $10.00 # # B3154 $7.00 # # B3129 $5.00 # B3154 $5.00 #

B3130 $10.00 # # B3155 $18.00 # # B3130 $5.00 # B3155 $5.00 #

B3131 $15.00 # # B3156 $20.00 # # B3131 $5.00 # B3156 $5.00 #

B3132 $15.00 # # B3157 $15.00 # # B3132 $5.00 # B3157 $5.00 #

B3133 $10.00 # # B3158 $15.00 # # B3133 $5.00 # B3158 $0.00 #

B3134 $12.00 # # B3159 $15.00 # # B3134 $6.50 # B3159 $0.00 #

B3135 $12.00 # # B3160 $15.00 # # B3135 $6.50 # B3160 $5.00 #

B3136 $10.00 # # B3161 $12.00 # # B3136 NADA # B3161 $5.00 #

B3137 $7.00 # # B3162 $10.00 # # B3137 $5.00 # B3162 $5.00 #

B3138 $5.00 # # B3163 $15.00 # # B3138 $5.00 # B3163 $5.00 #

B3139 $0.00 # # B3164 $15.00 # # B3139 $20.00 # B3164 $5.00 #

B3140 $0.00 # # B3165 $15.00 # # B3140 $20.00 # B3165 $5.00 #

B3141 $20.00 # # B3166 $10.00 # # B3141 NADA # B3166 $5.00 #

B3142 $20.00 # # B3167 $15.00 # # B3142 NADA # B3167 $5.00 #

B3143 $20.00 # # B3168 $10.00 # # B3143 $20.00 # B3168 $5.00 #

B3144 $15.00 # # B3169 $15.00 # # B3144 $5.00 # B3169 $5.00 #

B3145 $15.00 # # B3170 $15.00 # # B3145 $5.00 # B3170 $5.00 #

B3146 $10.00 # # B3171 $10.00 # # B3146 $5.00 # B3171 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3172 $15.00 # # B3197 $10.00 # # B3172 $5.00 # B3197 $5.00 #

B3173 $15.00 # # B3198 $10.00 # # B3173 $5.00 # B3198 $5.00 #

B3174 $12.00 # # B3199 $12.00 # # B3174 $5.00 # B3199 $5.00 #

B3175 $10.00 # # B3200 $15.00 # # B3175 $5.00 # B3200 $5.00 #

B3176 $15.00 # # B3201 $15.00 # # B3176 $5.00 # B3201 $5.00 #

B3177 $10.00 # # B3202 $15.00 # # B3177 $5.00 # B3202 $0.00 #

B3178 $10.00 # # B3203 $7.00 # # B3178 $5.00 # B3203 $5.00 #

B3179 $12.00 # # B3204 $12.00 # # B3179 $5.00 # B3204 $5.00 #

B3180 $10.00 # # B3205 $18.00 # # B3180 $5.00 # B3205 $5.00 #

B3181 $15.00 # # B3206 $15.00 # # B3181 $5.00 # B3206 $5.00 #

B3182 $10.00 # # B3207 $10.00 # # B3182 $5.00 # B3207 $5.00 #

B3183 $10.00 # # B3208 $12.00 # # B3183 $5.00 # B3208 $5.00 #

B3184 $12.00 # # B3209 $10.00 # # B3184 $5.00 # B3209 $5.00 #

B3185 $10.00 # # B3210 $20.00 # # B3185 $5.00 # B3210 $5.00 #

B3186 $12.00 # # B3211 $15.00 # # B3186 $5.00 # B3211 $5.00 #

B3187 $10.00 # # B3212 $15.00 # # B3187 $5.00 # B3212 $5.00 #

B3188 $10.00 # # B3213 $12.00 # # B3188 $5.00 # B3213 $5.00 #

B3189 $12.00 # # B3214 $15.00 # # B3189 $5.00 # B3214 $5.00 #

B3190 $12.00 # # B3215 $15.00 # # B3190 $5.00 # B3215 $7.00 #

B3191 $12.00 # # B3216 $22.00 # # B3191 $5.00 # B3216 $5.00 #

B3192 $10.00 # # B3217 $10.00 # # B3192 $5.00 # B3217 $5.00 #

B3193 $15.00 # # B3218 $15.00 # # B3193 $5.00 # B3218 $7.00 #

B3194 $15.00 # # B3219 $12.00 # # B3194 $5.00 # B3219 $5.00 #

B3195 $10.00 # # B3220 $12.00 # # B3195 $5.00 # B3220 $5.00 #

B3196 $15.00 # # B3221 $15.00 # # B3196 $5.00 # B3221 $7.00 #

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B3222 $15.00 # # B3247 $15.00 # # B3222 $5.00 # B3247 $5.00 #

B3223 $15.00 # # B3248 $15.00 # # B3223 $5.00 # B3248 $5.00 #

B3224 $10.00 # # B3249 $0.00 # # B3224 $5.00 # B3249 $20.00 #

B3225 $10.00 # # B3250 $15.00 # # B3225 $5.00 # B3250 $5.00 #

B3226 $10.00 # # B3251 $15.00 # # B3226 $5.00 # B3251 $5.00 #

B3227 $12.00 # # B3252 $15.00 # # B3227 $5.00 # B3252 $5.00 #

B3228 $3.00 # # B3253 $15.00 # # B3228 $5.00 # B3253 $5.00 #

B3229 $12.00 # # B3254 NADA # # B3229 $5.00 # B3254 $5.00 #

B3230 $12.00 # # B3255 $15.00 # # B3230 $5.00 # B3255 $5.00 #

B3231 $12.00 # # B3256 $12.00 # # B3231 $5.00 # B3256 $5.00 #

B3232 $12.00 # # B3257 $12.00 # # B3232 $5.00 # B3257 $5.00 #

B3233 $20.00 # # B3258 $15.00 # # B3233 $5.00 # B3258 $5.00 #

B3234 $12.00 # # B3259 $15.00 # # B3234 $5.00 # B3259 $5.00 #

B3235 $20.00 # # B3260 NADA # # B3235 $5.00 # B3260 $5.00 #

B3236 $20.00 # # B3261 $15.00 # # B3236 $5.00 # B3261 $5.00 #

B3237 $15.00 # # B3262 $15.00 # # B3237 $5.00 # B3262 $5.00 #

B3238 $15.00 # # B3263 $15.00 # # B3238 $5.00 # B3263 $5.00 #

B3239 $5.00 # # B3264 $15.00 # # B3239 $5.00 # B3264 $5.00 #

B3240 $15.00 # # B3265 $15.00 # # B3240 $5.00 # B3265 $5.00 #

B3241 $10.00 # # B3266 $12.00 # # B3241 $5.00 # B3266 $5.00 #

B3242 $15.00 # # B3267 $12.00 # # B3242 $5.00 # B3267 $5.00 #

B3243 $15.00 # # B3268 $0.00 # # B3243 $5.00 # B3268 $20.00 #

B3244 $12.00 # # B3269 $15.00 # # B3244 $5.00 # B3269 $5.00 #

B3245 $15.00 # # B3270 $15.00 # # B3245 $5.00 # B3270 $5.00 #

B3246 $15.00 # # B3271 $12.00 # # B3246 $5.00 # B3271 $5.00 #

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B3272 $15.00 # # B3297 $10.00 # # B3272 $5.00 # B3297 $5.00 #

B3273 $15.00 # # B3298 NADA # # B3273 $5.00 # B3298 NADA #

B3274 $15.00 # # B3299 $10.00 # # B3274 $5.00 # B3299 $5.00 #

B3275 $15.00 # # B3300 $10.00 # # B3275 $5.00 # B3300 $5.00 #

B3276 $10.00 # # B3301 $15.00 # # B3276 $5.00 # B3301 $5.00 #

B3277 $15.00 # # B3302 $12.00 # # B3277 $5.00 # B3302 $5.00 #

B3278 $5.00 # # B3303 $12.00 # # B3278 $5.00 # B3303 $5.00 #

B3279 $5.00 # # B3304 $10.00 # # B3279 $5.00 # B3304 $5.00 #

B3280 $15.00 # # B3305 $15.00 # # B3280 $5.00 # B3305 $5.00 #

B3281 $15.00 # # B3306 $10.00 # # B3281 $5.00 # B3306 $5.00 #

B3282 $10.00 # # B3307 $12.00 # # B3282 $5.00 # B3307 $5.00 #

B3283 $10.00 # # B3308 $12.00 # # B3283 $5.00 # B3308 $5.00 #

B3284 $15.00 # # B3309 $15.00 # # B3284 $5.00 # B3309 $5.00 #

B3285 $10.00 # # B3310 NADA # # B3285 $5.00 # B3310 $5.00 #

B3286 $20.00 # # B3311 $15.00 # # B3286 $5.00 # B3311 $5.00 #

B3287 $15.00 # # B3312 $15.00 # # B3287 $5.00 # B3312 $5.00 #

B3288 $15.00 # # B3313 $12.00 # # B3288 $5.00 # B3313 $5.00 #

B3289 $15.00 # # B3314 $12.00 # # B3289 $5.00 # B3314 $5.00 #

B3290 $12.00 # # B3315 $12.00 # # B3290 $5.00 # B3315 $5.00 #

B3291 $15.00 # # B3316 $12.00 # # B3291 $7.00 # B3316 $5.00 #

B3292 $12.00 # # B3317 $10.00 # # B3292 $5.00 # B3317 $5.00 #

B3293 $10.00 # # B3318 $10.00 # # B3293 $5.00 # B3318 $5.00 #

B3294 $10.00 # # B3319 $15.00 # # B3294 $5.00 # B3319 $5.00 #

B3295 $15.00 # # B3320 $15.00 # # B3295 $5.00 # B3320 $5.00 #

B3296 $12.00 # # B3321 $15.00 # # B3296 $5.00 # B3321 $5.00 #

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B3322 $18.00 # # B3347 $15.00 # # B3322 $5.00 # B3347 $5.00 #

B3323 $15.00 # # B3348 $15.00 # # B3323 $7.00 # B3348 $5.00 #

B3324 $15.00 # # B3349 $15.00 # # B3324 $5.00 # B3349 $5.00 #

B3325 $10.00 # # B3350 $15.00 # # B3325 $5.00 # B3350 $5.00 #

B3326 $7.00 # # B3351 $10.00 # # B3326 $5.00 # B3351 $5.00 #

B3327 $15.00 # # B3352 $15.00 # # B3327 $5.00 # B3352 $5.00 #

B3328 $15.00 # # B3353 $15.00 # # B3328 $5.00 # B3353 $5.00 #

B3329 $15.00 # # B3354 $10.00 # # B3329 $5.00 # B3354 $5.00 #

B3330 $15.00 # # B3355 $12.00 # # B3330 $5.00 # B3355 $5.00 #

B3331 $10.00 # # B3356 $15.00 # # B3331 $5.00 # B3356 $5.00 #

B3332 $15.00 # # B3357 $15.00 # # B3332 $5.00 # B3357 $5.00 #

B3333 $10.00 # # B3358 $15.00 # # B3333 $5.00 # B3358 $5.00 #

B3334 $15.00 # # B3359 $15.00 # # B3334 $5.00 # B3359 $5.00 #

B3335 $15.00 # # B3360 $15.00 # # B3335 $5.00 # B3360 $5.00 #

B3336 $15.00 # # B3361 $8.00 # # B3336 $5.00 # B3361 $5.00 #

B3337 $10.00 # # B3362 $15.00 # # B3337 $5.00 # B3362 $5.00 #

B3338 $15.00 # # B3363 $15.00 # # B3338 $5.00 # B3363 $5.00 #

B3339 $10.00 # # B3364 $15.00 # # B3339 $5.00 # B3364 $5.00 #

B3340 $10.00 # # B3365 $15.00 # # B3340 $5.00 # B3365 $5.00 #

B3341 $15.00 # # B3366 $15.00 # # B3341 $5.00 # B3366 $5.00 #

B3342 $10.00 # # B3367 $15.00 # # B3342 $5.00 # B3367 $5.00 #

B3343 $15.00 # # B3368 $12.00 # # B3343 $5.00 # B3368 $5.00 #

B3344 $15.00 # # B3369 $12.00 # # B3344 $5.00 # B3369 $5.00 #

B3345 $15.00 # # B3370 $7.00 # # B3345 $5.00 # B3370 $7.00 #

B3346 $15.00 # # B3371 $15.00 # # B3346 $5.00 # B3371 $5.00 #

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B3372 $12.00 # # B3397 $15.00 # # B3372 $5.00 # B3397 $5.00 #

B3373 $15.00 # # B3398 $15.00 # # B3373 $5.00 # B3398 $5.00 #

B3374 $15.00 # # B3399 $15.00 # # B3374 $5.00 # B3399 $5.00 #

B3375 $15.00 # # B3400 $10.00 # # B3375 $5.00 # B3400 $5.00 #

B3376 $15.00 # # B3401 $10.00 # # B3376 $5.00 # B3401 $10.00 #

B3377 $10.00 # # B3402 $15.00 # # B3377 $5.00 # B3402 $5.00 #

B3378 $20.00 # # B3403 $15.00 # # B3378 $5.00 # B3403 $5.00 #

B3379 $15.00 # # B3404 $15.00 # # B3379 $5.00 # B3404 $5.00 #

B3380 $15.00 # # B3405 $10.00 # # B3380 $5.00 # B3405 $5.00 #

B3381 $15.00 # # B3406 $15.00 # # B3381 $5.00 # B3406 $7.00 #

B3382 $10.00 # # B3407 $15.00 # # B3382 $5.00 # B3407 $5.00 #

B3383 $10.00 # # B3408 $15.00 # # B3383 $5.00 # B3408 $5.00 #

B3384 $10.00 # # B3409 $15.00 # # B3384 $5.00 # B3409 $5.00 #

B3385 $15.00 # # B3410 $15.00 # # B3385 $5.00 # B3410 $5.00 #

B3386 $10.00 # # B3411 $10.00 # # B3386 $5.00 # B3411 $7.00 #

B3387 $10.00 # # B3412 $15.00 # # B3387 $10.00 # B3412 $5.00 #

B3388 $12.00 # # B3413 $15.00 # # B3388 $12.00 # B3413 $5.00 #

B3389 $10.00 # # B3414 $10.00 # # B3389 $10.00 # B3414 $5.00 #

B3390 $15.00 # # B3415 $15.00 # # B3390 $5.00 # B3415 $5.00 #

B3391 $15.00 # # B3416 $20.00 # # B3391 $5.00 # B3416 $5.00 #

B3392 $15.00 # # B3417 $15.00 # # B3392 $5.00 # B3417 $5.00 #

B3393 $10.00 # # B3418 $12.00 # # B3393 $5.00 # B3418 $5.00 #

B3394 $15.00 # # B3419 $12.00 # # B3394 $5.00 # B3419 $5.00 #

B3395 $10.00 # # B3420 $15.00 # # B3395 $5.00 # B3420 $5.00 #

B3396 $15.00 # # B3421 $15.00 # # B3396 $5.00 # B3421 $5.00 #

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B3422 $15.00 # # B3447 $12.00 # # B3422 $5.00 # B3447 $5.00 #

B3423 $15.00 # # B3448 $12.00 # # B3423 $5.00 # B3448 $5.00 #

B3424 $15.00 # # B3449 $15.00 # # B3424 $5.00 # B3449 $5.00 #

B3425 $7.00 # # B3450 $10.00 # # B3425 $7.00 # B3450 $7.00 #

B3426 $10.00 # # B3451 $15.00 # # B3426 $5.00 # B3451 $7.00 #

B3427 $15.00 # # B3452 $12.00 # # B3427 $5.00 # B3452 $5.00 #

B3428 $15.00 # # B3453 $15.00 # # B3428 $5.00 # B3453 $7.00 #

B3429 $15.00 # # B3454 $10.00 # # B3429 $5.00 # B3454 $7.00 #

B3430 $10.00 # # B3455 $10.00 # # B3430 $5.00 # B3455 $7.00 #

B3431 $15.00 # # B3456 $15.00 # # B3431 $5.00 # B3456 $5.00 #

B3432 $15.00 # # B3457 $15.00 # # B3432 $5.00 # B3457 $7.00 #

B3433 $18.00 # # B3458 $15.00 # # B3433 $5.00 # B3458 $7.00 #

B3434 $18.00 # # B3459 $10.00 # # B3434 $5.00 # B3459 $7.00 #

B3435 $15.00 # # B3460 $12.00 # # B3435 $5.00 # B3460 $5.00 #

B3436 $15.00 # # B3461 $12.00 # # B3436 $15.00 # B3461 $5.00 #

B3437 $12.00 # # B3462 $15.00 # # B3437 $5.00 # B3462 $5.00 #

B3438 $12.00 # # B3463 NADA # # B3438 $5.00 # B3463 NADA #

B3439 $15.00 # # B3464 $12.00 # # B3439 $5.00 # B3464 $5.00 #

B3440 $15.00 # # B3465 $10.00 # # B3440 $5.00 # B3465 $5.00 #

B3441 $18.00 # # B3466 $18.00 # # B3441 $5.00 # B3466 $5.00 #

B3442 $15.00 # # B3467 $15.00 # # B3442 $7.00 # B3467 $5.00 #

B3443 $20.00 # # B3468 $15.00 # # B3443 $15.00 # B3468 $5.00 #

B3444 $20.00 # # B3469 $15.00 # # B3444 $15.00 # B3469 $7.00 #

B3445 $15.00 # # B3470 $10.00 # # B3445 $5.00 # B3470 $5.00 #

B3446 $15.00 # # B3471 $15.00 # # B3446 $5.00 # B3471 $7.00 #

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B3472 $15.00 # # B3497 $15.00 # # B3472 $7.00 # B3497 $5.00 #

B3473 $12.00 # # B3498 $10.00 # # B3473 $5.00 # B3498 $10.00 #

B3474 $18.00 # # B3499 $15.00 # # B3474 $5.00 # B3499 $5.00 #

B3475 $15.00 # # B3500 $15.00 # # B3475 $5.00 # B3500 $7.00 #

B3476 $15.00 # # B3501 $15.00 # # B3476 $5.00 # B3501 $5.00 #

B3477 $10.00 # # B3502 $15.00 # # B3477 $5.00 # B3502 $5.00 #

B3478 $15.00 # # B3503 $10.00 # # B3478 $5.00 # B3503 $5.00 #

B3479 $12.00 # # B3504 $15.00 # # B3479 $5.00 # B3504 $5.00 #

B3480 $15.00 # # B3505 $10.00 # # B3480 $5.00 # B3505 $7.00 #

B3481 $15.00 # # B3506 $15.00 # # B3481 $5.00 # B3506 $7.00 #

B3482 $20.00 # # B3507 $15.00 # # B3482 $5.00 # B3507 $5.00 #

B3483 NADA # # B3508 $15.00 # # B3483 $5.00 # B3508 $5.00 #

B3484 NADA # # B3509 $15.00 # # B3484 $5.00 # B3509 $7.00 #

B3485 $20.00 # # B3510 $15.00 # # B3485 $5.00 # B3510 $5.00 #

B3486 NADA # # B3511 $15.00 # # B3486 $5.00 # B3511 $5.00 #

B3487 NADA # # B3512 $12.00 # # B3487 $5.00 # B3512 $5.00 #

B3488 $20.00 # # B3513 $15.00 # # B3488 $10.00 # B3513 $5.00 #

B3489 $20.00 # # B3514 $10.00 # # B3489 $10.00 # B3514 $7.00 #

B3490 $15.00 # # B3515 $15.00 # # B3490 $5.00 # B3515 $5.00 #

B3491 $15.00 # # B3516 $10.00 # # B3491 $5.00 # B3516 $5.00 #

B3492 $15.00 # # B3517 $10.00 # # B3492 $5.00 # B3517 $7.00 #

B3493 $10.00 # # B3518 $10.00 # # B3493 $10.00 # B3518 $7.00 #

B3494 $15.00 # # B3519 $12.00 # # B3494 $15.00 # B3519 $15.00 #

B3495 $15.00 # # B3520 $12.00 # # B3495 $5.00 # B3520 $15.00 #

B3496 $10.00 # # B3521 $15.00 # # B3496 $7.00 # B3521 $5.00 #

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B3522 $12.00 # # B3547 $10.00 # # B3522 $5.00 # B3547 $10.00 #

B3523 $7.00 # # B3548 NADA # # B3523 $5.00 # B3548 NADA #

B3524 $15.00 # # B3549 $10.00 # # B3524 $5.00 # B3549 $5.00 #

B3525 $15.00 # # B3550 $10.00 # # B3525 $5.00 # B3550 $5.00 #

B3526 $10.00 # # B3551 $10.00 # # B3526 $5.00 # B3551 $5.00 #

B3527 $15.00 # # B3552 $10.00 # # B3527 $5.00 # B3552 $5.00 #

B3528 $12.00 # # B3553 $10.00 # # B3528 $5.00 # B3553 $5.00 #

B3529 $15.00 # # B3554 $10.00 # # B3529 $7.00 # B3554 $5.00 #

B3530 $15.00 # # B3555 $10.00 # # B3530 $5.00 # B3555 $5.00 #

B3531 $10.00 # # B3556 $15.00 # # B3531 $5.00 # B3556 $5.00 #

B3532 $18.00 # # B3557 $15.00 # # B3532 $5.00 # B3557 $5.00 #

B3533 $12.00 # # B3558 $20.00 # # B3533 $5.00 # B3558 $20.00 #

B3534 $12.00 # # B3559 $15.00 # # B3534 $5.00 # B3559 $5.00 #

B3535 $12.00 # # B3560 $18.00 # # B3535 $5.00 # B3560 $5.00 #

B3536 $15.00 # # B3561 $18.00 # # B3536 $5.00 # B3561 $5.00 #

B3537 $12.00 # # B3562 $15.00 # # B3537 $5.00 # B3562 $5.00 #

B3538 $15.00 # # B3563 $15.00 # # B3538 $5.00 # B3563 $5.00 #

B3539 $10.00 # # B3564 $12.00 # # B3539 NADA # B3564 $5.00 #

B3540 $10.00 # # B3565 $12.00 # # B3540 NADA # B3565 NADA #

B3541 $10.00 # # B3566 $15.00 # # B3541 NADA # B3566 $5.00 #

B3542 $7.00 # # B3567 $10.00 # # B3542 $7.00 # B3567 $5.00 #

B3543 $10.00 # # B3568 $15.00 # # B3543 $5.00 # B3568 $5.00 #

B3544 $10.00 # # B3569 $10.00 # # B3544 $10.00 # B3569 $5.00 #

B3545 $7.00 # # B3570 $12.00 # # B3545 $7.00 # B3570 $5.00 #

B3546 $12.00 # # B3571 $12.00 # # B3546 $5.00 # B3571 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3572 $12.00 # # B3597 $12.00 # # B3572 $5.00 # B3597 $5.00 #

B3573 $12.00 # # B3598 $15.00 # # B3573 $5.00 # B3598 $5.00 #

B3574 $15.00 # # B3599 $10.00 # # B3574 $5.00 # B3599 $5.00 #

B3575 $10.00 # # B3600 $10.00 # # B3575 $5.00 # B3600 $5.00 #

B3576 $10.00 # # B3601 $10.00 # # B3576 $5.00 # B3601 $5.00 #

B3577 $10.00 # # B3602 $10.00 # # B3577 $5.00 # B3602 $5.00 #

B3578 $8.00 # # B3603 $15.00 # # B3578 $5.00 # B3603 $5.00 #

B3579 $10.00 # # B3604 $12.00 # # B3579 $10.00 # B3604 $5.00 #

B3580 $12.00 # # B3605 $12.00 # # B3580 $5.00 # B3605 $5.00 #

B3581 $5.00 # # B3606 $10.00 # # B3581 $5.00 # B3606 $5.00 #

B3582 $10.00 # # B3607 $8.00 # # B3582 $10.00 # B3607 $5.00 #

B3583 $7.00 # # B3609 $10.00 # # B3583 $7.00 # B3609 $5.00 #

B3584 $10.00 # # B3610 $18.00 # # B3584 NADA # B3610 $18.00 #

B3585 $10.00 # # B3611 $12.00 # # B3585 NADA # B3611 $5.00 #

B3586 $10.00 # # B3612 $12.00 # # B3586 NADA # B3612 $5.00 #

B3587 $12.00 # # B3613 $15.00 # # B3587 $6.50 # B3613 $5.00 #

B3588 $10.00 # # B3614 $15.00 # # B3588 $5.00 # B3614 $5.00 #

B3589 $12.00 # # B3615 $12.00 # # B3589 $5.00 # B3615 $5.00 #

B3590 $5.00 # # B3616 $18.00 # # B3590 $5.00 # B3616 $5.00 #

B3591 $15.00 # # B3617 $15.00 # # B3591 $5.00 # B3617 $15.00 #

B3592 $10.00 # # B3618 $10.00 # # B3592 $10.00 # B3618 $5.00 #

B3593 $5.00 # # B3619 $15.00 # # B3593 $5.00 # B3619 $5.00 #

B3594 $15.00 # # B3620 $15.00 # # B3594 $5.00 # B3620 $5.00 #

B3595 $12.00 # # B3621 $6.00 # # B3595 $5.00 # B3621 $5.00 #

B3596 $10.00 # # B3622 $10.00 # # B3596 $5.00 # B3622 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3623 $15.00 # # B3648 $15.00 # # B3623 $5.00 # B3648 $5.00 #

B3624 $15.00 # # B3649 $8.00 # # B3624 $5.00 # B3649 $5.00 #

B3625 $15.00 # # B3650 $15.00 # # B3625 $5.00 # B3650 $5.00 #

B3626 $15.00 # # B3651 $15.00 # # B3626 $5.00 # B3651 $5.00 #

B3627 $15.00 # # B3652 $15.00 # # B3627 $5.00 # B3652 $5.00 #

B3628 $15.00 # # B3653 $15.00 # # B3628 $5.00 # B3653 $5.00 #

B3629 $15.00 # # B3654 $10.00 # # B3629 $5.00 # B3654 $5.00 #

B3630 $15.00 # # B3655 $15.00 # # B3630 $5.00 # B3655 $5.00 #

B3631 $12.00 # # B3656 $12.00 # # B3631 $5.00 # B3656 $5.00 #

B3632 $12.00 # # B3657 $10.00 # # B3632 $5.00 # B3657 $5.00 #

B3633 $12.00 # # B3658 $15.00 # # B3633 $5.00 # B3658 $5.00 #

B3634 $12.00 # # B3659 $15.00 # # B3634 $5.00 # B3659 $5.00 #

B3635 $15.00 # # B3660 $15.00 # # B3635 $5.00 # B3660 $5.00 #

B3636 $10.00 # # B3661 $10.00 # # B3636 $5.00 # B3661 $5.00 #

B3637 $8.00 # # B3662 $10.00 # # B3637 $5.00 # B3662 $5.00 #

B3638 $15.00 # # B3663 $10.00 # # B3638 $5.00 # B3663 $5.00 #

B3639 $15.00 # # B3664 $10.00 # # B3639 $5.00 # B3664 $5.00 #

B3640 $15.00 # # B3665 $15.00 # # B3640 $5.00 # B3665 $5.00 #

B3641 $15.00 # # B3666 $15.00 # # B3641 $5.00 # B3666 $5.00 #

B3642 $15.00 # # B3667 # # B3642 $5.00 # B3667 $5.00 #

B3643 $15.00 # # B3668 $15.00 # # B3643 $5.00 # B3668 $5.00 #

B3644 $10.00 # # B3669 $15.00 # # B3644 $5.00 # B3669 $5.00 #

B3645 $10.00 # # B3670 $15.00 # # B3645 $5.00 # B3670 $5.00 #

B3646 $15.00 # # B3671 $15.00 # # B3646 $5.00 # B3671 $5.00 #

B3647 $15.00 # # B3672 $12.00 # # B3647 $5.00 # B3672 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3673 $10.00 # # B3698 $15.00 # # B3673 $5.00 # B3698 $5.00 #

B3674 $10.00 # # B3699 $10.00 # # B3674 $10.00 # B3699 $5.00 #

B3675 $7.00 # # B3700 $10.00 # # B3675 $7.00 # B3700 $5.00 #

B3676 $15.00 # # B3701 $10.00 # # B3676 $5.00 # B3701 $5.00 #

B3677 $15.00 # # B3702 $15.00 # # B3677 $5.00 # B3702 $5.00 #

B3678 $15.00 # # B3703 $15.00 # # B3678 $5.00 # B3703 $5.00 #

B3679 $10.00 # # B3704 $15.00 # # B3679 $5.00 # B3704 $5.00 #

B3680 $15.00 # # B3705 $15.00 # # B3680 $5.00 # B3705 $5.00 #

B3681 $15.00 # # B3706 $15.00 # # B3681 $5.00 # B3706 $5.00 #

B3682 $15.00 # # B3707 $15.00 # # B3682 $5.00 # B3707 $5.00 #

B3683 $18.00 # # B3708 $12.00 # # B3683 # B3708 $5.00 #

B3684 $15.00 # # B3709 $15.00 # # B3684 $7.00 # B3709 $5.00 #

B3685 $15.00 # # B3710 $10.00 # # B3685 $5.00 # B3710 $5.00 #

B3686 $15.00 # # B3711 $15.00 # # B3686 $5.00 # B3711 $5.00 #

B3687 $20.00 # # B3712 $15.00 # # B3687 $5.00 # B3712 $5.00 #

B3688 $20.00 # # B3713 $15.00 # # B3688 $5.00 # B3713 $5.00 #

B3689 $15.00 # # B3714 $15.00 # # B3689 $5.00 # B3714 $5.00 #

B3690 $10.00 # # B3715 $15.00 # # B3690 $5.00 # B3715 $5.00 #

B3691 $15.00 # # B3716 $15.00 # # B3691 $5.00 # B3716 $5.00 #

B3692 $10.00 # # B3717 $15.00 # # B3692 $5.00 # B3717 $5.00 #

B3693 $12.00 # # B3718 $12.00 # # B3693 $5.00 # B3718 $5.00 #

B3694 $15.00 # # B3719 $15.00 # # B3694 $5.00 # B3719 $5.00 #

B3695 $15.00 # # B3720 $15.00 # # B3695 $5.00 # B3720 $5.00 #

B3696 $15.00 # # B3721 $12.00 # # B3696 $5.00 # B3721 $5.00 #

B3697 $15.00 # # B3722 $20.00 # # B3697 $5.00 # B3722 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3723 $15.00 # # B3748 $15.00 # # B3723 $5.00 # B3748 $5.00 #

B3724 # # B3749 $15.00 # # B3724 $5.00 # B3749 $5.00 #

B3725 $15.00 # # B3750 $15.00 # # B3725 $5.00 # B3750 $5.00 #

B3726 $18.00 # # B3751 $15.00 # # B3726 $5.00 # B3751 $5.00 #

B3727 $12.00 # # B3752 $15.00 # # B3727 $5.00 # B3752 $5.00 #

B3728 $12.00 # # B3753 $12.00 # # B3728 $5.00 # B3753 $5.00 #

B3729 $15.00 # # B3754 $15.00 # # B3729 $5.00 # B3754 $5.00 #

B3730 $15.00 # # B3755 $15.00 # # B3730 $5.00 # B3755 $5.00 #

B3731 $15.00 # # B3756 $15.00 # # B3731 $5.00 # B3756 $5.00 #

B3732 $15.00 # # B3757 $15.00 # # B3732 $5.00 # B3757 $5.00 #

B3733 $10.00 # # B3758 $15.00 # # B3733 $5.00 # B3758 $7.00 #

B3734 $15.00 # # B3759 $15.00 # # B3734 $5.00 # B3759 $5.00 #

B3735 $15.00 # # B3760 $15.00 # # B3735 $5.00 # B3760 $5.00 #

B3736 $12.00 # # B3761 $15.00 # # B3736 $5.00 # B3761 $5.00 #

B3737 $7.00 # # B3762 $15.00 # # B3737 $7.00 # B3762 $5.00 #

B3738 $12.00 # # B3763 $15.00 # # B3738 $5.00 # B3763 $5.00 #

B3739 $12.00 # # B3764 $15.00 # # B3739 $5.00 # B3764 $5.00 #

B3740 $12.00 # # B3765 $15.00 # # B3740 $5.00 # B3765 $5.00 #

B3741 $12.00 # # B3766 $15.00 # # B3741 $5.00 # B3766 $5.00 #

B3742 $15.00 # # B3767 $15.00 # # B3742 $5.00 # B3767 $5.00 #

B3743 $15.00 # # B3768 $15.00 # # B3743 $5.00 # B3768 $5.00 #

B3744 $15.00 # # B3769 $10.00 # # B3744 $7.00 # B3769 $5.00 #

B3745 $12.00 # # B3770 $15.00 # # B3745 $5.00 # B3770 $5.00 #

B3746 $10.00 # # B3771 $15.00 # # B3746 $5.00 # B3771 $5.00 #

B3747 $15.00 # # B3772 $15.00 # # B3747 $5.00 # B3772 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3773 $10.00 # # B3798 $15.00 # # B3773 $5.00 # B3798 $5.00 #

B3774 $10.00 # # B3799 $15.00 # # B3774 $5.00 # B3799 $5.00 #

B3775 $15.00 # # B3800 $15.00 # # B3775 $5.00 # B3800 $5.00 #

B3776 $12.00 # # B3801 $10.00 # # B3776 $5.00 # B3801 $5.00 #

B3777 $15.00 # # B3802 $15.00 # # B3777 $5.00 # B3802 $5.00 #

B3778 $15.00 # # B3803 $15.00 # # B3778 $5.00 # B3803 $5.00 #

B3779 $15.00 # # B3804 $12.00 # # B3779 $5.00 # B3804 $5.00 #

B3780 $10.00 # # B3805 $15.00 # # B3780 $5.00 # B3805 $5.00 #

B3781 $12.00 # # B3806 $15.00 # # B3781 $5.00 # B3806 $5.00 #

B3782 $15.00 # # B3807 $15.00 # # B3782 $5.00 # B3807 $5.00 #

B3783 $15.00 # # B3808 $15.00 # # B3783 $5.00 # B3808 $5.00 #

B3784 $15.00 # # B3809 $15.00 # # B3784 $5.00 # B3809 $5.00 #

B3785 $15.00 # # B3810 $15.00 # # B3785 $5.00 # B3810 $5.00 #

B3786 $10.00 # # B3811 $12.00 # # B3786 $5.00 # B3811 $5.00 #

B3787 $15.00 # # B3812 $15.00 # # B3787 $5.00 # B3812 $5.00 #

B3788 $10.00 # # B3813 $15.00 # # B3788 $5.00 # B3813 $5.00 #

B3789 $15.00 # # B3814 $10.00 # # B3789 $5.00 # B3814 $5.00 #

B3790 $15.00 # # B3815 $15.00 # # B3790 $5.00 # B3815 $5.00 #

B3791 $12.00 # # B3816 $15.00 # # B3791 $5.00 # B3816 $5.00 #

B3792 $10.00 # # B3817 $15.00 # # B3792 $5.00 # B3817 $5.00 #

B3793 $15.00 # # B3818 $15.00 # # B3793 $5.00 # B3818 $5.00 #

B3794 $15.00 # # B3819 $15.00 # # B3794 $5.00 # B3819 $5.00 #

B3795 $10.00 # # B3820 $15.00 # # B3795 $5.00 # B3820 $5.00 #

B3796 $15.00 # # B3821 $15.00 # # B3796 $5.00 # B3821 $5.00 #

B3797 $12.00 # # B3822 $15.00 # # B3797 $5.00 # B3822 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3823 $15.00 # # B3848 $15.00 # # B3823 $5.00 # B3848 $5.00 #

B3824 $15.00 # # B3849 $15.00 # # B3824 $5.00 # B3849 $5.00 #

B3825 $15.00 # # B3850 $10.00 # # B3825 $5.00 # B3850 $5.00 #

B3826 $10.00 # # B3851 $10.00 # # B3826 $5.00 # B3851 $5.00 #

B3827 $15.00 # # B3852 $15.00 # # B3827 $5.00 # B3852 $5.00 #

B3828 $15.00 # # B3853 $10.00 # # B3828 $5.00 # B3853 $5.00 #

B3829 $12.00 # # B3854 $12.00 # # B3829 $5.00 # B3854 $5.00 #

B3830 $15.00 # # B3855 $12.00 # # B3830 $5.00 # B3855 $5.00 #

B3831 $15.00 # # B3856 $12.00 # # B3831 $5.00 # B3856 $5.00 #

B3832 $15.00 # # B3857 $15.00 # # B3832 $5.00 # B3857 $5.00 #

B3833 $15.00 # # B3858 $15.00 # # B3833 $5.00 # B3858 $5.00 #

B3834 $12.00 # # B3859 $15.00 # # B3834 $5.00 # B3859 $5.00 #

B3835 $15.00 # # B3860 $10.00 # # B3835 $5.00 # B3860 $5.00 #

B3836 $15.00 # # B3861 $15.00 # # B3836 $5.00 # B3861 $5.00 #

B3837 $15.00 # # B3862 $15.00 # # B3837 $5.00 # B3862 $5.00 #

B3838 $15.00 # # B3863 $15.00 # # B3838 $5.00 # B3863 $5.00 #

B3839 $15.00 # # B3864 $15.00 # # B3839 $5.00 # B3864 $5.00 #

B3840 $15.00 # # B3865 $15.00 # # B3840 $5.00 # B3865 $5.00 #

B3841 $15.00 # # B3866 $15.00 # # B3841 $5.00 # B3866 $5.00 #

B3842 $15.00 # # B3867 $12.00 # # B3842 $5.00 # B3867 $5.00 #

B3843 $15.00 # # B3868 $12.00 # # B3843 $5.00 # B3868 $5.00 #

B3844 $15.00 # # B3869 $12.00 # # B3844 $5.00 # B3869 $5.00 #

B3845 $15.00 # # B3870 $15.00 # # B3845 $5.00 # B3870 $5.00 #

B3846 $15.00 # # B3871 $15.00 # # B3846 $5.00 # B3871 $5.00 #

B3847 $15.00 # # B3872 $12.00 # # B3847 $5.00 # B3872 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B3873 $15.00 # # B3898 $15.00 # # B3873 $5.00 # B3898 $5.00 #

B3874 $15.00 # # B3899 NADA # # B3874 $5.00 # B3899 NADA #

B3875 $15.00 # # B3900 NADA # # B3875 $5.00 # B3900 NADA #

B3876 $15.00 # # B3901 $12.00 # # B3876 $5.00 # B3901 $5.00 #

B3877 $12.00 # # B3902 $15.00 # # B3877 $5.00 # B3902 $5.00 #

B3878 $15.00 # # B3903 $15.00 # # B3878 $5.00 # B3903 $5.00 #

B3879 $15.00 # # B3904 $15.00 # # B3879 $5.00 # B3904 $5.00 #

B3880 $15.00 # # B3905 $15.00 # # B3880 $5.00 # B3905 $5.00 #

B3881 $15.00 # # B3906 $15.00 # # B3881 $5.00 # B3906 $5.00 #

B3882 $12.00 # # B3907 $15.00 # # B3882 $5.00 # B3907 $5.00 #

B3883 $10.00 # # B3908 $15.00 # # B3883 $5.00 # B3908 $5.00 #

B3884 $15.00 # # B3909 $12.00 # # B3884 $5.00 # B3909 $5.00 #

B3885 $15.00 # # B3910 $15.00 # # B3885 $5.00 # B3910 $5.00 #

B3886 $15.00 # # B3911 $15.00 # # B3886 $5.00 # B3911 $5.00 #

B3887 $15.00 # # B3912 $10.00 # # B3887 $5.00 # B3912 $5.00 #

B3888 $15.00 # # B3913 $10.00 # # B3888 $5.00 # B3913 $5.00 #

B3889 $15.00 # # B3914 $15.00 # # B3889 $5.00 # B3914 $5.00 #

B3890 $15.00 # # B3915 $15.00 # # B3890 $5.00 # B3915 $5.00 #

B3891 $15.00 # # B3916 $15.00 # # B3891 $5.00 # B3916 $5.00 #

B3892 $10.00 # # B3917 NADA # # B3892 $5.00 # B3917 NADA #

B3893 $15.00 # # B3918 $10.00 # # B3893 $7.00 # B3918 $5.00 #

B3894 $15.00 # # B3919 $15.00 # # B3894 $5.00 # B3919 $5.00 #

B3895 $15.00 # # B3920 $15.00 # # B3895 $5.00 # B3920 $5.00 #

B3896 $15.00 # # B3921 $10.00 # # B3896 $5.00 # B3921 $5.00 #

B3897 $15.00 # # B3922 $15.00 # # B3897 $5.00 # B3922 $5.00 #

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B3923 $15.00 # # B3948 $10.00 # # B3923 $5.00 # B3948 $5.00 #

B3924 $15.00 # # B3949 $10.00 # # B3924 $5.00 # B3949 $5.00 #

B3925 $15.00 # # B3950 $15.00 # # B3925 $5.00 # B3950 $5.00 #

B3926 $12.00 # # B3951 $15.00 # # B3926 $5.00 # B3951 $5.00 #

B3927 $15.00 # # B3952 $15.00 # # B3927 $5.00 # B3952 $5.00 #

B3928 $15.00 # # B3953 $15.00 # # B3928 $5.00 # B3953 $5.00 #

B3929 $12.00 # # B3954 $15.00 # # B3929 NADA # B3954 $5.00 #

B3930 $12.00 # # B3955 $15.00 # # B3930 $5.00 # B3955 $7.00 #

B3931 $12.00 # # B3956 $15.00 # # B3931 NADA # B3956 $5.00 #

B3932 $15.00 # # B3957 $12.00 # # B3932 $5.00 # B3957 $5.00 #

B3933 $10.00 # # B3958 $15.00 # # B3933 $5.00 # B3958 $5.00 #

B3934 $12.00 # # B3959 $15.00 # # B3934 $5.00 # B3959 $5.00 #

B3935 $10.00 # # B3960 $15.00 # # B3935 $5.00 # B3960 $5.00 #

B3936 $10.00 # # B3961 $15.00 # # B3936 $5.00 # B3961 $5.00 #

B3937 $10.00 # # B3962 $15.00 # # B3937 $5.00 # B3962 $5.00 #

B3938 $10.00 # # B3963 $15.00 # # B3938 $5.00 # B3963 $5.00 #

B3939 $10.00 # # B3964 $15.00 # # B3939 $5.00 # B3964 $7.00 #

B3940 $15.00 # # B3965 $15.00 # # B3940 $5.00 # B3965 $5.00 #

B3941 $10.00 # # B3966 $15.00 # # B3941 $5.00 # B3966 $5.00 #

B3942 $10.00 # # B3967 $18.00 # # B3942 $5.00 # B3967 $5.00 #

B3943 $15.00 # # B3968 $15.00 # # B3943 $5.00 # B3968 $5.00 #

B3944 $15.00 # # B3969 $15.00 # # B3944 $5.00 # B3969 $5.00 #

B3945 $15.00 # # B3970 $15.00 # # B3945 $5.00 # B3970 $5.00 #

B3946 $15.00 # # B3971 $15.00 # # B3946 $5.00 # B3971 $5.00 #

B3947 $15.00 # # B3972 $15.00 # # B3947 $7.00 # B3972 $5.00 #

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B3973 $15.00 # # B3998 $15.00 # # B3973 $5.00 # B3998 $5.00 #

B3974 $15.00 # # B3999 $10.00 # # B3974 $5.00 # B3999 $5.00 #

B3975 $15.00 # # B4000 $15.00 # # B3975 $5.00 # B4000 $5.00 #

B3976 $15.00 # # B4001 $12.00 # # B3976 $5.00 # B4001 $5.00 #

B3977 $15.00 # # B4002 $12.00 # # B3977 $5.00 # B4002 $5.00 #

B3978 $10.00 # # B4003 $12.00 # # B3978 $5.00 # B4003 $5.00 #

B3979 $15.00 # # B4004 $15.00 # # B3979 $5.00 # B4004 $5.00 #

B3980 $15.00 # # B4005 $12.00 # # B3980 $5.00 # B4005 $5.00 #

B3981 $15.00 # # B4006 $15.00 # # B3981 $5.00 # B4006 $5.00 #

B3982 $15.00 # # B4007 $15.00 # # B3982 $5.00 # B4007 $5.00 #

B3983 $15.00 # # B4008 $15.00 # # B3983 $5.00 # B4008 $5.00 #

B3984 $15.00 # # B4009 $10.00 # # B3984 $5.00 # B4009 $5.00 #

B3985 $15.00 # # B4010 $12.00 # # B3985 $5.00 # B4010 $5.00 #

B3986 $10.00 # # B4011 $15.00 # # B3986 $5.00 # B4011 $5.00 #

B3987 $10.00 # # B4012 $10.00 # # B3987 $5.00 # B4012 $5.00 #

B3988 $10.00 # # B4013 $12.00 # # B3988 $5.00 # B4013 $5.00 #

B3989 $15.00 # # B4014 $10.00 # # B3989 $5.00 # B4014 $7.00 #

B3990 $15.00 # # B4015 $12.00 # # B3990 $5.00 # B4015 $5.00 #

B3991 $10.00 # # B4016 $10.00 # # B3991 $5.00 # B4016 $5.00 #

B3992 $12.00 # # B4017 $15.00 # # B3992 $5.00 # B4017 $5.00 #

B3993 $15.00 # # B4018 $15.00 # # B3993 $5.00 # B4018 $5.00 #

B3994 $15.00 # # B4019 $15.00 # # B3994 $5.00 # B4019 $5.00 #

B3995 $15.00 # # B4020 $15.00 # # B3995 $5.00 # B4020 $5.00 #

B3996 $12.00 # # B4021 NADA # # B3996 $5.00 # B4021 NADA #

B3997 $15.00 # # B4022 NADA # # B3997 $5.00 # B4022 NADA #

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B4023 NADA # # B4048 $20.00 # # B4023 NADA # B4048 $20.00 #

B4024 $10.00 # # B4049 $5.00 # # B4024 $5.00 # B4049 $5.00 #

B4025 $10.00 # # B4050 $10.00 # # B4025 $5.00 # B4050 $5.00 #

B4026 $10.00 # # B4051 $15.00 # # B4026 $5.00 # B4051 $5.00 #

B4027 $12.00 # # B4052 $10.00 # # B4027 $5.00 # B4052 $5.00 #

B4028 $15.00 # # B4053 $15.00 # # B4028 $5.00 # B4053 $5.00 #

B4029 $15.00 # # B4054 $15.00 # # B4029 $5.00 # B4054 $7.00 #

B4030 $15.00 # # B4055 $12.00 # # B4030 $5.00 # B4055 $5.00 #

B4031 $10.00 # # B4056 $15.00 # # B4031 $5.00 # B4056 $5.00 #

B4032 $15.00 # # B4057 $15.00 # # B4032 $5.00 # B4057 $5.00 #

B4033 $15.00 # # B4058 $15.00 # # B4033 $5.00 # B4058 $5.00 #

B4034 $10.00 # # B4059 $15.00 # # B4034 $5.00 # B4059 $5.00 #

B4035 $15.00 # # B4060 $15.00 # # B4035 $5.00 # B4060 $5.00 #

B4036 $15.00 # # B4061 $10.00 # # B4036 $5.00 # B4061 $5.00 #

B4037 $15.00 # # B4062 $15.00 # # B4037 $5.00 # B4062 $5.00 #

B4038 $10.00 # # B4063 $15.00 # # B4038 $5.00 # B4063 $5.00 #

B4039 $15.00 # # B4064 $15.00 # # B4039 $5.00 # B4064 $5.00 #

B4040 $10.00 # # B4065 $15.00 # # B4040 $5.00 # B4065 $5.00 #

B4041 $10.00 # # B4066 $15.00 # # B4041 $5.00 # B4066 $5.00 #

B4042 $15.00 # # B4067 $15.00 # # B4042 $5.00 # B4067 $5.00 #

B4043 $10.00 # # B4068 $10.00 # # B4043 $5.00 # B4068 $5.00 #

B4044 $10.00 # # B4069 $15.00 # # B4044 $5.00 # B4069 $5.00 #

B4045 $10.00 # # B4070 $15.00 # # B4045 $5.00 # B4070 $5.00 #

B4046 $7.00 # # B4071 $15.00 # # B4046 $5.00 # B4071 $5.00 #

B4047 $12.00 # # B4072 $15.00 # # B4047 $12.00 # B4072 $5.00 #

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B4073 $15.00 # # B4098 $15.00 # # B4073 $5.00 # B4098 $5.00 #

B4074 $15.00 # # B4099 $12.00 # # B4074 $5.00 # B4099 $5.00 #

B4075 $10.00 # # B4100 $15.00 # # B4075 $5.00 # B4100 $5.00 #

B4076 $15.00 # # B4101 $15.00 # # B4076 $5.00 # B4101 $5.00 #

B4077 $15.00 # # B4102 $15.00 # # B4077 $5.00 # B4102 $5.00 #

B4078 $15.00 # # B4103 $15.00 # # B4078 $5.00 # B4103 $5.00 #

B4079 $15.00 # # B4104 $12.00 # # B4079 $5.00 # B4104 $5.00 #

B4080 $15.00 # # B4105 $15.00 # # B4080 $5.00 # B4105 $7.00 #

B4081 $15.00 # # B4106 $15.00 # # B4081 $5.00 # B4106 $5.00 #

B4082 $15.00 # # B4107 $15.00 # # B4082 $5.00 # B4107 $5.00 #

B4083 $12.00 # # B4108 $15.00 # # B4083 $5.00 # B4108 $5.00 #

B4084 $15.00 # # B4109 $15.00 # # B4084 $5.00 # B4109 $5.00 #

B4085 $15.00 # # B4110 $10.00 # # B4085 $5.00 # B4110 $5.00 #

B4086 $15.00 # # B4111 $15.00 # # B4086 $5.00 # B4111 $5.00 #

B4087 $10.00 # # B4112 $15.00 # # B4087 $5.00 # B4112 $5.00 #

B4088 $10.00 # # B4113 $10.00 # # B4088 $5.00 # B4113 $5.00 #

B4089 $15.00 # # B4114 $15.00 # # B4089 $5.00 # B4114 $5.00 #

B4090 $15.00 # # B4115 $15.00 # # B4090 $5.00 # B4115 $5.00 #

B4091 $10.00 # # B4116 $15.00 # # B4091 $5.00 # B4116 $5.00 #

B4092 $10.00 # # B4117 $15.00 # # B4092 $5.00 # B4117 $5.00 #

B4093 $15.00 # # B4118 $15.00 # # B4093 $5.00 # B4118 $5.00 #

B4094 $15.00 # # B4119 $12.00 # # B4094 $5.00 # B4119 $5.00 #

B4095 $15.00 # # B4120 $15.00 # # B4095 $5.00 # B4120 $5.00 #

B4096 $15.00 # # B4121 $12.00 # # B4096 $5.00 # B4121 $5.00 #

B4097 $12.00 # # B4122 $15.00 # # B4097 $5.00 # B4122 $5.00 #

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B4123 $15.00 # # B4148 $15.00 # # B4123 $5.00 # B4148 $7.00 #

B4124 $15.00 # # B4149 $15.00 # # B4124 $5.00 # B4149 $5.00 #

B4125 $12.00 # # B4150 $15.00 # # B4125 $5.00 # B4150 $7.00 #

B4126 $15.00 # # B4151 $15.00 # # B4126 $5.00 # B4151 $7.00 #

B4127 $10.00 # # B4152 $15.00 # # B4127 $10.00 # B4152 $7.00 #

B4128 $15.00 # # B4153 $15.00 # # B4128 $15.00 # B4153 $5.00 #

B4129 $10.00 # # B4154 $15.00 # # B4129 $10.00 # B4154 $5.00 #

B4130 $15.00 # # B4155 $15.00 # # B4130 $15.00 # B4155 $5.00 #

B4131 $12.00 # # B4156 $15.00 # # B4131 $5.00 # B4156 $5.00 #

B4132 $15.00 # # B4157 $12.00 # # B4132 $5.00 # B4157 $5.00 #

B4133 $12.00 # # B4158 $15.00 # # B4133 $5.00 # B4158 $7.00 #

B4134 $15.00 # # B4159 $10.00 # # B4134 $5.00 # B4159 $5.00 #

B4135 $15.00 # # B4160 $15.00 # # B4135 $5.00 # B4160 $5.00 #

B4136 $10.00 # # B4161 NADA # # B4136 $5.00 # B4161 $5.00 #

B4137 $15.00 # # B4162 $15.00 # # B4137 $5.00 # B4162 $7.00 #

B4138 $15.00 # # B4163 $18.00 # # B4138 $5.00 # B4163 $5.00 #

B4139 $15.00 # # B4164 $15.00 # # B4139 $5.00 # B4164 $5.00 #

B4140 $10.00 # # B4165 $10.00 # # B4140 $5.00 # B4165 $5.00 #

B4141 $15.00 # # B4166 $15.00 # # B4141 $7.00 # B4166 $5.00 #

B4142 $15.00 # # B4167 $15.00 # # B4142 $5.00 # B4167 $5.00 #

B4143 $15.00 # # B4168 $10.00 # # B4143 $5.00 # B4168 $5.00 #

B4144 $10.00 # # B4169 $18.00 # # B4144 $5.00 # B4169 $5.00 #

B4145 $12.00 # # B4170 $15.00 # # B4145 $5.00 # B4170 $5.00 #

B4146 $15.00 # # B4171 $15.00 # # B4146 $5.00 # B4171 $5.00 #

B4147 $15.00 # # B4172 $15.00 # # B4147 $5.00 # B4172 $5.00 #

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B4173 $15.00 # # B4198 $12.00 # # B4173 $5.00 # B4198 $5.00 #

B4174 $15.00 # # B4199 $15.00 # # B4174 NADA # B4199 NADA #

B4175 $15.00 # # B4200 $12.00 # # B4175 $5.00 # B4200 $5.00 #

B4176 $15.00 # # B4201 NADA # # B4176 $5.00 # B4201 NADA #

B4177 $15.00 # # B4202 $10.00 # # B4177 $7.00 # B4202 $5.00 #

B4178 $15.00 # # B4203 $5.00 # # B4178 $5.00 # B4203 $5.00 #

B4179 $15.00 # # B4204 $20.00 # # B4179 $5.00 # B4204 $5.00 #

B4180 $10.00 # # B4205 $12.00 # # B4180 $5.00 # B4205 $5.00 #

B4181 $12.00 # # B4206 $10.00 # # B4181 $12.00 # B4206 $5.00 #

B4182 $12.00 # # B4207 $15.00 # # B4182 $5.00 # B4207 $5.00 #

B4183 $10.00 # # B4208 $15.00 # # B4183 $5.00 # B4208 $5.00 #

B4184 $15.00 # # B4209 $15.00 # # B4184 $5.00 # B4209 $5.00 #

B4185 $15.00 # # B4210 NADA # # B4185 $5.00 # B4210 NADA #

B4186 $15.00 # # B4211 NADA # # B4186 $5.00 # B4211 NADA #

B4187 $15.00 # # B4212 $15.00 # # B4187 $5.00 # B4212 $5.00 #

B4188 $15.00 # # B4213 $12.00 # # B4188 $5.00 # B4213 $5.00 #

B4189 $15.00 # # B4214 $15.00 # # B4189 $5.00 # B4214 $5.00 #

B4190 $15.00 # # B4215 $15.00 # # B4190 NADA # B4215 $5.00 #

B4191 $10.00 # # B4216 $15.00 # # B4191 $5.00 # B4216 $5.00 #

B4192 $15.00 # # B4217 $15.00 # # B4192 NADA # B4217 $5.00 #

B4193 $10.00 # # B4218 $12.00 # # B4193 $5.00 # B4218 $5.00 #

B4194 $10.00 # # B4219 $10.00 # # B4194 $5.00 # B4219 $5.00 #

B4195 $15.00 # # B4220 $10.00 # # B4195 $5.00 # B4220 $5.00 #

B4196 $15.00 # # B4221 $15.00 # # B4196 $5.00 # B4221 $5.00 #

B4197 $12.00 # # B4222 $15.00 # # B4197 $5.00 # B4222 $5.00 #

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B4223 $10.00 # # B4248 $12.00 # # B4223 $5.00 # B4248 $5.00 #

B4224 $15.00 # # B4249 $10.00 # # B4224 $5.00 # B4249 $5.00 #

B4225 $15.00 # # B4250 $15.00 # # B4225 $5.00 # B4250 $5.00 #

B4226 $15.00 # # B4251 $15.00 # # B4226 $5.00 # B4251 $5.00 #

B4227 $15.00 # # B4252 $12.00 # # B4227 $5.00 # B4252 $5.00 #

B4228 $15.00 # # B4253 $15.00 # # B4228 $5.00 # B4253 $5.00 #

B4229 $15.00 # # B4254 $15.00 # # B4229 $5.00 # B4254 $5.00 #

B4230 $15.00 # # B4255 $15.00 # # B4230 $5.00 # B4255 $5.00 #

B4231 $15.00 # # B4256 $15.00 # # B4231 $5.00 # B4256 $5.00 #

B4232 $15.00 # # B4257 $15.00 # # B4232 $5.00 # B4257 $5.00 #

B4233 $15.00 # # B4258 $12.00 # # B4233 $5.00 # B4258 $5.00 #

B4234 $15.00 # # B4259 $15.00 # # B4234 $5.00 # B4259 $5.00 #

B4235 $15.00 # # B4260 $15.00 # # B4235 $5.00 # B4260 $5.00 #

B4236 $15.00 # # B4261 $15.00 # # B4236 $5.00 # B4261 $5.00 #

B4237 $10.00 # # B4262 $15.00 # # B4237 $5.00 # B4262 $5.00 #

B4238 $15.00 # # B4263 $10.00 # # B4238 $5.00 # B4263 $5.00 #

B4239 $12.00 # # B4264 $15.00 # # B4239 $5.00 # B4264 $5.00 #

B4240 $15.00 # # B4265 $12.00 # # B4240 $5.00 # B4265 $5.00 #

B4241 $15.00 # # B4266 $15.00 # # B4241 $5.00 # B4266 $5.00 #

B4242 $12.00 # # B4267 NADA # # B4242 $5.00 # B4267 $5.00 #

B4243 $15.00 # # B4268 $15.00 # # B4243 $5.00 # B4268 $5.00 #

B4244 $15.00 # # B4269 $15.00 # # B4244 $5.00 # B4269 $5.00 #

B4245 $15.00 # # B4270 $15.00 # # B4245 $5.00 # B4270 $5.00 #

B4246 $15.00 # # B4271 $12.00 # # B4246 $5.00 # B4271 $5.00 #

B4247 $15.00 # # B4272 $10.00 # # B4247 $5.00 # B4272 $10.00 #

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B4273 $10.00 # # B4298 $18.00 # # B4273 $10.00 # B4298 $5.00 #

B4274 $10.00 # # B4299 $15.00 # # B4274 $5.00 # B4299 $5.00 #

B4275 $15.00 # # B4300 $12.00 # # B4275 $5.00 # B4300 $5.00 #

B4276 $15.00 # # B4301 $10.00 # # B4276 $5.00 # B4301 $5.00 #

B4277 $15.00 # # B4302 $10.00 # # B4277 $5.00 # B4302 $5.00 #

B4278 $15.00 # # B4303 $15.00 # # B4278 $5.00 # B4303 $5.00 #

B4279 $15.00 # # B4304 $15.00 # # B4279 $5.00 # B4304 $5.00 #

B4280 $15.00 # # B4305 $15.00 # # B4280 $5.00 # B4305 $5.00 #

B4281 $10.00 # # B4306 $12.00 # # B4281 $5.00 # B4306 $5.00 #

B4282 $15.00 # # B4307 $12.00 # # B4282 $5.00 # B4307 $5.00 #

B4283 $15.00 # # B4308 $12.00 # # B4283 $5.00 # B4308 $5.00 #

B4284 $10.00 # # B4309 $15.00 # # B4284 $5.00 # B4309 $5.00 #

B4285 $15.00 # # B4310 $10.00 # # B4285 $5.00 # B4310 $5.00 #

B4286 $12.00 # # B4311 $12.00 # # B4286 $5.00 # B4311 $12.00 #

B4287 $15.00 # # B4312 $15.00 # # B4287 $5.00 # B4312 $7.00 #

B4288 $15.00 # # B4313 $15.00 # # B4288 $5.00 # B4313 $5.00 #

B4289 $10.00 # # B4314 $10.00 # # B4289 $5.00 # B4314 $5.00 #

B4290 $15.00 # # B4315 $15.00 # # B4290 $5.00 # B4315 $5.00 #

B4291 $15.00 # # B4316 $12.00 # # B4291 $5.00 # B4316 $5.00 #

B4292 $15.00 # # B4317 $15.00 # # B4292 $5.00 # B4317 $5.00 #

B4293 $15.00 # # B4318 $15.00 # # B4293 $5.00 # B4318 $5.00 #

B4294 $15.00 # # B4319 $15.00 # # B4294 $5.00 # B4319 $5.00 #

B4295 $10.00 # # B4320 $15.00 # # B4295 $5.00 # B4320 $5.00 #

B4296 $15.00 # # B4321 $15.00 # # B4296 $5.00 # B4321 $5.00 #

B4297 $15.00 # # B4322 $18.00 # # B4297 $5.00 # B4322 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4323 $12.00 # # B4348 $15.00 # # B4323 $5.00 # B4348 $5.00 #

B4324 $15.00 # # B4349 $15.00 # # B4324 $5.00 # B4349 $5.00 #

B4325 $15.00 # # B4350 $10.00 # # B4325 $7.00 # B4350 $5.00 #

B4326 $15.00 # # B4351 $15.00 # # B4326 $5.00 # B4351 $5.00 #

B4327 $15.00 # # B4352 $12.00 # # B4327 $5.00 # B4352 $5.00 #

B4328 $15.00 # # B4353 $10.00 # # B4328 $5.00 # B4353 $10.00 #

B4329 $15.00 # # B4354 $10.00 # # B4329 $5.00 # B4354 $10.00 #

B4330 $12.00 # # B4355 $10.00 # # B4330 $5.00 # B4355 $10.00 #

B4331 $10.00 # # B4356 $10.00 # # B4331 $5.00 # B4356 $10.00 #

B4332 $20.00 # # B4357 $10.00 # # B4332 $5.00 # B4357 $10.00 #

B4333 $15.00 # #

B4358 , r

NADA # # B4333

$5.00 # B4358 , r

$15.00 #

B4334 $15.00 # # B4359 $15.00 # # B4334 $5.00 # B4359 $5.00 #

B4335 $15.00 # # B4360 $15.00 # # B4335 $5.00 # B4360 $5.00 #

B4336 $15.00 # # B4361 $15.00 # # B4336 $5.00 # B4361 $5.00 #

B4337 $10.00 # # B4362 $15.00 # # B4337 $5.00 # B4362 $5.00 #

B4338 $12.00 # # B4363 $15.00 # # B4338 $5.00 # B4363 $5.00 #

B4339 $15.00 # # B4364 $10.00 # # B4339 $5.00 # B4364 NADA #

B4340 $15.00 # # B4365 $10.00 # # B4340 $5.00 # B4365 $5.00 #

B4341 $15.00 # # B4366 $12.00 # # B4341 $5.00 # B4366 $5.00 #

B4342 $10.00 # # B4367 w $15.00 # # B4342 $5.00 # B4367 w $5.00 #

B4343 $15.00 # # B4368 $18.00 # # B4343 $5.00 # B4368 $5.00 #

B4344 $15.00 # # B4369 $18.00 # # B4344 $5.00 # B4369 $5.00 #

B4345 $12.00 # # B4370 w $15.00 # # B4345 $5.00 # B4370 w $5.00 #

B4346 $15.00 # # B4371 $10.00 # # B4346 $5.00 # B4371 $5.00 #

B4347 , y

$5.00 # # B4372 $15.00 # # B4347 , y

$5.00 # B4372 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4373 $15.00 # # B4398 $15.00 # # B4373 $5.00 # B4398 $5.00 #

B4374 $10.00 # # B4399 $10.00 # # B4374 $5.00 # B4399 $5.00 #

B4375 $10.00 # # B4400 $10.00 # # B4375 $5.00 # B4400 $5.00 #

B4376 $10.00 # # B4401 $10.00 # # B4376 $5.00 # B4401 $5.00 #

B4377 $5.00 # # B4402 $10.00 # # B4377 $5.00 # B4402 $5.00 #

B4378 $5.00 # # B4403 $12.00 # # B4378 $5.00 # B4403 $5.00 #

B4379 $5.00 # # B4404 $10.00 # # B4379 $5.00 # B4404 $5.00 #

B4380 $10.00 # # B4405 $12.00 # # B4380 $6.00 # B4405 $5.00 #

B4381 $10.00 # # B4406 $15.00 # # B4381 $6.00 # B4406 $5.00 #

B4382 $12.00 # # B4407 $15.00 # # B4382 $5.00 # B4407 $5.00 #

B4383 $10.00 # # B4408 $15.00 # # B4383 NADA # B4408 $5.00 #

B4384 $10.00 # # B4409 $15.00 # # B4384 $5.00 # B4409 $5.00 #

B4385 $10.00 # # B4410 $15.00 # # B4385 $5.00 # B4410 $5.00 #

B4386 $10.00 # # B4411 $15.00 # # B4386 NADA # B4411 $5.00 #

B4387 $15.00 # # B4412 $15.00 # # B4387 $5.00 # B4412 $5.00 #

B4388 $15.00 # # B4413 $15.00 # # B4388 $5.00 # B4413 $5.00 #

B4389 $15.00 # # B4414 $15.00 # # B4389 $5.00 # B4414 $5.00 #

B4390 $15.00 # # B4415 $15.00 # # B4390 $5.00 # B4415 $5.00 #

B4391 $15.00 # # B4416 $15.00 # # B4391 $5.00 # B4416 $5.00 #

B4392 $15.00 # # B4417 $15.00 # # B4392 $5.00 # B4417 $5.00 #

B4393 $15.00 # # B4418 $15.00 # # B4393 $5.00 # B4418 $5.00 #

B4394 $15.00 # # B4419 $15.00 # # B4394 $5.00 # B4419 $5.00 #

B4395 $15.00 # # B4420 $15.00 # # B4395 $5.00 # B4420 $5.00 #

B4396 $15.00 # # B4421 $15.00 # # B4396 $5.00 # B4421 $5.00 #

B4397 $15.00 # # B4422 $15.00 # # B4397 $5.00 # B4422 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4423 $12.00 # # B4448 NADA # # B4423 $12.00 # B4448 NADA #

B4424 $12.00 # # B4449 NADA # # B4424 $12.00 # B4449 NADA #

B4425 $12.00 # # B4450 NADA # # B4425 $12.00 # B4450 NADA #

B4426 $10.00 # # B4451 $10.00 # # B4426 $15.00 # B4451 $5.00 #

B4427 $8.00 # # B4452 $8.00 # # B4427 $10.00 # B4452 $5.00 #

B4428 $10.00 # # B4453 $8.00 # # B4428 $15.00 # B4453 $5.00 #

B4429 $15.00 # # B4454 $12.00 # # B4429 $15.00 # B4454 $12.00 #

B4430 $10.00 # # B4455 $17.00 # # B4430 $10.00 # B4455 $5.00 #

B4431 $8.00 # # B4456 $10.00 # # B4431 $8.00 # B4456 $18.00 #

B4432 $8.00 # # B4457 $8.00 # # B4432 $8.00 # B4457 $8.00 #

B4433 $8.00 # # B4458 $8.00 # # B4433 $8.00 # B4458 $8.00 #

B4434 NADA # # B4459 $15.00 # # B4434 NADA # B4459 $5.00 #

B4435 $10.00 # # B4460 $15.00 # # B4435 $15.00 # B4460 $5.00 #

B4436 NADA # # B4461 $15.00 # # B4436 NADA # B4461 $5.00 #

B4437 $7.00 # # B4462 $15.00 # # B4437 $7.00 # B4462 $5.00 #

B4438 $15.00 # # B4463 $15.00 # # B4438 $5.00 # B4463 $5.00 #

B4439 NADA # # B4464 $15.00 # # B4439 NADA # B4464 $5.00 #

B4440 $8.00 # # B4465 $10.00 # # B4440 $5.00 # B4465 $5.00 #

B4441 $10.00 # # B4466 $10.00 # # B4441 $5.00 # B4466 $5.00 #

B4442 $8.00 # # B4467 $15.00 # # B4442 $5.00 # B4467 $5.00 #

B4443 $15.00 # # B4468 $15.00 # # B4443 $15.00 # B4468 $5.00 #

B4444 $8.00 # # B4469 $15.00 # # B4444 $5.00 # B4469 $5.00 #

B4445 $8.00 # # B4470 $15.00 # # B4445 $5.00 # B4470 $5.00 #

B4446 $10.00 # # B4471 $15.00 # # B4446 $5.00 # B4471 $5.00 #

B4447 $10.00 # # B4472 $12.00 # # B4447 $10.00 # B4472 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4473 $15.00 # # B4498 $15.00 # # B4473 $5.00 # B4498 $5.00 #

B4474 $15.00 # # B4499 $12.00 # # B4474 $5.00 # B4499 $5.00 #

B4475 $15.00 # # B4500 $12.00 # # B4475 $5.00 # B4500 $5.00 #

B4476 $10.00 # # B4501 $12.00 # # B4476 $5.00 # B4501 $5.00 #

B4477 $15.00 # # B4502 $12.00 # # B4477 $5.00 # B4502 $5.00 #

B4478 $15.00 # # B4503 $15.00 # # B4478 $5.00 # B4503 $5.00 #

B4479 $15.00 # # B4504 $10.00 # # B4479 $5.00 # B4504 $5.00 #

B4480 $12.00 # # B4505 $16.00 # # B4480 $5.00 # B4505 $5.00 #

B4481 $15.00 # # B4506 $15.00 # # B4481 $5.00 # B4506 $5.00 #

B4482 $15.00 # # B4507 $10.00 # # B4482 $5.00 # B4507 $5.00 #

B4483 $15.00 # # B4508 $12.00 # # B4483 $5.00 # B4508 $5.00 #

B4484 $15.00 # # B4509 $15.00 # # B4484 $5.00 # B4509 $5.00 #

B4485 $12.00 # # B4510 $10.00 # # B4485 $5.00 # B4510 $5.00 #

B4486 $12.00 # # B4511 $10.00 # # B4486 $5.00 # B4511 $10.00 #

B4487 $15.00 # # B4512 $10.00 # # B4487 $5.00 # B4512 $5.00 #

B4488 $15.00 # # B4513 $15.00 # # B4488 $5.00 # B4513 $5.00 #

B4489 $15.00 # # B4514 $12.00 # # B4489 $5.00 # B4514 $5.00 #

B4490 $12.00 # # B4515 $12.00 # # B4490 $5.00 # B4515 $5.00 #

B4491 $10.00 # # B4516 $15.00 # # B4491 $5.00 # B4516 $5.00 #

B4492 $15.00 # # B4517 $10.00 # # B4492 $5.00 # B4517 $5.00 #

B4493 $15.00 # # B4518 $10.00 # # B4493 $5.00 # B4518 $5.00 #

B4494 $15.00 # # B4519 $10.00 # # B4494 $5.00 # B4519 $5.00 #

B4495 $15.00 # # B4520 $10.00 # # B4495 $5.00 # B4520 $5.00 #

B4496 $15.00 # # B4521 $12.00 # # B4496 $5.00 # B4521 $5.00 #

B4497 $15.00 # # B4522 $15.00 # # B4497 $5.00 # B4522 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4523 $15.00 # # B4548 $15.00 # # B4523 $5.00 # B4548 $5.00 #

B4524 $12.00 # # B4549 $15.00 # # B4524 $5.00 # B4549 $5.00 #

B4525 $10.00 # # B4550 $15.00 # # B4525 $5.00 # B4550 $5.00 #

B4526 $10.00 # # B4551 $15.00 # # B4526 $5.00 # B4551 $5.00 #

B4527 $15.00 # # B4552 $15.00 # # B4527 $5.00 # B4552 $5.00 #

B4528 $15.00 # # B4553 $12.00 # # B4528 $5.00 # B4553 $5.00 #

B4529 $10.00 # # B4554 $15.00 # # B4529 $5.00 # B4554 $5.00 #

B4530 $15.00 # # B4555 $12.00 # # B4530 $5.00 # B4555 $5.00 #

B4531 $15.00 # # B4556 $15.00 # # B4531 $5.00 # B4556 $5.00 #

B4532 $15.00 # # B4557 $12.00 # # B4532 $5.00 # B4557 $12.00 #

B4533 $15.00 # # B4558 $12.00 # # B4533 $5.00 # B4558 $5.00 #

B4534 $12.00 # # B4559 $12.00 # # B4534 $5.00 # B4559 $5.00 #

B4535 NADA # # B4560 $15.00 # # B4535 $7.00 # B4560 $5.00 #

B4536 $15.00 # # B4561 $15.00 # # B4536 $5.00 # B4561 $5.00 #

B4537 $15.00 # # B4562 $15.00 # # B4537 $5.00 # B4562 $5.00 #

B4538 $15.00 # # B4563 $12.00 # # B4538 $5.00 # B4563 $5.00 #

B4539 $15.00 # # B4564 $12.00 # # B4539 $5.00 # B4564 $5.00 #

B4540 $15.00 # # B4565 $15.00 # # B4540 $5.00 # B4565 $5.00 #

B4541 $12.00 # # B4566 $12.00 # # B4541 $5.00 # B4566 $5.00 #

B4542 $12.00 # # B4567 $12.00 # # B4542 $5.00 # B4567 $5.00 #

B4543 $10.00 # # B4568 $12.00 # # B4543 $5.00 # B4568 $5.00 #

B4544 $12.00 # # B4569 $12.00 # # B4544 $5.00 # B4569 $5.00 #

B4545 $15.00 # # B4570 $12.00 # # B4545 $5.00 # B4570 $5.00 #

B4546 $15.00 # # B4571 $12.00 # # B4546 $5.00 # B4571 $5.00 #

B4547 $8.00 # # B4572 $15.00 # # B4547 $8.00 # B4572 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4573 $15.00 # # B4598 $12.00 # # B4573 $5.00 # B4598 $5.00 #

B4574 $15.00 # # B4599 $12.00 # # B4574 $5.00 # B4599 $5.00 #

B4575 $12.00 # # B4600 $12.00 # # B4575 $5.00 # B4600 $5.00 #

B4576 $12.00 # # B4601 $12.00 # # B4576 $5.00 # B4601 $5.00 #

B4577 $12.00 # # B4602 $17.00 # # B4577 $5.00 # B4602 $5.00 #

B4578 $12.00 # # B4603 $15.00 # # B4578 $5.00 # B4603 $5.00 #

B4579 $12.00 # # B4604 $12.00 # # B4579 $5.00 # B4604 $5.00 #

B4580 $15.00 # # B4605 $15.00 # # B4580 $5.00 # B4605 $5.00 #

B4581 $12.00 # # B4606 $15.00 # # B4581 $5.00 # B4606 $5.00 #

B4582 $10.00 # # B4607 $15.00 # # B4582 $5.00 # B4607 $5.00 #

B4583 $12.00 # # B4608 $12.00 # # B4583 $5.00 # B4608 $5.00 #

B4584 $15.00 # # B4609 $15.00 # # B4584 $5.00 # B4609 $5.00 #

B4585 $15.00 # # B4610 $15.00 # # B4585 $5.00 # B4610 $5.00 #

B4586 $15.00 # # B4611 $15.00 # # B4586 $5.00 # B4611 $5.00 #

B4587 $12.00 # # B4612 $12.00 # # B4587 $5.00 # B4612 $5.00 #

B4588 $12.00 # # B4613 $12.00 # # B4588 $5.00 # B4613 $5.00 #

B4589 $12.00 # # B4614 $15.00 # # B4589 $5.00 # B4614 $5.00 #

B4590 $12.00 # # B4615 $15.00 # # B4590 $5.00 # B4615 $5.00 #

B4591 $12.00 # # B4616 $15.00 # # B4591 $5.00 # B4616 $5.00 #

B4592 $15.00 # # B4617 $15.00 # # B4592 $5.00 # B4617 $5.00 #

B4593 $15.00 # # B4618 $15.00 # # B4593 $5.00 # B4618 $5.00 #

B4594 $15.00 # # B4619 $15.00 # # B4594 $5.00 # B4619 $5.00 #

B4595 $15.00 # # B4620 $10.00 # # B4595 $5.00 # B4620 $5.00 #

B4596 $15.00 # # B4621 $15.00 # # B4596 $5.00 # B4621 $5.00 #

B4597 $15.00 # # B4622 $15.00 # # B4597 $5.00 # B4622 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4623 $15.00 # # B4648 $15.00 # # B4623 $5.00 # B4648 $5.00 #

B4624 $15.00 # # B4649 $12.00 # # B4624 $5.00 # B4649 $5.00 #

B4625 $15.00 # # B4650 $10.00 # # B4625 $5.00 # B4650 $5.00 #

B4626 $10.00 # # B4651 $10.00 # # B4626 $5.00 # B4651 $5.00 #

B4627 $15.00 # # B4652 $15.00 # # B4627 $5.00 # B4652 $5.00 #

B4628 $15.00 # # B4653 $15.00 # # B4628 $5.00 # B4653 $5.00 #

B4629 $15.00 # # B4654 $15.00 # # B4629 $5.00 # B4654 $5.00 #

B4630 $15.00 # # B4655 $15.00 # # B4630 $5.00 # B4655 $5.00 #

B4631 $15.00 # # B4656 $15.00 # # B4631 $5.00 # B4656 $5.00 #

B4632 $15.00 # # B4657 $15.00 # # B4632 $5.00 # B4657 $5.00 #

B4633 $15.00 # # B4658 $15.00 # # B4633 $5.00 # B4658 $5.00 #

B4634 $15.00 # # B4659 $10.00 # # B4634 $5.00 # B4659 $5.00 #

B4635 $10.00 # # B4660 $15.00 # # B4635 $5.00 # B4660 $5.00 #

B4636 $12.00 # # B4661 $10.00 # # B4636 $5.00 # B4661 $5.00 #

B4637 $15.00 # # B4662 $15.00 # # B4637 $5.00 # B4662 $5.00 #

B4638 $15.00 # # B4663 $12.00 # # B4638 $5.00 # B4663 $5.00 #

B4639 $15.00 # # B4664 $15.00 # # B4639 $5.00 # B4664 $5.00 #

B4640 $15.00 # # B4665 $12.00 # # B4640 $5.00 # B4665 $5.00 #

B4641 $15.00 # # B4666 $15.00 # # B4641 $5.00 # B4666 $5.00 #

B4642 $15.00 # # B4667 $15.00 # # B4642 $5.00 # B4667 $5.00 #

B4643 $15.00 # # B4668 $15.00 # # B4643 $7.00 # B4668 $5.00 #

B4644 $15.00 # # B4669 $15.00 # # B4644 $5.00 # B4669 $5.00 #

B4645 $12.00 # # B4670 $15.00 # # B4645 $5.00 # B4670 $5.00 #

B4646 $20.00 # # B4671 $15.00 # # B4646 $5.00 # B4671 $5.00 #

B4647 $10.00 # # B4672 $15.00 # # B4647 $5.00 # B4672 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4673 $10.00 # # B4698 $10.00 # # B4673 $5.00 # B4698 $10.00 #

B4674 $15.00 # # B4699 $15.00 # # B4674 $5.00 # B4699 $15.00 #

B4675 $15.00 # # B4700 $10.00 # # B4675 $5.00 # B4700 $10.00 #

B4676 $10.00 # # B4701 $10.00 # # B4676 $5.00 # B4701 $10.00 #

B4677 $15.00 # # B4702 $15.00 # # B4677 $15.00 # B4702 $5.00 #

B4678 $15.00 # # B4703 $15.00 # # B4678 $5.00 # B4703 $5.00 #

B4679 $15.00 # # B4704 $18.00 # # B4679 $5.00 # B4704 $5.00 #

B4680 $15.00 # # B4705 $15.00 # # B4680 $5.00 # B4705 $15.00 #

B4681 $10.00 # # B4706 $15.00 # # B4681 $5.00 # B4706 $5.00 #

B4682 $15.00 # # B4707 $15.00 # # B4682 $5.00 # B4707 $15.00 #

B4683 $15.00 # # B4708 $15.00 # # B4683 $5.00 # B4708 $5.00 #

B4684 $15.00 # # B4709 $15.00 # # B4684 $5.00 # B4709 $5.00 #

B4685 $15.00 # # B4710 $15.00 # # B4685 $5.00 # B4710 $5.00 #

B4686 $15.00 # # B4711 $10.00 # # B4686 $5.00 # B4711 $10.00 #

B4687 $15.00 # # B4712 $12.00 # # B4687 $15.00 # B4712 $5.00 #

B4688 $15.00 # # B4713 $12.00 # # B4688 $5.00 # B4713 $5.00 #

B4689 $15.00 # # B4714 $15.00 # # B4689 $5.00 # B4714 $5.00 #

B4690 $15.00 # # B4715 $15.00 # # B4690 $5.00 # B4715 $5.00 #

B4691 $3.00 # # B4716 $15.00 # # B4691 $5.00 # B4716 $5.00 #

B4692 $15.00 # # B4717 $15.00 # # B4692 $5.00 # B4717 $5.00 #

B4693 $10.00 # # B4718 $15.00 # # B4693 $10.00 # B4718 $5.00 #

B4694 $15.00 # # B4719 $10.00 # # B4694 $15.00 # B4719 $5.00 #

B4695 $10.00 # # B4720 $15.00 # # B4695 $10.00 # B4720 $15.00 #

B4696 $12.00 # # B4721 $15.00 # # B4696 $5.00 # B4721 $5.00 #

B4697 $15.00 # # B4722 $10.00 # # B4697 $15.00 # B4722 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4723 $12.00 # # B4748 $15.00 # # B4723 $5.00 # B4748 $5.00 #

B4724 $7.00 # # B4749 $10.00 # # B4724 NADA # B4749 $5.00 #

B4725 $12.00 # # B4750 $12.00 # # B4725 NADA # B4750 $12.00 #

B4726 $12.00 # # B4751 $15.00 # # B4726 NADA # B4751 $15.00 #

B4727 $10.00 # # B4752 $15.00 # # B4727 $5.00 # B4752 $15.00 #

B4728 $10.00 # # B4753 $10.00 # # B4728 $5.00 # B4753 $5.00 #

B4729 $15.00 # # B4754 $15.00 # # B4729 $5.00 # B4754 $5.00 #

B4730 $15.00 # # B4755 $15.00 # # B4730 $5.00 # B4755 $5.00 #

B4731 $12.00 # # B4756 $15.00 # # B4731 $5.00 # B4756 $5.00 #

B4732 $15.00 # # B4757 $15.00 # # B4732 $5.00 # B4757 $5.00 #

B4733 $15.00 # # B4758 $15.00 # # B4733 $5.00 # B4758 $5.00 #

B4734 $15.00 # # B4759 $15.00 # # B4734 $5.00 # B4759 $5.00 #

B4735 $12.00 # # B4760 $15.00 # # B4735 $5.00 # B4760 $5.00 #

B4736 $15.00 # # B4761 $15.00 # # B4736 $5.00 # B4761 $5.00 #

B4737 $12.00 # # B4762 $10.00 # # B4737 $5.00 # B4762 $5.00 #

B4738 $15.00 # # B4763 $15.00 # # B4738 $7.00 # B4763 $5.00 #

B4739 $15.00 # # B4764 $10.00 # # B4739 $5.00 # B4764 $5.00 #

B4740 $10.00 # # B4765 $15.00 # # B4740 $5.00 # B4765 $5.00 #

B4741 $12.00 # # B4766 $15.00 # # B4741 $5.00 # B4766 $5.00 #

B4742 $15.00 # # B4767 $15.00 # # B4742 $5.00 # B4767 $5.00 #

B4743 $12.00 # # B4768 $15.00 # # B4743 $5.00 # B4768 $5.00 #

B4744 $10.00 # # B4769 $10.00 # # B4744 $5.00 # B4769 $5.00 #

B4745 $15.00 # # B4770 $15.00 # # B4745 $5.00 # B4770 $5.00 #

B4746 $15.00 # # B4771 $12.00 # # B4746 $5.00 # B4771 $5.00 #

B4747 $15.00 # # B4772 $15.00 # # B4747 $5.00 # B4772 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4773 $15.00 # # B4798 $15.00 # # B4773 $5.00 # B4798 $7.00 #

B4774 $15.00 # # B4799 $15.00 # # B4774 $5.00 # B4799 $5.00 #

B4775 $15.00 # # B4800 $15.00 # # B4775 $5.00 # B4800 $15.00 #

B4776 $12.00 # # B4801 $15.00 # # B4776 $5.00 # B4801 $5.00 #

B4777 $15.00 # # B4802 $15.00 # # B4777 $5.00 # B4802 $5.00 #

B4778 $15.00 # # B4803 $18.00 # # B4778 $15.00 # B4803 $5.00 #

B4779 $10.00 # # B4804 $10.00 # # B4779 $5.00 # B4804 $10.00 #

B4780 $15.00 # # B4805 $15.00 # # B4780 $5.00 # B4805 $5.00 #

B4781 $15.00 # # B4806 $15.00 # # B4781 $5.00 # B4806 $5.00 #

B4782 $15.00 # # B4807 $10.00 # # B4782 $5.00 # B4807 $5.00 #

B4783 $15.00 # # B4808 $15.00 # # B4783 $5.00 # B4808 $5.00 #

B4784 $12.00 # # B4809 $8.00 # # B4784 $5.00 # B4809 $5.00 #

B4785 $10.00 # # B4810 $12.00 # # B4785 $5.00 # B4810 $12.00 #

B4786 $15.00 # # B4811 $15.00 # # B4786 $5.00 # B4811 $15.00 #

B4787 $10.00 # # B4812 $15.00 # # B4787 $5.00 # B4812 $5.00 #

B4788 $15.00 # # B4813 $15.00 # # B4788 $5.00 # B4813 $5.00 #

B4789 $15.00 # # B4814 $15.00 # # B4789 $5.00 # B4814 $5.00 #

B4790 $15.00 # # B4815 $15.00 # # B4790 $5.00 # B4815 $5.00 #

B4791 $10.00 # # B4816 $15.00 # # B4791 $5.00 # B4816 $5.00 #

B4792 $15.00 # # B4817 $12.00 # # B4792 $5.00 # B4817 $5.00 #

B4793 NADA # # B4818 $15.00 # # B4793 $5.00 # B4818 $5.00 #

B4794 $15.00 # # B4819 $15.00 # # B4794 $5.00 # B4819 $5.00 #

B4795 NADA # # B4820 $15.00 # # B4795 $5.00 # B4820 $5.00 #

B4796 NADA # # B4821 $15.00 # # B4796 $5.00 # B4821 $5.00 #

B4797 $15.00 # # B4822 $15.00 # # B4797 $5.00 # B4822 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4823 $12.00 # # B4848 $12.00 # # B4823 $5.00 # B4848 $12.00 #

B4824 $10.00 # # B4849 $12.00 # # B4824 $5.00 # B4849 $12.00 #

B4825 $15.00 # # B4850 $15.00 # # B4825 $5.00 # B4850 $5.00 #

B4826 $15.00 # # B4851 $15.00 # # B4826 $5.00 # B4851 $5.00 #

B4827 $12.00 # # B4852 $15.00 # # B4827 $5.00 # B4852 $5.00 #

B4828 $15.00 # # B4853 $15.00 # # B4828 $7.00 # B4853 $5.00 #

B4829 $15.00 # # B4854 $12.00 # # B4829 $5.00 # B4854 $5.00 #

B4830 $15.00 # # B4855 $15.00 # # B4830 $5.00 # B4855 $5.00 #

B4831 $12.00 # # B4856 $15.00 # # B4831 $5.00 # B4856 $5.00 #

B4832 $15.00 # # B4857 $18.00 # # B4832 $5.00 # B4857 $5.00 #

B4833 $10.00 # # B4858 $18.00 # # B4833 $5.00 # B4858 $5.00 #

B4834 $15.00 # # B4859 $15.00 # # B4834 $5.00 # B4859 $5.00 #

B4835 $10.00 # # B4860 NADA # # B4835 $5.00 # B4860 $7.00 #

B4836 $15.00 # # B4861 $15.00 # # B4836 $5.00 # B4861 $5.00 #

B4837 NADA # # B4862 $10.00 # # B4837 NADA # B4862 $5.00 #

B4838 NADA # # B4863 $12.00 # # B4838 NADA # B4863 $5.00 #

B4839 $15.00 # # B4864 $12.00 # # B4839 $15.00 # B4864 $12.00 #

B4840 $12.00 # # B4865 $10.00 # # B4840 $5.00 # B4865 $5.00 #

B4841 $15.00 # # B4866 $10.00 # # B4841 $5.00 # B4866 $5.00 #

B4842 $12.00 # # B4867 $10.00 # # B4842 $5.00 # B4867 $5.00 #

B4843 $12.00 # # B4868 $15.00 # # B4843 $5.00 # B4868 $15.00 #

B4844 $15.00 # # B4869 $12.00 # # B4844 $5.00 # B4869 $5.00 #

B4845 $20.00 # # B4870 NADA # # B4845 $15.00 # B4870 $5.00 #

B4846 $15.00 # # B4871 $15.00 # # B4846 $5.00 # B4871 $15.00 #

B4847 $15.00 # # B4872 $20.00 # # B4847 $15.00 # B4872 $15.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4873 $20.00 # # B4898 $10.00 # # B4873 $15.00 # B4898 $10.00 #

B4874 $12.00 # # B4899 $12.00 # # B4874 $5.00 # B4899 $12.00 #

B4875 $20.00 # # B4900 $20.00 # # B4875 $5.00 # B4900 $5.00 #

B4876 $20.00 # # B4901 $15.00 # # B4876 $5.00 # B4901 $5.00 #

B4877 $12.00 # # B4902 $10.00 # # B4877 $12.00 # B4902 $5.00 #

B4878 $10.00 # # B4903 $15.00 # # B4878 $5.00 # B4903 $5.00 #

B4879 $10.00 # # B4904 $10.00 # # B4879 $5.00 # B4904 $18.00 #

B4880 $12.00 # # B4905 $15.00 # # B4880 $5.00 # B4905 $5.00 #

B4881 $10.00 # # B4906 $15.00 # # B4881 $5.00 # B4906 $5.00 #

B4882 $15.00 # # B4907 $15.00 # # B4882 $5.00 # B4907 $5.00 #

B4883 $15.00 # # B4908 $15.00 # # B4883 $5.00 # B4908 $5.00 #

B4884 $15.00 # # B4909 $15.00 # # B4884 $5.00 # B4909 $5.00 #

B4885 $15.00 # # B4910 $15.00 # # B4885 $5.00 # B4910 $5.00 #

B4886 $15.00 # # B4911 $12.00 # # B4886 $7.00 # B4911 $12.00 #

B4887 $15.00 # # B4912 $10.00 # # B4887 $5.00 # B4912 $5.00 #

B4888 $15.00 # # B4913 $15.00 # # B4888 $5.00 # B4913 $5.00 #

B4889 $15.00 # # B4914 $15.00 # # B4889 $5.00 # B4914 $5.00 #

B4890 $15.00 # # B4915 $15.00 # # B4890 $5.00 # B4915 $5.00 #

B4891 $15.00 # # B4916 $15.00 # # B4891 $5.00 # B4916 $5.00 #

B4892 $12.00 # # B4917 $15.00 # # B4892 $5.00 # B4917 $5.00 #

B4893 $15.00 # # B4918 $15.00 # # B4893 $5.00 # B4918 $5.00 #

B4894 $10.00 # # B4919 $15.00 # # B4894 $5.00 # B4919 $5.00 #

B4895 $15.00 # # B4920 $18.00 # # B4895 $5.00 # B4920 $5.00 #

B4896 $15.00 # # B4921 $5.00 # # B4896 $5.00 # B4921 $5.00 #

B4897 $15.00 # # B4922 $15.00 # # B4897 $5.00 # B4922 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4923 $15.00 # # B4948 $15.00 # # B4923 $5.00 # B4948 $5.00 #

B4924 $15.00 # # B4949 $15.00 # # B4924 $5.00 # B4949 $5.00 #

B4925 $15.00 # # B4950 $12.00 # # B4925 $5.00 # B4950 $5.00 #

B4926 $15.00 # # B4951 $10.00 # # B4926 $5.00 # B4951 $5.00 #

B4927 $15.00 # # B4952 $15.00 # # B4927 $5.00 # B4952 $5.00 #

B4928 $15.00 # # B4953 $12.00 # # B4928 $5.00 # B4953 $5.00 #

B4929 $12.00 # # B4954 $15.00 # # B4929 $5.00 # B4954 $5.00 #

B4930 $10.00 # # B4955 $15.00 # # B4930 $5.00 # B4955 $5.00 #

B4931 $15.00 # # B4956 $15.00 # # B4931 $5.00 # B4956 $5.00 #

B4932 $15.00 # # B4957 $15.00 # # B4932 $5.00 # B4957 $5.00 #

B4933 $10.00 # # B4958 $15.00 # # B4933 $5.00 # B4958 $5.00 #

B4934 $10.00 # # B4959 $15.00 # # B4934 $10.00 # B4959 $5.00 #

B4935 $20.00 # # B4960 $15.00 # # B4935 $10.00 # B4960 $5.00 #

B4936 $20.00 # # B4961 $15.00 # # B4936 $10.00 # B4961 $5.00 #

B4937 $20.00 # # B4962 $7.00 # # B4937 $5.00 # B4962 $7.00 #

B4938 $15.00 # # B4963 $7.00 # # B4938 $5.00 # B4963 $7.00 #

B4939 $15.00 # # B4964 $15.00 # # B4939 $5.00 # B4964 $5.00 #

B4940 $12.00 # # B4965 $15.00 # # B4940 $12.00 # B4965 $5.00 #

B4941 $15.00 # # B4966 $20.00 # # B4941 $5.00 # B4966 $5.00 #

B4942 $12.00 # # B4967 $15.00 # # B4942 $12.00 # B4967 $5.00 #

B4943 $15.00 # # B4968 $18.00 # # B4943 $5.00 # B4968 $5.00 #

B4944 $15.00 # # B4969 $15.00 # # B4944 $5.00 # B4969 $5.00 #

B4945 $15.00 # # B4970 $15.00 # # B4945 $5.00 # B4970 $5.00 #

B4946 $15.00 # # B4971 $18.00 # # B4946 $5.00 # B4971 $5.00 #

B4947 $15.00 # # B4972 $18.00 # # B4947 $5.00 # B4972 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B4973 $10.00 # # B4998 $12.00 # # B4973 $5.00 # B4998 $15.00 #

B4974 $12.00 # # B4999 $12.00 # # B4974 $5.00 # B4999 $5.00 #

B4975 $15.00 # # B5000 $12.00 # # B4975 $5.00 # B5000 $5.00 #

B4976 $12.00 # # B5001 $18.00 # # B4976 $5.00 # B5001 $5.00 #

B4977 $15.00 # # B5002 $12.00 # # B4977 $5.00 # B5002 $5.00 #

B4978 $15.00 # # B5003 $10.00 # # B4978 $5.00 # B5003 $5.00 #

B4979 $12.00 # # B5004 $15.00 # # B4979 $5.00 # B5004 $5.00 #

B4980 $15.00 # # B5005 $15.00 # # B4980 $5.00 # B5005 $5.00 #

B4981 $15.00 # # B5006 $15.00 # # B4981 $5.00 # B5006 $15.00 #

B4982 $10.00 # # B5007 $12.00 # # B4982 $5.00 # B5007 $12.00 #

B4983 $15.00 # # B5008 $15.00 # # B4983 $5.00 # B5008 $5.00 #

B4984 $15.00 # # B5009 $12.00 # # B4984 $5.00 # B5009 $5.00 #

B4985 $15.00 # # B5010 $15.00 # # B4985 $5.00 # B5010 $5.00 #

B4986 $7.00 # # B5011 $15.00 # # B4986 $5.00 # B5011 $5.00 #

B4987 $15.00 # # B5012 $15.00 # # B4987 $5.00 # B5012 $15.00 #

B4988 $15.00 # # B5013 $15.00 # # B4988 $5.00 # B5013 $5.00 #

B4989 $15.00 # # B5014 $12.00 # # B4989 $5.00 # B5014 $5.00 #

B4990 $10.00 # # B5015 $7.00 # # B4990 $5.00 # B5015 $5.00 #

B4991 $12.00 # # B5016 $15.00 # # B4991 $6.50 # B5016 $5.00 #

B4992 $18.00 # # B5017 $15.00 # # B4992 $5.00 # B5017 $5.00 #

B4993 $15.00 # # B5018 $10.00 # # B4993 $5.00 # B5018 $5.00 #

B4994 $15.00 # # B5019 $15.00 # # B4994 $5.00 # B5019 $15.00 #

B4995 $15.00 # # B5020 $15.00 # # B4995 $5.00 # B5020 $5.00 #

B4996 $7.00 # # B5021 $15.00 # # B4996 $5.00 # B5021 $5.00 #

B4997 $12.00 # # B5022 $10.00 # # B4997 $15.00 # B5022 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5023 $15.00 # # B5048 $15.00 # # B5023 $5.00 # B5048 $5.00 #

B5024 $5.00 # # B5049 $15.00 # # B5024 $5.00 # B5049 $5.00 #

B5025 $12.00 # # B5050 $12.00 # # B5025 $5.00 # B5050 $5.00 #

B5026 $15.00 # # B5051 $15.00 # # B5026 $5.00 # B5051 $5.00 #

B5027 $18.00 # # B5052 $15.00 # # B5027 $5.00 # B5052 $5.00 #

B5028 $15.00 # # B5053 $15.00 # # B5028 $5.00 # B5053 $5.00 #

B5029 $15.00 # # B5054 $12.00 # # B5029 $5.00 # B5054 $5.00 #

B5030 $15.00 # # B5055 $12.00 # # B5030 $5.00 # B5055 $5.00 #

B5031 $10.00 # # B5056 $15.00 # # B5031 $10.00 # B5056 $5.00 #

B5032 $15.00 # # B5057 $18.00 # # B5032 $5.00 # B5057 $5.00 #

B5033 $10.00 # # B5058 $12.00 # # B5033 $5.00 # B5058 $12.00 #

B5034 $18.00 # # B5059 $15.00 # # B5034 $5.00 # B5059 $5.00 #

B5035 $15.00 # # B5060 $12.00 # # B5035 $5.00 # B5060 $12.00 #

B5036 $10.00 # # B5061 $15.00 # # B5036 $5.00 # B5061 $5.00 #

B5037 $10.00 # # B5062 $10.00 # # B5037 $5.00 # B5062 $5.00 #

B5038 $15.00 # # B5063 $20.00 # # B5038 $12.00 # B5063 $5.00 #

B5039 $15.00 # # B5064 $15.00 # # B5039 $5.00 # B5064 $5.00 #

B5040 $15.00 # # B5065 $15.00 # # B5040 $5.00 # B5065 $5.00 #

B5041 $15.00 # # B5066 $15.00 # # B5041 $5.00 # B5066 $5.00 #

B5042 $15.00 # # B5067 $15.00 # # B5042 $5.00 # B5067 $5.00 #

B5043 $15.00 # # B5068 $15.00 # # B5043 $5.00 # B5068 $5.00 #

B5044 $15.00 # # B5069 $20.00 # # B5044 $5.00 # B5069 $5.00 #

B5045 $10.00 # # B5070 $15.00 # # B5045 $5.00 # B5070 $5.00 #

B5046 $15.00 # # B5071 $15.00 # # B5046 $5.00 # B5071 $5.00 #

B5047 $15.00 # # B5072 $15.00 # # B5047 $5.00 # B5072 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5073 $15.00 # # B5098 $10.00 # # B5073 $5.00 # B5098 $5.00 #

B5074 $15.00 # # B5099 $12.00 # # B5074 $15.00 # B5099 $5.00 #

B5075 $15.00 # # B5100 $15.00 # # B5075 $7.00 # B5100 $5.00 #

B5076 $15.00 # # B5101 $12.00 # # B5076 $5.00 # B5101 $5.00 #

B5077 NADA # # B5102 $12.00 # # B5077 $7.00 # B5102 $5.00 #

B5078 $15.00 # # B5103 $15.00 # # B5078 $5.00 # B5103 $15.00 #

B5079 $15.00 # # B5104 NADA # # B5079 $5.00 # B5104 NADA #

B5080 $10.00 # # B5105 $12.00 # # B5080 $5.00 # B5105 $5.00 #

B5081 $15.00 # # B5106 $15.00 # # B5081 $5.00 # B5106 $5.00 #

B5082 $12.00 # # B5107 $10.00 # # B5082 $5.00 # B5107 $10.00 #

B5083 $15.00 # # B5108 $15.00 # # B5083 $5.00 # B5108 $5.00 #

B5084 $10.00 # # B5109 $15.00 # # B5084 $5.00 # B5109 $5.00 #

B5085 $15.00 # # B5110 $15.00 # # B5085 $5.00 # B5110 $5.00 #

B5086 $15.00 # # B5111 $20.00 # # B5086 $15.00 # B5111 $5.00 #

B5087 $10.00 # # B5112 $15.00 # # B5087 $10.00 # B5112 $5.00 #

B5088 $10.00 # # B5113 $15.00 # # B5088 $5.00 # B5113 $5.00 #

B5089 $10.00 # # B5114 $15.00 # # B5089 $5.00 # B5114 $5.00 #

B5090 $10.00 # # B5115 $15.00 # # B5090 $5.00 # B5115 $5.00 #

B5091 $15.00 # # B5116 $15.00 # # B5091 $5.00 # B5116 $5.00 #

B5092 $15.00 # # B5117 $12.00 # # B5092 $5.00 # B5117 $5.00 #

B5093 $15.00 # # B5118 $15.00 # # B5093 $15.00 # B5118 $5.00 #

B5094 $10.00 # # B5119 $10.00 # # B5094 $10.00 # B5119 $5.00 #

B5095 $15.00 # # B5120 $15.00 # # B5095 $5.00 # B5120 $5.00 #

B5096 $15.00 # # B5121 $15.00 # # B5096 $5.00 # B5121 $5.00 #

B5097 $15.00 # # B5122 $12.00 # # B5097 $15.00 # B5122 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5123 $15.00 # # B5147 $18.00 # # B5123 $5.00 # B5147 $5.00 #

B5124 $10.00 # # B5148 $12.00 # # B5124 $5.00 # B5148 $5.00 #

B5125 $15.00 # # B5149 $15.00 # # B5125 $5.00 # B5149 $5.00 #

B5125 $15.00 # # B5150 $12.00 # # B5125 $5.00 # B5150 $5.00 #

B5126 $10.00 # # B5151 $15.00 # # B5126 $5.00 # B5151 $15.00 #

B5127 $15.00 # # B5152 $10.00 # # B5127 $5.00 # B5152 $5.00 #

B5128 $10.00 # # B5153 $12.00 # # B5128 $5.00 # B5153 $5.00 #

B5129 $15.00 # # B5154 $15.00 # # B5129 $5.00 # B5154 $5.00 #

B5130 $10.00 # # B5155 $10.00 # # B5130 $5.00 # B5155 $5.00 #

B5131 $10.00 # # B5156 $10.00 # # B5131 $5.00 # B5156 $5.00 #

B5132 $15.00 # # B5157 $10.00 # # B5132 $20.00 # B5157 $5.00 #

B5133 $15.00 # # B5158 $15.00 # # B5133 $5.00 # B5158 $5.00 #

B5134 $15.00 # # B5159 $15.00 # # B5134 $5.00 # B5159 $5.00 #

B5135 $10.00 # # B5160 $15.00 # # B5135 $5.00 # B5160 $5.00 #

B5136 $15.00 # # B5161 $15.00 # # B5136 $5.00 # B5161 $5.00 #

B5137 $15.00 # # B5162 $15.00 # # B5137 $5.00 # B5162 $5.00 #

B5138 $10.00 # # B5163 $10.00 # # B5138 $5.00 # B5163 $15.00 #

B5139 $10.00 # # B5164 $10.00 # # B5139 $5.00 # B5164 $15.00 #

B5140 $12.00 # # B5165 $8.00 # # B5140 $12.00 # B5165 $8.00 #

B5141 $15.00 # # B5166 $15.00 # # B5141 $5.00 # B5166 $5.00 #

B5142 $15.00 # # B5167 $8.00 # # B5142 $5.00 # B5167 $12.00 #

B5143 $15.00 # # B5168 $15.00 # # B5143 $5.00 # B5168 $5.00 #

B5144 $18.00 # # B5169 $15.00 # # B5144 $5.00 # B5169 $5.00 #

B5145 $15.00 # # B5170 $12.00 # # B5145 $5.00 # B5170 $5.00 #

B5146 $15.00 # # B5171 $10.00 # # B5146 $5.00 # B5171 $15.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5172 $12.00 # # B5197 $15.00 # # B5172 $5.00 # B5197 $5.00 #

B5173 $12.00 # # B5198 $15.00 # # B5173 $5.00 # B5198 $5.00 #

B5174 $15.00 # # B5199 $15.00 # # B5174 $5.00 # B5199 $5.00 #

B5175 $15.00 # # B5200 $15.00 # # B5175 $5.00 # B5200 $5.00 #

B5176 $10.00 # # B5201 NADA # # B5176 $5.00 # B5201 NADA #

B5177 $15.00 # # B5202 NADA # # B5177 $5.00 # B5202 NADA #

B5178 $15.00 # # B5203 $10.00 # # B5178 $5.00 # B5203 $7.00 #

B5179 $18.00 # # B5204 $15.00 # # B5179 $5.00 # B5204 $5.00 #

B5180 $15.00 # # B5205 $20.00 # # B5180 $5.00 # B5205 $5.00 #

B5181 $10.00 # # B5206 $7.00 # # B5181 $5.00 # B5206 $7.00 #

B5182 $18.00 # # B5207 $10.00 # # B5182 $5.00 # B5207 $7.00 #

B5183 $18.00 # # B5208 $15.00 # # B5183 $5.00 # B5208 $5.00 #

B5184 $15.00 # # B5209 $15.00 # # B5184 $5.00 # B5209 $5.00 #

B5185 $15.00 # # B5210 $15.00 # # B5185 $5.00 # B5210 $5.00 #

B5186 $15.00 # # B5211 $12.00 # # B5186 $5.00 # B5211 $5.00 #

B5187 $10.00 # # B5212 $8.00 # # B5187 $5.00 # B5212 $5.00 #

B5188 $15.00 # # B5213 $15.00 # # B5188 $5.00 # B5213 $5.00 #

B5189 $10.00 # # B5214 $8.00 # # B5189 $5.00 # B5214 $5.00 #

B5190 $15.00 # # B5215 $10.00 # # B5190 $5.00 # B5215 $5.00 #

B5191 $15.00 # # B5216 $15.00 # # B5191 $5.00 # B5216 $5.00 #

B5192 $15.00 # # B5217 $15.00 # # B5192 $15.00 # B5217 $5.00 #

B5193 $10.00 # # B5218 $12.00 # # B5193 $5.00 # B5218 $5.00 #

B5194 $15.00 # # B5219 $5.00 # # B5194 $5.00 # B5219 $5.00 #

B5195 $18.00 # # B5220 $20.00 # # B5195 $5.00 # B5220 $5.00 #

B5196 $15.00 # # B5221 $12.00 # # B5196 $5.00 # B5221 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5222 $15.00 # # B5247 $10.00 # # B5222 $5.00 # B5247 $5.00 #

B5223 $15.00 # # B5248 $10.00 # # B5223 $5.00 # B5248 $5.00 #

B5224 $15.00 # # B5249 $15.00 # # B5224 $5.00 # B5249 $5.00 #

B5225 $15.00 # # B5250 $15.00 # # B5225 $5.00 # B5250 $5.00 #

B5226 $12.00 # # B5251 $10.00 # # B5226 $12.00 # B5251 $5.00 #

B5227 $12.00 # # B5252 $18.00 # # B5227 $5.00 # B5252 $5.00 #

B5228 $15.00 # # B5253 $15.00 # # B5228 $5.00 # B5253 $5.00 #

B5229 $15.00 # # B5254 $12.00 # # B5229 $5.00 # B5254 $5.00 #

B5230 $15.00 # # B5255 $15.00 # # B5230 $5.00 # B5255 $15.00 #

B5231 $15.00 # # B5256 $15.00 # # B5231 $5.00 # B5256 $5.00 #

B5232 $15.00 # # B5257 $12.00 # # B5232 $5.00 # B5257 $5.00 #

B5233 $18.00 # # B5258 $15.00 # # B5233 $5.00 # B5258 $5.00 #

B5234 $15.00 # # B5259 $15.00 # # B5234 $5.00 # B5259 $5.00 #

B5235 $15.00 # # B5260 $20.00 # # B5235 $5.00 # B5260 $5.00 #

B5236 $12.00 # # B5261 $18.00 # # B5236 $12.00 # B5261 $7.00 #

B5237 $10.00 # # B5262 $12.00 # # B5237 $5.00 # B5262 $5.00 #

B5238 $10.00 # # B5263 $15.00 # # B5238 $5.00 # B5263 $5.00 #

B5239 $12.00 # # B5264 $15.00 # # B5239 $5.00 # B5264 $5.00 #

B5240 $10.00 # # B5265 $15.00 # # B5240 $5.00 # B5265 $5.00 #

B5241 $15.00 # # B5266 $15.00 # # B5241 $5.00 # B5266 $5.00 #

B5242 $15.00 # # B5267 $15.00 # # B5242 $5.00 # B5267 $5.00 #

B5243 $15.00 # # B5268 $15.00 # # B5243 $5.00 # B5268 $5.00 #

B5244 $15.00 # # B5269 $15.00 # # B5244 $7.00 # B5269 $5.00 #

B5245 $10.00 # # B5270 $15.00 # # B5245 $5.00 # B5270 $5.00 #

B5246 $10.00 # # B5271 NADA # # B5246 $5.00 # B5271 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5272 NADA # # B5297 $15.00 # # B5272 $5.00 # B5297 $15.00 #

B5273 NADA # # B5298 $12.00 # # B5273 $5.00 # B5298 $12.00 #

B5274 NADA # # B5299 $15.00 # # B5274 $5.00 # B5299 $5.00 #

B5275 $15.00 # # B5300 $10.00 # # B5275 $5.00 # B5300 $10.00 #

B5276 $10.00 # # B5301 $10.00 # # B5276 $5.00 # B5301 $10.00 #

B5277 $15.00 # # B5302 $15.00 # # B5277 $5.00 # B5302 $5.00 #

B5278 $15.00 # # B5303 $20.00 # # B5278 $5.00 # B5303 $5.00 #

B5279 $15.00 # # B5304 $20.00 # # B5279 $5.00 # B5304 $5.00 #

B5280 $12.00 # # B5305 $15.00 # # B5280 $5.00 # B5305 $5.00 #

B5281 NADA # # B5306 $20.00 # # B5281 $5.00 # B5306 $5.00 #

B5282 $15.00 # # B5307 $20.00 # # B5282 $5.00 # B5307 $5.00 #

B5283 $15.00 # # B5308 $12.00 # # B5283 $5.00 # B5308 $12.00 #

B5284 $15.00 # # B5309 $15.00 # # B5284 $5.00 # B5309 $5.00 #

B5286 $15.00 # # B5310 $12.00 # # B5286 $5.00 # B5310 $5.00 #

B5287 $15.00 # # B5311 $15.00 # # B5287 $5.00 # B5311 $5.00 #

B5288 $15.00 # # B5312 $15.00 # # B5288 $5.00 # B5312 $5.00 #

B5289 $15.00 # # B5313 NADA # # B5289 $7.00 # B5313 NADA #

B5290 $8.00 # # B5314 $15.00 # # B5290 $5.00 # B5314 $15.00 #

B5291 $10.00 # # B5315 $15.00 # # B5291 $5.00 # B5315 $5.00 #

B5292 $12.00 # # B5316 $10.00 # # B5292 $12.00 # B5316 $5.00 #

B5293 $12.00 # # B5317 $15.00 # # B5293 $12.00 # B5317 $5.00 #

B5294 $10.00 # # B5318 $10.00 # # B5294 $5.00 # B5318 $5.00 #

B5295 $15.00 # # B5319 $12.00 # # B5295 $5.00 # B5319 $5.00 #

B5296 $12.00 # # B5320 $12.00 # # B5296 $12.00 # B5320 $5.00 #

B5286 $15.00 # # B5321 $12.00 # # B5286 $5.00 # B5321 $12.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5322 $15.00 # # B5347 $10.00 # # B5322 $5.00 # B5347 NADA #

B5323 $15.00 # # B5348 $10.00 # # B5323 $5.00 # B5348 NADA #

B5324 $15.00 # # B5349 $10.00 # # B5324 $5.00 # B5349 NADA #

B5325 $8.00 # # B5350 $10.00 # # B5325 $5.00 # B5350 $10.00 #

B5326 $15.00 # # B5351 $10.00 # # B5326 $5.00 # B5351 NADA #

B5327 $2.00 # # B5352 $10.00 # # B5327 NADA # B5352 NADA #

B5328 $15.00 # # B5353 $10.00 # # B5328 $5.00 # B5353 NADA #

B5329 $12.00 # # B5354 $10.00 # # B5329 $5.00 # B5354 NADA #

B5330 $20.00 # # B5355 $10.00 # # B5330 $5.00 # B5355 $10.00 #

B5331 NADA # # B5356 $10.00 # # B5331 $5.00 # B5356 NADA #

B5332 $15.00 # # B5357 $10.00 # # B5332 $5.00 # B5357 NADA #

B5333 $15.00 # # B5358 $10.00 # # B5333 $5.00 # B5358 NADA #

B5334 $15.00 # # B5359 $10.00 # # B5334 $5.00 # B5359 NADA #

B5335 $12.00 # # B5360 $12.00 # # B5335 $12.00 # B5360 $12.00 #

B5336 $15.00 # # B5361 $15.00 # # B5336 $5.00 # B5361 $5.00 #

B5337 $12.00 # # B5362 $15.00 # # B5337 $12.00 # B5362 $5.00 #

B5338 $10.00 # # B5363 $10.00 # # B5338 $5.00 # B5363 $5.00 #

B5339 $15.00 # # B5364 $10.00 # # B5339 $5.00 # B5364 $5.00 #

B5340 $10.00 # # B5365 $10.00 # # B5340 $10.00 # B5365 $5.00 #

B5341 $18.00 # # B5366 $20.00 # # B5341 $5.00 # B5366 $5.00 #

B5342 $10.00 # # B5367 $20.00 # # B5342 NADA # B5367 $5.00 #

B5343 $10.00 # # B5368 $10.00 # # B5343 NADA # B5368 $5.00 #

B5344 $10.00 # # B5369 $15.00 # # B5344 $5.00 # B5369 NADA #

B5345 $10.00 # # B5370 $15.00 # # B5345 $10.00 # B5370 NADA #

B5346 $10.00 # # B5371 $15.00 # # B5346 NADA # B5371 NADA #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5372 $15.00 # # B5396 $15.00 # # B5372 $5.00 # B5396 $15.00 #

B5373 $15.00 # # B5397 $15.00 # # B5373 $5.00 # B5397 $15.00 #

B5374 $20.00 # # B5398 $5.00 # # B5374 $5.00 # B5398 $10.00 #

B5375 $20.00 # # B5399 $10.00 # # B5375 $5.00 # B5399 $10.00 #

B5376 $20.00 # # B5400 $15.00 # # B5376 $5.00 # B5400 $15.00 #

B5377 $15.00 # # B5401 $12.00 # # B5377 $5.00 # B5401 $12.00 #

B5378 $15.00 # # B5402 $15.00 # # B5378 $5.00 # B5402 $15.00 #

B5379 $15.00 # # B5403 $15.00 # # B5379 $5.00 # B5403 $15.00 #

B5380 $10.00 # # B5404 $15.00 # # B5380 $5.00 # B5404 $15.00 #

B5381 $12.00 # # B5405 $15.00 # # B5381 $5.00 # B5405 $15.00 #

B5382 $15.00 # # B5406 $15.00 # # B5382 $5.00 # B5406 $15.00 #

B5383 $10.00 # # B5407 $15.00 # # B5383 $5.00 # B5407 $15.00 #

B5384 $10.00 # # B5408 $15.00 # # B5384 $5.00 # B5408 $15.00 #

B5385 $15.00 # # B5409 $15.00 # # B5385 $5.00 # B5409 $15.00 #

B5386 $15.00 # # B5410 NADA # # B5386 $5.00 # B5410 NADA #

B5387 $15.00 # # B5411 $15.00 # # B5387 $5.00 # B5411 $15.00 #

B5388 $15.00 # # B5412 NADA # # B5388 $5.00 # B5412 NADA #

B5389 $15.00 # # B5413 $15.00 # # B5389 $5.00 # B5413 $15.00 #

B5390 $20.00 # # B5414 NADA # # B5390 $20.00 # B5414 NADA #

B5391 $10.00 # # B5415 $15.00 # # B5391 $10.00 # B5415 $15.00 #

B5392 $15.00 # # B5416 $17.00 # # B5392 $15.00 # B5416 $17.00 #

B5393 $12.00 # # B5417 $15.00 # # B5393 $12.00 # B5417 $15.00 #

B5394 $15.00 # # B5418 NADA # # B5394 $15.00 # B5418 $15.00 #

B5395 $10.00 # # B5419 NADA # # B5395 $10.00 # B5419 $15.00 #

B5390 $20.00 # # B5420 $10.00 # # B5390 $20.00 # B5420 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5421 $10.00 # # B5446 NADA # # B5421 $10.00 # B5446 NADA #

B5422 $10.00 # # B5447 $15.00 # # B5422 $10.00 # B5447 NADA #

B5423 $10.00 # # B5448 $15.00 # # B5423 $10.00 # B5448 NADA #

B5424 $10.00 # # B5449 $15.00 # # B5424 $10.00 # B5449 $15.00 #

B5425 $10.00 # # B5450 $15.00 # # B5425 $10.00 # B5450 $15.00 #

B5426 $15.00 # # B5451 $15.00 # # B5426 $15.00 # B5451 $15.00 #

B5427 $10.00 # # B5452 $15.00 # # B5427 $10.00 # B5452 $15.00 #

B5428 $12.00 # # B5453 $15.00 # # B5428 $12.00 # B5453 $15.00 #

B5429 $10.00 # # B5454 $15.00 # # B5429 $10.00 # B5454 $15.00 #

B5430 $15.00 # # B5455 $15.00 # # B5430 $15.00 # B5455 $15.00 #

B5431 NADA # # B5456 $15.00 # # B5431 $12.00 # B5456 $15.00 #

B5431 NADA # # B5457 $15.00 # # B5431 $12.00 # B5457 $15.00 #

B5432 NADA # # B5458 $15.00 # # B5432 NADA # B5458 $15.00 #

B5433 NADA # # B5459 $15.00 # # B5433 $12.00 # B5459 $15.00 #

B5434 $12.00 # # B5460 $12.00 # # B5434 $12.00 # B5460 $12.00 #

B5436 $15.00 # # B5461 $12.00 # # B5436 $15.00 # B5461 $12.00 #

B5437 $15.00 # # B5462 $15.00 # # B5437 $15.00 # B5462 $20.00 #

B5438 $15.00 # # B5463 $12.00 # # B5438 $15.00 # B5463 $12.00 #

B5439 $12.00 # # B5464 $15.00 # # B5439 $12.00 # B5464 $20.00 #

B5440 $15.00 # # B5465 $15.00 # # B5440 $15.00 # B5465 $15.00 #

B5441 NADA # # B5466 $15.00 # # B5441 $20.00 # B5466 $15.00 #

B5442 $15.00 # # B5467 $12.00 # # B5442 NADA # B5467 $12.00 #

B5443 $15.00 # # B5468 $15.00 # # B5443 $15.00 # B5468 $20.00 #

B5444 $12.00 # # B5469 $12.00 # # B5444 $12.00 # B5469 $12.00 #

B5445 NADA # # B5470 $12.00 # # B5445 NADA # B5470 $12.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5471 $12.00 # # B5496 $12.00 # # B5471 $12.00 # B5496 $12.00 #

B5472 $15.00 # # B5497 $12.00 # # B5472 $15.00 # B5497 $12.00 #

B5473 $12.00 # # B5498 $12.00 # # B5473 $12.00 # B5498 $12.00 #

B5474 $12.00 # # B5499 $12.00 # # B5474 $12.00 # B5499 $12.00 #

B5475 $12.00 # # B5500 $15.00 # # B5475 $12.00 # B5500 $20.00 #

B5476 $2.00 # # B5501 $10.00 # # B5476 $2.00 # B5501 $10.00 #

B5477 $15.00 # # B5502 $7.00 # # B5477 $15.00 # B5502 $18.00 #

B5478 $15.00 # # B5503 $15.00 # # B5478 $15.00 # B5503 $15.00 #

B5479 $15.00 # # B5504 NADA # # B5479 $15.00 # B5504 NADA #

B5480 $12.00 # # B5505 NADA # # B5480 $12.00 # B5505 NADA #

B5481 $15.00 # # B5506 $15.00 # # B5481 $15.00 # B5506 $15.00 #

B5482 $15.00 # # B5507 NADA # # B5482 $15.00 # B5507 NADA #

B5483 $15.00 # # B5508 NADA # # B5483 $15.00 # B5508 NADA #

B5484 $15.00 # # B5509 $15.00 # # B5484 $15.00 # B5509 $15.00 #

B5485 $15.00 # # B5510 NADA # # B5485 $15.00 # B5510 NADA #

B5486 $18.00 # # B5511 NADA # # B5486 $18.00 # B5511 NADA #

B5487 $15.00 # # B5512 $12.00 # # B5487 $20.00 # B5512 $12.00 #

B5488 $12.00 # # B5513 $12.00 # # B5488 $12.00 # B5513 $12.00 #

B5489 $15.00 # # B5514 NADA # # B5489 $20.00 # B5514 NADA #

B5490 $15.00 # # B5515 NADA # # B5490 $15.00 # B5515 NADA #

B5491 $15.00 # # B5516 NADA # # B5491 $15.00 # B5516 NADA #

B5492 $15.00 # # B5517 $15.00 # # B5492 $15.00 # B5517 $15.00 #

B5493 $15.00 # # B5518 $15.00 # # B5493 $15.00 # B5518 $15.00 #

B5494 $15.00 # # B5519 NADA # # B5494 $15.00 # B5519 NADA #

B5495 $15.00 # # B5520 $12.00 # # B5495 $15.00 # B5520 $12.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5521 NADA # # B5546 $15.00 # # B5521 NADA # B5546 $5.00 #

B5522 NADA # # B5547 $15.00 # # B5522 NADA # B5547 $5.00 #

B5523 NADA # # B5548 $15.00 # # B5523 NADA # B5548 $5.00 #

B5524 NADA # # B5549 $15.00 # # B5524 NADA # B5549 $5.00 #

B5525 $12.00 # # B5550 $15.00 # # B5525 $12.00 # B5550 $15.00 #

B5526 $15.00 # # B5551 $15.00 # # B5526 $15.00 # B5551 $15.00 #

B5527 $15.00 # # B5552 $12.00 # # B5527 $15.00 # B5552 $12.00 #

B5528 $15.00 # # B5553 $12.00 # # B5528 $15.00 # B5553 $12.00 #

B5529 NADA # # B5554 $15.00 # # B5529 $10.00 # B5554 $5.00 #

B5530 NADA # # B5555 $15.00 # # B5530 $10.00 # B5555 $5.00 #

B5531 NADA # # B5556 $15.00 # # B5531 NADA # B5556 $5.00 #

B5532 NADA # # B5557 $15.00 # # B5532 NADA # B5557 $5.00 #

B5533 NADA # # B5558 $15.00 # # B5533 NADA # B5558 $5.00 #

B5534 $15.00 # # B5559 $12.00 # # B5534 $15.00 # B5559 $12.00 #

B5535 $12.00 # # B5560 $15.00 # # B5535 $12.00 # B5560 $15.00 #

B5536 NADA # # B5561 $15.00 # # B5536 NADA # B5561 $5.00 #

B5537 $12.00 # # B5562 $10.00 # # B5537 $12.00 # B5562 $5.00 #

B5538 NADA # # B5563 $18.00 # # B5538 NADA # B5563 $5.00 #

B5539 $15.00 # # B5564 $15.00 # # B5539 $15.00 # B5564 $15.00 #

B5540 $15.00 # # B5565 $15.00 # # B5540 $15.00 # B5565 $15.00 #

B5541 $15.00 # # B5566 $18.00 # # B5541 $15.00 # B5566 $5.00 #

B5542 $15.00 # # B5567 $15.00 # # B5542 $15.00 # B5567 $5.00 #

B5543 $12.00 # # B5568 $15.00 # # B5543 $12.00 # B5568 $15.00 #

B5544 $10.00 # # B5569 $15.00 # # B5544 $10.00 # B5569 $5.00 #

B5545 $12.00 # # B5570 $18.00 # # B5545 $12.00 # B5570 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5571 $18.00 # # B5596 $12.00 # # B5571 $5.00 # B5596 $5.00 #

B5572 $15.00 # # B5597 $10.00 # # B5572 $5.00 # B5597 $5.00 #

B5573 $10.00 # # B5598 $10.00 # # B5573 $10.00 # B5598 $10.00 #

B5574 $12.00 # # B5599 $10.00 # # B5574 $12.00 # B5599 $10.00 #

B5575 $12.00 # # B5600 $10.00 # # B5575 $5.00 # B5600 $10.00 #

B5576 $15.00 # # B5601 $12.00 # # B5576 $5.00 # B5601 $5.00 #

B5577 $12.00 # # B5602 $20.00 # # B5577 $12.00 # B5602 $5.00 #

B5578 $15.00 # # B5603 $20.00 # # B5578 $5.00 # B5603 $5.00 #

B5579 $18.00 # # B5604 $10.00 # # B5579 $5.00 # B5604 $5.00 #

B5580 $15.00 # # B5605 $12.00 # # B5580 $5.00 # B5605 $5.00 #

B5581 $18.00 # # B5606 $12.00 # # B5581 $7.00 # B5606 $12.00 #

B5582 $12.00 # # B5607 $12.00 # # B5582 $5.00 # B5607 $5.00 #

B5583 $12.00 # # B5608 $10.00 # # B5583 $5.00 # B5608 $5.00 #

B5584 $15.00 # # B5609 NADA # # B5584 $5.00 # B5609 $5.00 #

B5585 $15.00 # # B5610 $18.00 # # B5585 $5.00 # B5610 $5.00 #

B5586 $18.00 # # B5611 $15.00 # # B5586 $7.00 # B5611 $5.00 #

B5587 $12.00 # # B5612 $15.00 # # B5587 $12.00 # B5612 $5.00 #

B5588 $15.00 # # B5613 $18.00 # # B5588 $5.00 # B5613 $5.00 #

B5589 $15.00 # # B5614 $18.00 # # B5589 NADA # B5614 $5.00 #

B5590 NADA # # B5615 $15.00 # # B5590 NADA # B5615 $5.00 #

B5591 NADA # # B5616 $15.00 # # B5591 NADA # B5616 $5.00 #

B5592 $15.00 # # B5617 $18.00 # # B5592 NADA # B5617 $5.00 #

B5593 $15.00 # # B5618 $15.00 # # B5593 NADA # B5618 $5.00 #

B5594 $15.00 # # B5619 $15.00 # # B5594 NADA # B5619 $5.00 #

B5595 $15.00 # # B5620 $15.00 # # B5595 $5.00 # B5620 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5621 $15.00 # # B5646 $15.00 # # B5621 $5.00 # B5646 $5.00 #

B5622 $15.00 # # B5647 $15.00 # # B5622 $5.00 # B5647 $10.00 #

B5623 $15.00 # # B5648 $15.00 # # B5623 $5.00 # B5648 $10.00 #

B5624 $15.00 # # B5649 $12.00 # # B5624 $5.00 # B5649 $5.00 #

B5625 $12.00 # # B5650 $15.00 # # B5625 $12.00 # B5650 $5.00 #

B5626 $15.00 # # B5651 $15.00 # # B5626 $5.00 # B5651 $5.00 #

B5627 $15.00 # # B5652 $15.00 # # B5627 $5.00 # B5652 $5.00 #

B5628 $15.00 # # B5653 $15.00 # # B5628 $5.00 # B5653 $5.00 #

B5629 $15.00 # # B5654 $12.00 # # B5629 $5.00 # B5654 $5.00 #

B5630 $15.00 # # B5655 $15.00 # # B5630 $15.00 # B5655 $5.00 #

B5631 $18.00 # # B5656 $15.00 # # B5631 $7.00 # B5656 $15.00 #

B5632 $18.00 # # B5657 $8.00 # # B5632 $7.00 # B5657 $5.00 #

B5633 $20.00 # # B5658 $15.00 # # B5633 $5.00 # B5658 $5.00 #

B5634 $15.00 # # B5659 $15.00 # # B5634 $7.00 # B5659 $5.00 #

B5635 $12.00 # # B5660 $15.00 # # B5635 $5.00 # B5660 $5.00 #

B5636 $15.00 # # B5661 $15.00 # # B5636 $5.00 # B5661 $5.00 #

B5637 $15.00 # # B5662 $15.00 # # B5637 $5.00 # B5662 $5.00 #

B5638 $10.00 # # B5663 $15.00 # # B5638 $10.00 # B5663 $5.00 #

B5639 $12.00 # # B5664 $15.00 # # B5639 $5.00 # B5664 $5.00 #

B5640 $15.00 # # B5665 $12.00 # # B5640 $5.00 # B5665 $12.00 #

B5641 $12.00 # # B5666 $12.00 # # B5641 $5.00 # B5666 $5.00 #

B5642 $15.00 # # B5667 $10.00 # # B5642 $5.00 # B5667 $5.00 #

B5643 $12.00 # # B5668 $12.00 # # B5643 $5.00 # B5668 $12.00 #

B5644 $15.00 # # B5669 $15.00 # # B5644 $5.00 # B5669 $15.00 #

B5645 $15.00 # # B5670 $15.00 # # B5645 $5.00 # B5670 $5.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5671 $15.00 # # B5696 $20.00 # # B5671 $5.00 # B5696 $5.00 #

B5672 $15.00 # # B5697 $15.00 # # B5672 $5.00 # B5697 $5.00 #

B5673 $10.00 # # B5698 $20.00 # # B5673 $10.00 # B5698 $5.00 #

B5674 $15.00 # # B5699 $15.00 # # B5674 $5.00 # B5699 $5.00 #

B5675 $12.00 # # B5700 NADA # # B5675 $5.00 # B5700 $5.00 #

B5676 $15.00 # # B5701 $10.00 # # B5676 $7.00 # B5701 $5.00 #

B5677 $15.00 # # B5702 $15.00 # # B5677 $5.00 # B5702 $5.00 #

B5678 $10.00 # # B5703 $15.00 # # B5678 $10.00 # B5703 $5.00 #

B5679 $15.00 # # B5704 $15.00 # # B5679 $7.00 # B5704 $5.00 #

B5680 $15.00 # # B5705 $15.00 # # B5680 $7.00 # B5705 $5.00 #

B5681 $15.00 # # B5706 $12.00 # # B5681 $5.00 # B5706 $12.00 #

B5682 $15.00 # # B5707 $15.00 # # B5682 $5.00 # B5707 $5.00 #

B5683 $12.00 # # B5708 $18.00 # # B5683 $5.00 # B5708 $5.00 #

B5684 $10.00 # # B5709 $18.00 # # B5684 $5.00 # B5709 $5.00 #

B5685 $10.00 # # B5710 $18.00 # # B5685 $5.00 # B5710 $5.00 #

B5686 $10.00 # # B5711 $20.00 # # B5686 $5.00 # B5711 $5.00 #

B5687 $8.00 # # B5712 $20.00 # # B5687 $5.00 # B5712 $5.00 #

B5688 $18.00 # # B5713 $12.00 # # B5688 $18.00 # B5713 $5.00 #

B5689 $5.00 # # B5714 $15.00 # # B5689 $5.00 # B5714 $5.00 #

B5690 $15.00 # # B5715 $15.00 # # B5690 $7.00 # B5715 $5.00 #

B5691 $10.00 # # B5716 $12.00 # # B5691 $5.00 # B5716 $12.00 #

B5692 $15.00 # # B5717 $12.00 # # B5692 $5.00 # B5717 $5.00 #

B5693 $15.00 # # B5718 $10.00 # # B5693 $5.00 # B5718 $5.00 #

B5694 $10.00 # # B5719 $15.00 # # B5694 $5.00 # B5719 NADA #

B5695 $15.00 # # B5720 $8.00 # # B5695 $5.00 # B5720 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5721 $15.00 # # B5762 $12.00 # # B5721 $5.00 # B5762 $10.00 #

B5722 $15.00 # # B5764 $15.00 # # B5722 $5.00 # B5764 $5.00 #

B5725 $15.00 # # B5765 NADA # # B5725 $5.00 # B5765 NADA #

B5726 $15.00 # # B5766 $7.00 # # B5726 $5.00 # B5766 $5.00 #

B5729 $15.00 # # B5769 $12.00 # # B5729 $5.00 # B5769 NADA #

B5730 $15.00 # # B5770 $10.00 # # B5730 $15.00 # B5770 $10.00 #

B5731 $15.00 # # B5771 $10.00 # # B5731 $5.00 # B5771 $10.00 #

B5732 $12.00 # # B5772 $10.00 # # B5732 $5.00 # B5772 $10.00 #

B5733 $12.00 # # B5773 $15.00 # # B5733 $5.00 # B5773 $15.00 #

B5734 $20.00 # # B5774 $15.00 # # B5734 $5.00 # B5774 $15.00 #

B5735 $20.00 # # B5777 $15.00 # # B5735 $5.00 # B5777 NADA #

B5736 $15.00 # # B5778 $12.00 # # B5736 $5.00 # B5778 $5.00 #

B5737 $15.00 # # B5781 $18.00 # # B5737 $5.00 # B5781 $5.00 #

B5738 $15.00 # # B5782 $18.00 # # B5738 NADA # B5782 $5.00 #

B5740 $15.00 # # B5783 $15.00 # # B5740 NADA # B5783 $5.00 #

B5741 $15.00 # # B5784 $15.00 # # B5741 NADA # B5784 $5.00 #

B5742 $12.00 # # B5785 $10.00 # # B5742 NADA # B5785 $5.00 #

B5745 NADA # # B5786 $10.00 # # B5745 NADA # B5786 $5.00 #

B5746 $15.00 # # B5787 $12.00 # # B5746 $15.00 # B5787 $5.00 #

B5749 $15.00 # # B5788 $10.00 # # B5749 $5.00 # B5788 $5.00 #

B5754 $15.00 # # B5789 $12.00 # # B5754 $5.00 # B5789 $5.00 #

B5755 $10.00 # # B5790 $10.00 # # B5755 $5.00 # B5790 $5.00 #

B5757 $15.00 # # B5797 $15.00 # # B5757 $5.00 # B5797 $5.00 #

B5760 $12.00 # # B5798 $15.00 # # B5760 $5.00 # B5798 $5.00 #

B5761 $12.00 # # B5799 $15.00 # # B5761 $5.00 # B5799 NADA #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5800 $15.00 # # B5831 $20.00 # # B5800 NADA # B5831 $10.00 #

B5801 $10.00 # # B5832 NADA # # B5801 NADA # B5832 NADA #

B5803 $12.00 # # B5833 $15.00 # # B5803 $5.00 # B5833 NADA #

B5807 $15.00 # # B5834 NADA # # B5807 $5.00 # B5834 NADA #

B5808 $10.00 # # B5835 $7.00 # # B5808 $5.00 # B5835 $5.00 #

B5810 $12.00 # # B5836 $5.00 # # B5810 $10.00 # B5836 $5.00 #

B5811 $10.00 # # B5837 $12.00 # # B5811 $6.00 # B5837 $5.00 #

B5812 $10.00 # # B5838 $12.00 # # B5812 $6.00 # B5838 $10.00 #

B5813 $15.00 # # B5839 $20.00 # # B5813 $5.00 # B5839 $5.00 #

B5814 $12.00 # # B5840 $20.00 # # B5814 $5.00 # B5840 $5.00 #

B5815 $15.00 # # B5841 $18.00 # # B5815 $5.00 # B5841 $5.00 #

B5817 $15.00 # # B5842 $15.00 # # B5817 $5.00 # B5842 $5.00 #

B5818 $12.00 # # B5843 $18.00 # # B5818 $5.00 # B5843 $5.00 #

B5819 $10.00 # # B5844 $15.00 # # B5819 $5.00 # B5844 $5.00 #

B5820 $10.00 # # B5845 $10.00 # # B5820 $5.00 # B5845 $5.00 #

B5821 $20.00 # # B5846 $15.00 # # B5821 $5.00 # B5846 $5.00 #

B5822 $12.00 # # B5847 $15.00 # # B5822 $12.00 # B5847 $5.00 #

B5823 $10.00 # # B5848 $18.00 # # B5823 $5.00 # B5848 $5.00 #

B5824 $10.00 # # B5849 $10.00 # # B5824 $10.00 # B5849 NADA #

B5825 $10.00 # # B5850 $5.00 # # B5825 $10.00 # B5850 $5.00 #

B5826 $10.00 # # B5851 NADA # # B5826 $10.00 # B5851 NADA #

B5827 $15.00 # # B5852 $15.00 # # B5827 $10.00 # B5852 $5.00 #

B5828 $15.00 # # B5853 $8.00 # # B5828 $10.00 # B5853 $8.00 #

B5829 $20.00 # # B5854 $15.00 # # B5829 $10.00 # B5854 $5.00 #

B5830 NADA # # B5855 $18.00 # # B5830 NADA # B5855 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5856 $15.00 # # B5881 $7.00 # # B5856 $5.00 # B5881 $7.00 #

B5857 $12.00 # # B5883 $15.00 # # B5857 $5.00 # B5883 $5.00 #

B5858 $18.00 # # B5884 $20.00 # # B5858 $5.00 # B5884 $5.00 #

B5859 $12.00 # # B5885 $10.00 # # B5859 $5.00 # B5885 $5.00 #

B5860 $10.00 # # B5886 $10.00 # # B5860 NADA # B5886 $5.00 #

B5861 $10.00 # # B5887 $15.00 # # B5861 $5.00 # B5887 $5.00 #

B5862 $5.00 # # B5888 $10.00 # # B5862 $5.00 # B5888 $5.00 #

B5863 $12.00 # # B5889 $10.00 # # B5863 $5.00 # B5889 $5.00 #

B5864 $15.00 # # B5890 $15.00 # # B5864 $15.00 # B5890 $5.00 #

B5865 $18.00 # # B5891 $10.00 # # B5865 $5.00 # B5891 $7.00 #

B5866 $15.00 # # B5892 $10.00 # # B5866 $5.00 # B5892 $5.00 #

B5867 $12.00 # # B5893 $15.00 # # B5867 $5.00 # B5893 $5.00 #

B5868 $15.00 # # B5894 $3.00 # # B5868 $5.00 # B5894 $3.00 #

B5869 $5.00 # # B5895 $15.00 # # B5869 $5.00 # B5895 $5.00 #

B5870 $15.00 # # B5896 $15.00 # # B5870 $5.00 # B5896 $5.00 #

B5871 $15.00 # # B5897 $20.00 # # B5871 $5.00 # B5897 $10.00 #

B5872 $18.00 # # B5898 $20.00 # # B5872 $5.00 # B5898 $10.00 #

B5873 $20.00 # # B5899 $18.00 # # B5873 $5.00 # B5899 NADA #

B5874 $10.00 # # B5900 $18.00 # # B5874 $5.00 # B5900 $7.00 #

B5875 $12.00 # # B5901 $12.00 # # B5875 $5.00 # B5901 $10.00 #

B5876 $10.00 # # B5902 NADA # # B5876 $5.00 # B5902 $7.00 #

B5877 $10.00 # # B5903 $15.00 # # B5877 $5.00 # B5903 $10.00 #

B5878 $15.00 # # B5904 $10.00 # # B5878 $5.00 # B5904 $5.00 #

B5879 $15.00 # # B5905 $20.00 # # B5879 $5.00 # B5905 $5.00 #

B5880 $7.00 # # B5906 $12.00 # # B5880 $7.00 # B5906 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5907 $12.00 # # B5935 $20.00 # # B5907 $5.00 # B5935 $5.00 #

B5908 $15.00 # # B5936 $15.00 # # B5908 $5.00 # B5936 $5.00 #

B5909 $15.00 # # B5937 $15.00 # # B5909 $5.00 # B5937 $7.00 #

B5910 $15.00 # # B5938 $20.00 # # B5910 $5.00 # B5938 $10.00 #

B5911 $15.00 # # B5939 $15.00 # # B5911 $5.00 # B5939 $7.00 #

B5912 $15.00 # # B5940 $10.00 # # B5912 $5.00 # B5940 $10.00 #

B5913 $15.00 # # B5941 $10.00 # # B5913 $5.00 # B5941 $10.00 #

B5914 $12.00 # # B5942 $15.00 # # B5914 $5.00 # B5942 $7.00 #

B5915 $10.00 # # B5943 $10.00 # # B5915 $10.00 # B5943 $10.00 #

B5916 $18.00 # # B5944 $15.00 # # B5916 $5.00 # B5944 $5.00 #

B5917 $22.00 # # B5945 $15.00 # # B5917 $5.00 # B5945 $5.00 #

B5918 $15.00 # # B5946 $12.00 # # B5918 $5.00 # B5946 $5.00 #

B5919 $15.00 # # B5947 $15.00 # # B5919 $5.00 # B5947 $7.00 #

B5920 $15.00 # # B5948 $8.00 # # B5920 $5.00 # B5948 $8.00 #

B5921 $10.00 # # B5949 $8.00 # # B5921 $8.00 # B5949 $8.00 #

B5923 $5.00 # # B5950 $15.00 # # B5923 $5.00 # B5950 $7.00 #

B5924 $12.00 # # B5951 $10.00 # # B5924 $10.00 # B5951 $10.00 #

B5925 NADA # # B5952 $10.00 # # B5925 NADA # B5952 $5.00 #

B5926 $25.00 # # B5953 $8.00 # # B5926 NADA # B5953 $5.00 #

B5927 $8.00 # # B5954 $8.00 # # B5927 $8.00 # B5954 $5.00 #

B5928 $10.00 # # B5955 NADA # # B5928 $10.00 # B5955 NADA #

B5931 NADA # # B5956 $10.00 # # B5931 NADA # B5956 $5.00 #

B5932 $15.00 # # B5957 $8.00 # # B5932 $5.00 # B5957 $5.00 #

B5933 $15.00 # # B5958 $8.00 # # B5933 $5.00 # B5958 $5.00 #

B5934 $12.00 # # B5959 $15.00 # # B5934 NADA # B5959 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B5961 $15.00 # # B5986 $20.00 # # B5961 $15.00 # B5986 $5.00 #

B5962 $18.00 # # B5987 $15.00 # # B5962 $5.00 # B5987 $5.00 #

B5963 $18.00 # # B5988 $20.00 # # B5963 $5.00 # B5988 $10.00 #

B5964 $15.00 # # B5989 $10.00 # # B5964 $5.00 # B5989 $7.00 #

B5965 $8.00 # # B5990 $10.00 # # B5965 $5.00 # B5990 $10.00 #

B5966 $8.00 # # B5991 $15.00 # # B5966 $5.00 # B5991 $5.00 #

B5967 $10.00 # # B5992 $10.00 # # B5967 $5.00 # B5992 $5.00 #

B5968 $18.00 # # B5993 NADA # # B5968 $5.00 # B5993 $10.00 #

B5969 $15.00 # # B5994 $15.00 # # B5969 $5.00 # B5994 $7.00 #

B5970 $18.00 # # B5995 $15.00 # # B5970 $5.00 # B5995 $7.00 #

B5971 NADA # # B5996 $10.00 # # B5971 NADA # B5996 $7.00 #

B5972 $18.00 # # B5997 $10.00 # # B5972 $5.00 # B5997 $10.00 #

B5973 $15.00 # # B5998 $18.00 # # B5973 $5.00 # B5998 $5.00 #

B5974 $15.00 # # B5999 $12.00 # # B5974 $5.00 # B5999 NADA #

B5975 $10.00 # # B6000 $12.00 # # B5975 $10.00 # B6000 NADA #

B5976 $15.00 # # B6001 $15.00 # # B5976 $5.00 # B6001 $7.00 #

B5977 $15.00 # # B6002 $15.00 # # B5977 $5.00 # B6002 $5.00 #

B5978 $12.00 # # B6003 $5.00 # # B5978 $5.00 # B6003 $10.00 #

B5979 $15.00 # # B6004 $15.00 # # B5979 $5.00 # B6004 $5.00 #

B5980 $15.00 # # B6005 $15.00 # # B5980 $5.00 # B6005 $5.00 #

B5981 $15.00 # # B6006 $15.00 # # B5981 $7.00 # B6006 $5.00 #

B5982 $20.00 # # B6007 $15.00 # # B5982 $5.00 # B6007 $7.00 #

B5983 $15.00 # # B6008 $15.00 # # B5983 $5.00 # B6008 $7.00 #

B5984 $12.00 # # B6009 $18.00 # # B5984 $5.00 # B6009 $5.00 #

B5985 $20.00 # # B6010 NADA # # B5985 $5.00 # B6010 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6011 $10.00 # # B6037 $5.00 # # B6011 $7.00 # B6037 $10.00 #

B6012 $12.00 # # B6038 $10.00 # # B6012 $5.00 # B6038 $5.00 #

B6013 $15.00 # # B6039 $12.00 # # B6013 $5.00 # B6039 $5.00 #

B6014 $7.00 # # B6040 $20.00 # # B6014 $5.00 # B6040 NADA #

B6015 $15.00 # # B6041 $15.00 # # B6015 $5.00 # B6041 NADA #

B6016 $18.00 # # B6042 $15.00 # # B6016 $5.00 # B6042 $7.00 #

B6017 $5.00 # # B6043 $15.00 # # B6017 $10.00 # B6043 $7.00 #

B6018 $15.00 # # B6044 $15.00 # # B6018 $7.00 # B6044 $7.00 #

B6019 $10.00 # # B6045 $15.00 # # B6019 $10.00 # B6045 $7.00 #

B6020 $18.00 # # B6046 $15.00 # # B6020 $5.00 # B6046 $7.00 #

B6021 $15.00 # # B6047 $15.00 # # B6021 $5.00 # B6047 $7.00 #

B6022 $15.00 # # B6048 $15.00 # # B6022 $5.00 # B6048 $7.00 #

B6023 $15.00 # # B6049 $15.00 # # B6023 $7.00 # B6049 $5.00 #

B6024 $20.00 # # B6050 $15.00 # # B6024 $5.00 # B6050 $7.00 #

B6025 $20.00 # # B6051 $15.00 # # B6025 $5.00 # B6051 $5.00 #

B6026 $20.00 # # B6052 $15.00 # # B6026 $5.00 # B6052 $5.00 #

B6027 $10.00 # # B6053 NADA # # B6027 $7.00 # B6053 NADA #

B6028 $15.00 # # B6054 $15.00 # # B6028 $10.00 # B6054 $5.00 #

B6029 NADA # # B6055 $15.00 # # B6029 $7.00 # B6055 $5.00 #

B6030 $5.00 # # B6056 $15.00 # # B6030 $10.00 # B6056 $5.00 #

B6031 $15.00 # # B6057 $10.00 # # B6031 $7.00 # B6057 $5.00 #

B6032 $10.00 # # B6058 $10.00 # # B6032 $7.00 # B6058 $10.00 #

B6033 $10.00 # # B6059 $15.00 # # B6033 $10.00 # B6059 $5.00 #

B6034 $7.00 # # B6060 $10.00 # # B6034 $5.00 # B6060 $10.00 #

B6036 $18.00 # # B6061 $15.00 # # B6036 $10.00 # B6061 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6062 NADA # # B6087 $20.00 # # B6062 $7.00 # B6087 $5.00 #

B6063 $15.00 # # B6088 $15.00 # # B6063 NADA # B6088 $5.00 #

B6064 $15.00 # # B6089 $10.00 # # B6064 $5.00 # B6089 $10.00 #

B6065 $10.00 # # B6090 NADA # # B6065 $5.00 # B6090 NADA #

B6066 $10.00 # # B6091 $12.00 # # B6066 $10.00 # B6091 $5.00 #

B6067 $10.00 # # B6092 NADA # # B6067 $10.00 # B6092 NADA #

B6068 $10.00 # # B6093 NADA # # B6068 $5.00 # B6093 NADA #

B6069 $15.00 # # B6094 $15.00 # # B6069 $5.00 # B6094 $7.00 #

B6070 $15.00 # # B6095 $15.00 # # B6070 $5.00 # B6095 $5.00 #

B6071 $20.00 # # B6096 $15.00 # # B6071 $5.00 # B6096 $5.00 #

B6072 $17.00 # # B6097 $15.00 # # B6072 $5.00 # B6097 $5.00 #

B6073 $15.00 # # B6098 NADA # # B6073 $5.00 # B6098 $7.00 #

B6074 $18.00 # # B6099 $12.00 # # B6074 $5.00 # B6099 $5.00 #

B6075 $18.00 # # B6100 $20.00 # # B6075 $5.00 # B6100 $15.00 #

B6076 $18.00 # # B6101 $12.00 # # B6076 $5.00 # B6101 $5.00 #

B6077 $10.00 # # B6102 $15.00 # # B6077 $5.00 # B6102 $5.00 #

B6078 $10.00 # # B6103 $15.00 # # B6078 $5.00 # B6103 $5.00 #

B6079 $12.00 # # B6104 $15.00 # # B6079 $5.00 # B6104 $7.00 #

B6080 $12.00 # # B6105 $10.00 # # B6080 $10.00 # B6105 $10.00 #

B6081 $20.00 # # B6106 $15.00 # # B6081 $10.00 # B6106 NADA #

B6082 $12.00 # # B6109 $18.00 # # B6082 $5.00 # B6109 $5.00 #

B6083 $15.00 # # B6110 $15.00 # # B6083 $7.00 # B6110 $7.00 #

B6084 $18.00 # # B6111 $10.00 # # B6084 $5.00 # B6111 $10.00 #

B6085 $10.00 # # B6112 $15.00 # # B6085 $10.00 # B6112 $7.00 #

B6086 NADA # # B6113 $10.00 # # B6086 $7.00 # B6113 $10.00 #

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VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6115 $15.00 # # B6140 $10.00 # # B6115 $5.00 # B6140 $10.00 #

B6116 $10.00 # # B6141 $12.00 # # B6116 $5.00 # B6141 $5.00 #

B6117 $15.00 # # B6142 $10.00 # # B6117 $5.00 # B6142 $10.00 #

B6118 $10.00 # # B6143 $12.00 # # B6118 $10.00 # B6143 $5.00 #

B6119 $10.00 # # B6144 $12.00 # # B6119 $10.00 # B6144 $7.00 #

B6120 $15.00 # # B6145 $10.00 # # B6120 $5.00 # B6145 $10.00 #

B6121 $15.00 # # B6146 $15.00 # # B6121 $5.00 # B6146 $7.00 #

B6122 $10.00 # # B6147 $10.00 # # B6122 $5.00 # B6147 $10.00 #

B6123 $10.00 # # B6148 $15.00 # # B6123 $5.00 # B6148 $7.00 #

B6124 $5.00 # # B6149 $15.00 # # B6124 $10.00 # B6149 NADA #

B6125 $10.00 # # B6150 $20.00 # # B6125 $10.00 # B6150 $5.00 #

B6126 $5.00 # # B6151 $15.00 # # B6126 $5.00 # B6151 $5.00 #

B6127 $10.00 # # B6152 $20.00 # # B6127 $10.00 # B6152 $10.00 #

B6128 $5.00 # # B6153 $20.00 # # B6128 NADA # B6153 $5.00 #

B6129 $15.00 # # B6154 $12.00 # # B6129 $5.00 # B6154 $5.00 #

B6130 $15.00 # # B6156 $15.00 # # B6130 $5.00 # B6156 $7.00 #

B6131 $15.00 # # B6159 $15.00 # # B6131 $7.00 # B6159 $5.00 #

B6132 $20.00 # # B6160 $15.00 # # B6132 NADA # B6160 $5.00 #

B6133 $15.00 # # B6163 $10.00 # # B6133 $5.00 # B6163 $10.00 #

B6134 $10.00 # # B6164 $15.00 # # B6134 $5.00 # B6164 $7.00 #

B6135 $20.00 # # B6165 $12.00 # # B6135 NADA # B6165 NADA #

B6136 $20.00 # # B6166 $18.00 # # B6136 NADA # B6166 $5.00 #

B6137 $15.00 # # B6167 $18.00 # # B6137 $5.00 # B6167 $5.00 #

B6138 $12.00 # # B6168 NADA # # B6138 $5.00 # B6168 $5.00 #

B6139 $15.00 # # B6172 $15.00 # # B6139 $5.00 # B6172 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6173 $12.00 # # B6205 $12.00 # # B6173 $5.00 # B6205 $5.00 #

B6180 $10.00 # # B6206 $18.00 # # B6180 $10.00 # B6206 $5.00 #

B6181 $15.00 # # B6207 $15.00 # # B6181 $7.00 # B6207 $5.00 #

B6182 $10.00 # # B6208 $15.00 # # B6182 $7.00 # B6208 $5.00 #

B6183 $15.00 # # B6209 $12.00 # # B6183 $5.00 # B6209 $5.00 #

B6184 $18.00 # # B6210 $10.00 # # B6184 $5.00 # B6210 $5.00 #

B6185 $18.00 # # B6211 $15.00 # # B6185 $5.00 # B6211 $5.00 #

B6187 $20.00 # # B6212 $12.00 # # B6187 NADA # B6212 $5.00 #

B6188 $20.00 # # B6213 $12.00 # # B6188 NADA # B6213 $5.00 #

B6189 NADA # # B6214 $12.00 # # B6189 $7.00 # B6214 $5.00 #

B6190 $20.00 # # B6215 $15.00 # # B6190 NADA # B6215 $5.00 #

B6191 $20.00 # # B6216 $15.00 # # B6191 NADA # B6216 $5.00 #

B6192 $7.00 # # B6217 $18.00 # # B6192 $5.00 # B6217 $10.00 #

B6193 $15.00 # # B6218 $12.00 # # B6193 $5.00 # B6218 $5.00 #

B6194 $10.00 # # B6219 $12.00 # # B6194 $5.00 # B6219 $5.00 #

B6195 $20.00 # # B6220 $10.00 # # B6195 $5.00 # B6220 $5.00 #

B6196 $18.00 # # B6221 NADA # # B6196 $10.00 # B6221 $7.00 #

B6197 $15.00 # # B6222 $12.00 # # B6197 $5.00 # B6222 $5.00 #

B6198 $20.00 # # B6223 $7.00 # # B6198 $10.00 # B6223 $5.00 #

B6199 $15.00 # # B6224 $7.00 # # B6199 $5.00 # B6224 $5.00 #

B6200 NADA # # B6225 $12.00 # # B6200 NADA # B6225 $5.00 #

B6201 $20.00 # # B6226 $20.00 # # B6201 $5.00 # B6226 $15.00 #

B6202 $20.00 # # B6227 $15.00 # # B6202 $5.00 # B6227 $5.00 #

B6203 $20.00 # # B6228 $15.00 # # B6203 NADA # B6228 $5.00 #

B6204 $15.00 # # B6229 $20.00 # # B6204 $5.00 # B6229 $15.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6230 $20.00 # # B6256 $15.00 # # B6230 $5.00 # B6256 $5.00 #

B6231 $12.00 # # B6257 $10.00 # # B6231 NADA # B6257 $5.00 #

B6232 $12.00 # # B6258 $15.00 # # B6232 $5.00 # B6258 $5.00 #

B6233 $20.00 # # B6259 $15.00 # # B6233 $5.00 # B6259 $7.00 #

B6234 $12.00 # # B6260 $12.00 # # B6234 $5.00 # B6260 $5.00 #

B6235 NADA # # B6261 $10.00 # # B6235 NADA # B6261 $5.00 #

B6236 $20.00 # # B6262 $15.00 # # B6236 $5.00 # B6262 $5.00 #

B6237 $12.00 # # B6263 $20.00 # # B6237 $5.00 # B6263 $5.00 #

B6238 $15.00 # # B6264 $20.00 # # B6238 $7.00 # B6264 $5.00 #

B6239 $12.00 # # B6265 $20.00 # # B6239 $5.00 # B6265 $15.00 #

B6240 $20.00 # # B6266 $20.00 # # B6240 $5.00 # B6266 $5.00 #

B6241 $15.00 # # B6267 $15.00 # # B6241 $5.00 # B6267 $5.00 #

B6242 $12.00 # # B6268 $7.00 # # B6242 $5.00 # B6268 $5.00 #

B6243 $12.00 # # B6269 $18.00 # # B6243 $5.00 # B6269 $5.00 #

B6244 $12.00 # # B6270 $15.00 # # B6244 $5.00 # B6270 $5.00 #

B6245 $15.00 # # B6271 $20.00 # # B6245 $5.00 # B6271 $5.00 #

B6246 $15.00 # # B6273 $15.00 # # B6246 $7.00 # B6273 $5.00 #

B6248 $15.00 # # B6274 $10.00 # # B6248 NADA # B6274 $7.00 #

B6249 $15.00 # # B6275 $18.00 # # B6249 NADA # B6275 $5.00 #

B6250 $18.00 # # B6277 $18.00 # # B6250 $5.00 # B6277 $5.00 #

B6251 $15.00 # # B6278 $25.00 # # B6251 $5.00 # B6278 $5.00 #

B6252 $12.00 # # B6279 $15.00 # # B6252 $5.00 # B6279 $5.00 #

B6253 $20.00 # # B6280 $15.00 # # B6253 $5.00 # B6280 $5.00 #

B6254 $12.00 # # B6281 $15.00 # # B6254 $5.00 # B6281 $5.00 #

B6255 $12.00 # # B6282 $12.00 # # B6255 $5.00 # B6282 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6283 NADA # # B6313 $15.00 # # B6283 NADA # B6313 $7.00 #

B6284 $10.00 # # B6314 $15.00 # # B6284 $5.00 # B6314 $7.00 #

B6285 NADA # # B6315 $15.00 # # B6285 NADA # B6315 NADA #

B6286 NADA # # B6316 $10.00 # # B6286 NADA # B6316 $5.00 #

B6287 $15.00 # # B6317 $10.00 # # B6287 $5.00 # B6317 $5.00 #

B6288 $15.00 # # B6319 $15.00 # # B6288 $7.00 # B6319 $5.00 #

B6289 $18.00 # # B6321 $10.00 # # B6289 $5.00 # B6321 $7.00 #

B6290 $15.00 # # B6322 $12.00 # # B6290 NADA # B6322 $5.00 #

B6291 $15.00 # # B6323 $10.00 # # B6291 $7.00 # B6323 $7.00 #

B6292 $15.00 # # B6324 $12.00 # # B6292 $7.00 # B6324 $7.00 #

B6293 $15.00 # # B6325 $18.00 # # B6293 $7.00 # B6325 $18.00 #

B6295 $18.00 # # B6326 $15.00 # # B6295 $5.00 # B6326 $7.00 #

B6296 $15.00 # # B6327 $18.00 # # B6296 $5.00 # B6327 $5.00 #

B6297 $12.00 # # B6328 $15.00 # # B6297 $5.00 # B6328 $5.00 #

B6299 $18.00 # # B6329 $20.00 # # B6299 $7.00 # B6329 $5.00 #

B6300 $10.00 # # B6330 $12.00 # # B6300 $5.00 # B6330 $5.00 #

B6301 $15.00 # # B6331 $12.00 # # B6301 $5.00 # B6331 $5.00 #

B6302 $15.00 # # B6332 $20.00 # # B6302 $5.00 # B6332 $5.00 #

B6303 $18.00 # # B6333 $15.00 # # B6303 $10.00 # B6333 $5.00 #

B6304 NADA # # B6334 $15.00 # # B6304 $7.00 # B6334 $5.00 #

B6305 $15.00 # # B6335 $15.00 # # B6305 $5.00 # B6335 $5.00 #

B6307 $15.00 # # B6336 $12.00 # # B6307 $7.00 # B6336 $5.00 #

B6308 $10.00 # # B6337 $15.00 # # B6308 $5.00 # B6337 $5.00 #

B6309 $18.00 # # B6338 $10.00 # # B6309 $7.00 # B6338 $7.00 #

B6312 $20.00 # # B6339 $10.00 # # B6312 $15.00 # B6339 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6340 $12.00 # # B6365 $15.00 # # B6340 $7.00 # B6365 $10.00 #

B6341 $10.00 # # B6366 $15.00 # # B6341 $7.00 # B6366 $10.00 #

B6342 $15.00 # # B6367 $18.00 # # B6342 $7.00 # B6367 $5.00 #

B6343 $15.00 # # B6368 $15.00 # # B6343 $5.00 # B6368 $5.00 #

B6344 $10.00 # # B6369 $7.00 # # B6344 $7.00 # B6369 $5.00 #

B6345 $15.00 # # B6370 $15.00 # # B6345 $5.00 # B6370 $5.00 #

B6346 $5.00 # # B6371 $15.00 # # B6346 $5.00 # B6371 $7.00 #

B6347 $10.00 # # B6372 $5.00 # # B6347 $7.00 # B6372 $10.00 #

B6348 $15.00 # # B6373 $15.00 # # B6348 $5.00 # B6373 $5.00 #

B6349 $20.00 # # B6374 $18.00 # # B6349 $10.00 # B6374 $5.00 #

B6350 NADA # # B6375 $18.00 # # B6350 $7.00 # B6375 $5.00 #

B6351 $10.00 # # B6376 $18.00 # # B6351 $7.00 # B6376 $5.00 #

B6352 $12.00 # # B6377 $18.00 # # B6352 NADA # B6377 $5.00 #

B6353 $15.00 # # B6378 $12.00 # # B6353 $5.00 # B6378 $7.00 #

B6354 $20.00 # # B6379 $10.00 # # B6354 $5.00 # B6379 $7.00 #

B6355 $18.00 # # B6380 $12.00 # # B6355 $5.00 # B6380 $5.00 #

B6356 $18.00 # # B6381 $15.00 # # B6356 $5.00 # B6381 $5.00 #

B6357 $12.00 # # B6382 $12.00 # # B6357 $5.00 # B6382 $5.00 #

B6358 $12.00 # # B6383 $10.00 # # B6358 $5.00 # B6383 $5.00 #

B6359 $15.00 # # B6384 $10.00 # # B6359 $5.00 # B6384 $10.00 #

B6360 $15.00 # # B6385 $15.00 # # B6360 $5.00 # B6385 $5.00 #

B6361 $10.00 # # B6386 $15.00 # # B6361 $5.00 # B6386 $5.00 #

B6362 $15.00 # # B6387 $12.00 # # B6362 $7.00 # B6387 $5.00 #

B6363 $15.00 # # B6388 $12.00 # # B6363 $7.00 # B6388 $5.00 #

B6364 $12.00 # # B6389 $15.00 # # B6364 $5.00 # B6389 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6390 $10.00 # # B6415 $18.00 # # B6390 $5.00 # B6415 $7.00 #

B6391 $12.00 # # B6416 $15.00 # # B6391 $5.00 # B6416 $5.00 #

B6392 $10.00 # # B6417 $18.00 # # B6392 $5.00 # B6417 $5.00 #

B6393 $15.00 # # B6418 $18.00 # # B6393 $5.00 # B6418 $5.00 #

B6394 $15.00 # # B6419 $18.00 # # B6394 $5.00 # B6419 $7.00 #

B6395 $15.00 # # B6420 $20.00 # # B6395 $5.00 # B6420 $5.00 #

B6396 $20.00 # # B6421 $15.00 # # B6396 $5.00 # B6421 $5.00 #

B6397 NADA # # B6422 $15.00 # # B6397 $7.00 # B6422 $5.00 #

B6398 NADA # # B6423 $12.00 # # B6398 $7.00 # B6423 $5.00 #

B6399 $20.00 # # B6424 $20.00 # # B6399 $5.00 # B6424 $5.00 #

B6400 $20.00 # # B6425 $5.00 # # B6400 $5.00 # B6425 NADA #

B6401 $20.00 # # B6426 $15.00 # # B6401 $5.00 # B6426 $5.00 #

B6402 $20.00 # # B6427 $15.00 # # B6402 $5.00 # B6427 $5.00 #

B6403 $12.00 # # B6428 $18.00 # # B6403 $5.00 # B6428 $5.00 #

B6404 $12.00 # # B6429 $7.00 # # B6404 $5.00 # B6429 $5.00 #

B6405 $15.00 # # B6430 $7.00 # # B6405 $5.00 # B6430 $5.00 #

B6406 $15.00 # # B6431 $20.00 # # B6406 $5.00 # B6431 $5.00 #

B6407 $15.00 # # B6432 $15.00 # # B6407 $5.00 # B6432 $7.00 #

B6408 $10.00 # # B6433 $12.00 # # B6408 $10.00 # B6433 $5.00 #

B6409 $10.00 # # B6434 $18.00 # # B6409 $5.00 # B6434 $5.00 #

B6410 $15.00 # # B6435 $12.00 # # B6410 $7.00 # B6435 $5.00 #

B6411 $15.00 # # B6436 $15.00 # # B6411 $7.00 # B6436 $5.00 #

B6412 $15.00 # # B6437 $15.00 # # B6412 $5.00 # B6437 $5.00 #

B6413 $18.00 # # B6438 $15.00 # # B6413 $5.00 # B6438 $5.00 #

B6414 $18.00 # # B6439 $15.00 # # B6414 $5.00 # B6439 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6440 $10.00 # # B6465 $12.00 # # B6440 $7.00 # B6465 $10.00 #

B6441 $10.00 # # B6466 $15.00 # # B6441 $5.00 # B6466 $5.00 #

B6442 $15.00 # # B6467 $10.00 # # B6442 $5.00 # B6467 $10.00 #

B6443 $15.00 # # B6468 $12.00 # # B6443 $5.00 # B6468 $10.00 #

B6444 $15.00 # # B6469 $15.00 # # B6444 $7.00 # B6469 $10.00 #

B6445 $15.00 # # B6470 $10.00 # # B6445 $5.00 # B6470 $10.00 #

B6446 $10.00 # # B6471 $12.00 # # B6446 $5.00 # B6471 $10.00 #

B6447 $7.00 # # B6472 $15.00 # # B6447 $7.00 # B6472 $10.00 #

B6448 $20.00 # # B6473 $12.00 # # B6448 $5.00 # B6473 $5.00 #

B6449 $20.00 # # B6474 $20.00 # # B6449 $5.00 # B6474 NADA #

B6450 $15.00 # # B6475 $15.00 # # B6450 NADA # B6475 $5.00 #

B6451 $15.00 # # B6476 $10.00 # # B6451 NADA # B6476 $7.00 #

B6452 $15.00 # # B6477 NADA # # B6452 $5.00 # B6477 $5.00 #

B6453 $20.00 # # B6478 $15.00 # # B6453 $15.00 # B6478 $5.00 #

B6454 $12.00 # # B6479 $15.00 # # B6454 $5.00 # B6479 $5.00 #

B6455 $15.00 # # B6480 $15.00 # # B6455 $5.00 # B6480 $5.00 #

B6456 $12.00 # # B6481 $15.00 # # B6456 $5.00 # B6481 $5.00 #

B6457 $15.00 # # B6483 $15.00 # # B6457 $5.00 # B6483 $5.00 #

B6458 $15.00 # # B6484 $15.00 # # B6458 $5.00 # B6484 $5.00 #

B6459 $10.00 # # B6485 $15.00 # # B6459 NADA # B6485 $5.00 #

B6460 $20.00 # # B6486 $10.00 # # B6460 $5.00 # B6486 $10.00 #

B6461 $15.00 # # B6487 $15.00 # # B6461 $5.00 # B6487 $5.00 #

B6462 $15.00 # # B6488 $15.00 # # B6462 $5.00 # B6488 $5.00 #

B6463 $20.00 # # B6489 $18.00 # # B6463 $5.00 # B6489 $5.00 #

B6464 $12.00 # # B6490 $10.00 # # B6464 $10.00 # B6490 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6493 $10.00 # # B6524 NADA # # B6493 $5.00 # B6524 $5.00 #

B6494 $15.00 # # B6525 $15.00 # # B6494 $5.00 # B6525 $5.00 #

B6495 $15.00 # # B6526 $10.00 # # B6495 $5.00 # B6526 $10.00 #

B6496 $15.00 # # B6527 $15.00 # # B6496 NADA # B6527 $5.00 #

B6498 $7.00 # # B6528 NADA # # B6498 $7.00 # B6528 $5.00 #

B6499 $7.50 # # B6529 $12.00 # # B6499 $7.50 # B6529 $5.00 #

B6500 $12.00 # # B6530 NADA # # B6500 $5.00 # B6530 NADA #

B6501 $10.00 # # B6531 NADA # # B6501 $5.00 # B6531 NADA #

B6502 $10.00 # # B6532 $10.00 # # B6502 $5.00 # B6532 $5.00 #

B6503 $10.00 # # B6533 NADA # # B6503 $10.00 # B6533 NADA #

B6504 $10.00 # # B6534 $12.00 # # B6504 $5.00 # B6534 $5.00 #

B6506 $20.00 # # B6535 $10.00 # # B6506 $5.00 # B6535 $5.00 #

B6507 $15.00 # # B6536 $12.00 # # B6507 $5.00 # B6536 $5.00 #

B6508 $12.00 # # B6537 $8.00 # # B6508 NADA # B6537 $5.00 #

B6509 $12.00 # # B6538 $15.00 # # B6509 $5.00 # B6538 $5.00 #

B6510 $15.00 # # B6539 $20.00 # # B6510 NADA # B6539 $5.00 #

B6513 $12.00 # # B6540 $15.00 # # B6513 $5.00 # B6540 $5.00 #

B6514 $15.00 # # B6541 $15.00 # # B6514 $5.00 # B6541 $5.00 #

B6515 $15.00 # # B6542 $15.00 # # B6515 NADA # B6542 $5.00 #

B6518 $15.00 # # B6543 $10.00 # # B6518 $5.00 # B6543 $10.00 #

B6519 $15.00 # # B6544 $15.00 # # B6519 $5.00 # B6544 $15.00 #

B6520 $12.00 # # B6545 $15.00 # # B6520 $5.00 # B6545 $5.00 #

B6521 NADA # # B6546 $12.00 # # B6521 NADA # B6546 $12.00 #

B6522 $7.00 # # B6547 $20.00 # # B6522 $5.00 # B6547 $5.00 #

B6523 $15.00 # # B6548 $12.00 # # B6523 $5.00 # B6548 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6549 $10.00 # # B6574 $15.00 # # B6549 $5.00 # B6574 $5.00 #

B6550 $8.00 # # B6575 $10.00 # # B6550 $5.00 # B6575 $5.00 #

B6551 $15.00 # # B6576 $12.00 # # B6551 $5.00 # B6576 $5.00 #

B6552 $15.00 # # B6577 $10.00 # # B6552 $5.00 # B6577 $5.00 #

B6553 $12.00 # # B6578 $15.00 # # B6553 $5.00 # B6578 $5.00 #

B6554 $15.00 # # B6579 $15.00 # # B6554 $5.00 # B6579 $5.00 #

B6555 $15.00 # # B6580 $12.00 # # B6555 $7.00 # B6580 $5.00 #

B6556 $10.00 # # B6581 $10.00 # # B6556 $10.00 # B6581 NADA #

B6557 $10.00 # # B6582 $15.00 # # B6557 $10.00 # B6582 NADA #

B6558 $20.00 # # B6583 $15.00 # # B6558 $5.00 # B6583 NADA #

B6559 $10.00 # # B6584 $15.00 # # B6559 $10.00 # B6584 NADA #

B6560 $12.00 # # B6585 $20.00 # # B6560 NADA # B6585 $5.00 #

B6561 $15.00 # # B6586 $10.00 # # B6561 $5.00 # B6586 $5.00 #

B6562 $15.00 # # B6587 $10.00 # # B6562 $5.00 # B6587 $5.00 #

B6563 $18.00 # # B6588 $10.00 # # B6563 $5.00 # B6588 $5.00 #

B6564 $7.00 # # B6589 $15.00 # # B6564 $5.00 # B6589 $5.00 #

B6565 $12.00 # # B6590 $12.00 # # B6565 $5.00 # B6590 $5.00 #

B6566 $12.00 # # B6591 $20.00 # # B6566 $5.00 # B6591 $5.00 #

B6567 $15.00 # # B6592 $20.00 # # B6567 $5.00 # B6592 $5.00 #

B6568 $7.00 # # B6593 $15.00 # # B6568 $5.00 # B6593 $5.00 #

B6569 $15.00 # # B6594 $12.00 # # B6569 $5.00 # B6594 $5.00 #

B6570 $20.00 # # B6595 $15.00 # # B6570 $5.00 # B6595 $5.00 #

B6571 $15.00 # # B6596 $15.00 # # B6571 $5.00 # B6596 $5.00 #

B6572 $10.00 # # B6597 $10.00 # # B6572 $10.00 # B6597 $5.00 #

B6573 $20.00 # # B6598 $20.00 # # B6573 $5.00 # B6598 $6.50 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6599 $15.00 # # B6624 $15.00 # # B6599 $5.00 # B6624 $5.00 #

B6600 $15.00 # # B6625 $15.00 # # B6600 $5.00 # B6625 $12.00 #

B6601 $15.00 # # B6626 NADA # # B6601 $5.00 # B6626 NADA #

B6602 $15.00 # # B6627 NADA # # B6602 $5.00 # B6627 $10.00 #

B6603 $15.00 # # B6628 $8.00 # # B6603 $5.00 # B6628 $10.00 #

B6604 $10.00 # # B6629 $12.00 # # B6604 $5.00 # B6629 $5.00 #

B6605 $12.00 # # B6630 $15.00 # # B6605 NADA # B6630 $5.00 #

B6606 $15.00 # # B6631 $12.00 # # B6606 NADA # B6631 $7.00 #

B6607 $15.00 # # B6632 $20.00 # # B6607 $5.00 # B6632 $5.00 #

B6608 $15.00 # # B6633 $20.00 # # B6608 $5.00 # B6633 $5.00 #

B6609 $15.00 # # B6634 $8.00 # # B6609 $5.00 # B6634 $10.00 #

B6610 $20.00 # # B6635 $15.00 # # B6610 $5.00 # B6635 $5.00 #

B6611 $20.00 # # B6636 $15.00 # # B6611 $5.00 # B6636 $5.00 #

B6612 $18.00 # # B6637 $10.00 # # B6612 $5.00 # B6637 $10.00 #

B6613 $18.00 # # B6638 $10.00 # # B6613 $5.00 # B6638 $10.00 #

B6614 $15.00 # # B6639 $10.00 # # B6614 $5.00 # B6639 $10.00 #

B6615 $15.00 # # B6640 $15.00 # # B6615 $5.00 # B6640 $15.00 #

B6616 $20.00 # # B6641 $15.00 # # B6616 $5.00 # B6641 $15.00 #

B6617 $15.00 # # B6642 $20.00 # # B6617 $10.00 # B6642 $5.00 #

B6618 NADA # # B6643 $15.00 # # B6618 $5.00 # B6643 $5.00 #

B6619 $20.00 # # B6644 $10.00 # # B6619 $5.00 # B6644 $5.00 #

B6620 $12.00 # # B6645 $15.00 # # B6620 $5.00 # B6645 $5.00 #

B6621 $10.00 # # B6646 $12.00 # # B6621 $10.00 # B6646 $5.00 #

B6622 $15.00 # # B6647 $10.00 # # B6622 $5.00 # B6647 $5.00 #

B6623 $20.00 # # B6648 NADA # # B6623 $5.00 # B6648 NADA #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6649 NADA # # B6674 $10.00 # # B6649 NADA # B6674 $5.00 #

B6650 NADA # # B6675 NADA # # B6650 NADA # B6675 NADA #

B6651 $8.00 # # B6676 $20.00 # # B6651 $5.00 # B6676 $10.00 #

B6652 $10.00 # # B6677 $15.00 # # B6652 $5.00 # B6677 $10.00 #

B6653 $15.00 # # B6678 $5.00 # # B6653 $5.00 # B6678 $10.00 #

B6654 $15.00 # # B6679 $10.00 # # B6654 $5.00 # B6679 $5.00 #

B6655 $10.00 # # B6680 $15.00 # # B6655 $5.00 # B6680 $5.00 #

B6656 $12.00 # # B6681 $12.00 # # B6656 $5.00 # B6681 $5.00 #

B6657 $12.00 # # B6682 $15.00 # # B6657 $5.00 # B6682 $5.00 #

B6658 $15.00 # # B6683 $15.00 # # B6658 $15.00 # B6683 NADA #

B6659 $10.00 # # B6684 $15.00 # # B6659 $5.00 # B6684 $5.00 #

B6660 $15.00 # # B6685 $12.00 # # B6660 $7.00 # B6685 NADA #

B6661 $12.00 # # B6686 $15.00 # # B6661 $5.00 # B6686 NADA #

B6662 $15.00 # # B6687 $15.00 # # B6662 $5.00 # B6687 $5.00 #

B6663 $12.00 # # B6688 $15.00 # # B6663 $10.00 # B6688 $5.00 #

B6664 $20.00 # # B6689 $15.00 # # B6664 $5.00 # B6689 $5.00 #

B6665 $12.00 # # B6690 $15.00 # # B6665 $5.00 # B6690 $7.00 #

B6666 $20.00 # # B6691 $15.00 # # B6666 $15.00 # B6691 $7.00 #

B6667 $15.00 # # B6692 $12.00 # # B6667 $5.00 # B6692 $5.00 #

B6668 $20.00 # # B6693 $15.00 # # B6668 $5.00 # B6693 $7.00 #

B6669 $12.00 # # B6694 $15.00 # # B6669 $5.00 # B6694 $5.00 #

B6670 $12.00 # # B6695 $15.00 # # B6670 $5.00 # B6695 $5.00 #

B6671 $10.00 # # B6696 $15.00 # # B6671 $5.00 # B6696 $10.00 #

B6672 $10.00 # # B6697 $20.00 # # B6672 $5.00 # B6697 $10.00 #

B6673 $15.00 # # B6698 $12.00 # # B6673 $5.00 # B6698 $10.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6699 $15.00 # # B6724 $20.00 # # B6699 $5.00 # B6724 $10.00 #

B6700 $15.00 # # B6725 $10.00 # # B6700 $5.00 # B6725 $5.00 #

B6701 $15.00 # # B6726 $12.00 # # B6701 $5.00 # B6726 $5.00 #

B6702 $15.00 # # B6727 $15.00 # # B6702 NADA # B6727 $5.00 #

B6703 $18.00 # # B6728 $12.00 # # B6703 $5.00 # B6728 $10.00 #

B6704 $12.00 # # B6729 $12.00 # # B6704 $5.00 # B6729 $10.00 #

B6705 $15.00 # # B6730 $7.00 # # B6705 $5.00 # B6730 $5.00 #

B6706 $15.00 # # B6731 $12.00 # # B6706 NADA # B6731 NADA #

B6707 $12.00 # # B6732 NADA # # B6707 $5.00 # B6732 NADA #

B6708 $15.00 # # B6733 $10.00 # # B6708 $5.00 # B6733 $10.00 #

B6709 $15.00 # # B6734 $10.00 # # B6709 $5.00 # B6734 $10.00 #

B6710 $15.00 # # B6735 $12.00 # # B6710 $15.00 # B6735 $5.00 #

B6711 NADA # # B6736 $15.00 # # B6711 NADA # B6736 $5.00 #

B6712 $10.00 # # B6737 $15.00 # # B6712 $10.00 # B6737 $5.00 #

B6713 $15.00 # # B6738 $15.00 # # B6713 $7.00 # B6738 $5.00 #

B6714 $10.00 # # B6739 $15.00 # # B6714 $5.00 # B6739 $5.00 #

B6715 $15.00 # # B6740 $12.00 # # B6715 $5.00 # B6740 $5.00 #

B6716 $10.00 # # B6741 $20.00 # # B6716 NADA # B6741 $5.00 #

B6717 $12.00 # # B6742 $20.00 # # B6717 $5.00 # B6742 $5.00 #

B6718 $12.00 # # B6743 $12.00 # # B6718 $5.00 # B6743 $5.00 #

B6719 $15.00 # # B6744 $15.00 # # B6719 $7.00 # B6744 $5.00 #

B6720 $10.00 # # B6745 $15.00 # # B6720 $5.00 # B6745 $5.00 #

B6721 $12.00 # # B6746 $15.00 # # B6721 $5.00 # B6746 $5.00 #

B6722 $10.00 # # B6747 $15.00 # # B6722 $5.00 # B6747 $5.00 #

B6723 $15.00 # # B6748 $20.00 # # B6723 $7.00 # B6748 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6749 $15.00 # # B6774 $18.00 # # B6749 $5.00 # B6774 $5.00 #

B6750 $15.00 # # B6775 NADA # # B6750 $5.00 # B6775 NADA #

B6751 $15.00 # # B6776 $15.00 # # B6751 $5.00 # B6776 $5.00 #

B6752 $12.00 # # B6777 $15.00 # # B6752 $5.00 # B6777 $5.00 #

B6753 $12.00 # # B6778 $15.00 # # B6753 $5.00 # B6778 $5.00 #

B6754 $15.00 # # B6779 $18.00 # # B6754 $5.00 # B6779 $5.00 #

B6755 $10.00 # # B6780 $3.00 # # B6755 $5.00 # B6780 $3.00 #

B6756 $15.00 # # B6781 $18.00 # # B6756 $5.00 # B6781 $5.00 #

B6757 $15.00 # # B6782 $18.00 # # B6757 $5.00 # B6782 $5.00 #

B6758 $20.00 # # B6783 $15.00 # # B6758 $5.00 # B6783 $5.00 #

B6759 NADA # # B6784 $10.00 # # B6759 $5.00 # B6784 $5.00 #

B6760 $15.00 # # B6785 $15.00 # # B6760 $5.00 # B6785 $5.00 #

B6761 $15.00 # # B6788 $10.00 # # B6761 $7.00 # B6788 $7.00 #

B6762 $15.00 # # B6789 $15.00 # # B6762 $15.00 # B6789 $7.00 #

B6763 $15.00 # # B6790 $18.00 # # B6763 NADA # B6790 $5.00 #

B6764 $15.00 # # B6791 $15.00 # # B6764 NADA # B6791 $5.00 #

B6765 $15.00 # # B6792 $15.00 # # B6765 NADA # B6792 $5.00 #

B6766 NADA # # B6793 $15.00 # # B6766 NADA # B6793 $7.00 #

B6767 $10.00 # # B6794 $15.00 # # B6767 $5.00 # B6794 $7.00 #

B6768 $12.00 # # B6795 $15.00 # # B6768 NADA # B6795 $7.00 #

B6769 $12.00 # # B6796 $8.00 # # B6769 $5.00 # B6796 $5.00 #

B6770 $12.00 # # B6797 $8.00 # # B6770 $5.00 # B6797 $5.00 #

B6771 $10.00 # # B6798 $10.00 # # B6771 $5.00 # B6798 $5.00 #

B6772 $18.00 # # B6799 NADA # # B6772 $5.00 # B6799 NADA #

B6773 $15.00 # # B6800 $15.00 # # B6773 $5.00 # B6800 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6801 $15.00 # # B6826 $15.00 # # B6801 $5.00 # B6826 $7.00 #

B6802 $12.00 # # B6827 $15.00 # # B6802 $5.00 # B6827 $7.00 #

B6803 $15.00 # # B6828 $12.00 # # B6803 $5.00 # B6828 $7.00 #

B6804 $15.00 # # B6829 $10.00 # # B6804 $5.00 # B6829 $5.00 #

B6805 $15.00 # # B6830 $10.00 # # B6805 $5.00 # B6830 $7.00 #

B6806 $15.00 # # B6831 $12.00 # # B6806 $5.00 # B6831 $7.00 #

B6807 $15.00 # # B6832 $15.00 # # B6807 $7.00 # B6832 $7.00 #

B6808 $10.00 # # B6833 $10.00 # # B6808 $10.00 # B6833 $10.00 #

B6809 $15.00 # # B6834 $10.00 # # B6809 $5.00 # B6834 $10.00 #

B6810 $15.00 # # B6835 $10.00 # # B6810 $5.00 # B6835 $5.00 #

B6811 NADA # # B6836 $15.00 # # B6811 $5.00 # B6836 $5.00 #

B6812 $15.00 # # B6837 $15.00 # # B6812 $5.00 # B6837 $7.00 #

B6813 $15.00 # # B6838 $15.00 # # B6813 $5.00 # B6838 $5.00 #

B6814 $15.00 # # B6839 $18.00 # # B6814 $5.00 # B6839 $10.00 #

B6815 $15.00 # # B6840 $12.00 # # B6815 $5.00 # B6840 $7.00 #

B6816 $10.00 # # B6841 $15.00 # # B6816 $5.00 # B6841 $7.00 #

B6817 $20.00 # # B6842 $15.00 # # B6817 $5.00 # B6842 $7.00 #

B6818 $20.00 # # B6843 $15.00 # # B6818 $10.00 # B6843 $7.00 #

B6819 $12.00 # # B6844 $12.00 # # B6819 $7.00 # B6844 $7.00 #

B6820 $15.00 # # B6845 $15.00 # # B6820 $5.00 # B6845 $7.00 #

B6821 $12.00 # # B6846 $12.00 # # B6821 $7.00 # B6846 $5.00 #

B6822 $15.00 # # B6847 $12.00 # # B6822 $5.00 # B6847 $5.00 #

B6823 $15.00 # # B6848 $15.00 # # B6823 $7.00 # B6848 $7.00 #

B6824 $15.00 # # B6849 $15.00 # # B6824 $5.00 # B6849 $7.00 #

B6825 $15.00 # # B6850 $15.00 # # B6825 $5.00 # B6850 $7.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6851 $10.00 # # B6876 $15.00 # # B6851 $7.00 # B6876 $7.00 #

B6852 $10.00 # # B6877 $10.00 # # B6852 $10.00 # B6877 $5.00 #

B6853 $10.00 # # B6878 $20.00 # # B6853 $10.00 # B6878 $5.00 #

B6854 $15.00 # # B6879 $10.00 # # B6854 $5.00 # B6879 $10.00 #

B6855 $10.00 # # B6880 $20.00 # # B6855 $7.00 # B6880 $5.00 #

B6856 $15.00 # # B6881 $15.00 # # B6856 $5.00 # B6881 $5.00 #

B6857 $18.00 # # B6882 $15.00 # # B6857 $10.00 # B6882 $5.00 #

B6858 $12.00 # # B6883 $15.00 # # B6858 $7.00 # B6883 $7.00 #

B6859 $10.00 # # B6884 $12.00 # # B6859 $5.00 # B6884 $7.00 #

B6860 $15.00 # # B6885 $15.00 # # B6860 $7.00 # B6885 $5.00 #

B6861 $12.00 # # B6886 $20.00 # # B6861 $7.00 # B6886 $10.00 #

B6862 $10.00 # # B6887 $15.00 # # B6862 $5.00 # B6887 $7.00 #

B6863 $10.00 # # B6888 $12.00 # # B6863 $5.00 # B6888 $7.00 #

B6864 $15.00 # # B6889 $15.00 # # B6864 $5.00 # B6889 $5.00 #

B6865 $15.00 # # B6890 $10.00 # # B6865 $5.00 # B6890 $10.00 #

B6866 $10.00 # # B6891 $10.00 # # B6866 $5.00 # B6891 $7.00 #

B6867 $15.00 # # B6892 $15.00 # # B6867 $7.00 # B6892 $5.00 #

B6868 $15.00 # # B6893 $15.00 # # B6868 $5.00 # B6893 NADA #

B6869 $15.00 # # B6894 $12.00 # # B6869 $5.00 # B6894 $7.00 #

B6870 $20.00 # # B6895 $10.00 # # B6870 $10.00 # B6895 $5.00 #

B6871 $15.00 # # B6896 $8.00 # # B6871 $10.00 # B6896 $8.00 #

B6872 $8.00 # # B6897 $8.00 # # B6872 $8.00 # B6897 $8.00 #

B6873 $12.00 # # B6898 $22.00 # # B6873 $5.00 # B6898 $5.00 #

B6874 $20.00 # # B6899 $15.00 # # B6874 $5.00 # B6899 $5.00 #

B6875 $18.00 # # B6900 $15.00 # # B6875 $5.00 # B6900 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6901 $15.00 # # B6926 $18.00 # # B6901 $7.00 # B6926 $5.00 #

B6902 $10.00 # # B6927 $15.00 # # B6902 $10.00 # B6927 $5.00 #

B6903 $15.00 # # B6928 NADA # # B6903 $5.00 # B6928 NADA #

B6904 $15.00 # # B6929 $15.00 # # B6904 $5.00 # B6929 $5.00 #

B6905 $12.00 # # B6930 $10.00 # # B6905 $5.00 # B6930 $5.00 #

B6906 $15.00 # # B6931 $12.00 # # B6906 $5.00 # B6931 $5.00 #

B6907 $12.00 # # B6932 $15.00 # # B6907 $5.00 # B6932 $7.00 #

B6908 $10.00 # # B6933 $15.00 # # B6908 $10.00 # B6933 $10.00 #

B6909 $20.00 # # B6934 $10.00 # # B6909 $5.00 # B6934 $10.00 #

B6910 $15.00 # # B6935 $15.00 # # B6910 $5.00 # B6935 $7.00 #

B6911 $15.00 # # B6936 $20.00 # # B6911 $5.00 # B6936 $10.00 #

B6912 $20.00 # # B6937 $15.00 # # B6912 $10.00 # B6937 $5.00 #

B6913 $15.00 # # B6938 $10.00 # # B6913 $15.00 # B6938 $5.00 #

B6914 $12.00 # # B6939 $15.00 # # B6914 $10.00 # B6939 $5.00 #

B6915 $18.00 # # B6940 $8.00 # # B6915 $5.00 # B6940 $5.00 #

B6916 $18.00 # # B6941 $12.00 # # B6916 $5.00 # B6941 $5.00 #

B6917 $18.00 # # B6942 $10.00 # # B6917 $5.00 # B6942 $5.00 #

B6918 $15.00 # # B6943 $15.00 # # B6918 $7.00 # B6943 $5.00 #

B6919 $20.00 # # B6944 $20.00 # # B6919 $10.00 # B6944 $5.00 #

B6920 $15.00 # # B6945 $15.00 # # B6920 $5.00 # B6945 $10.00 #

B6921 $15.00 # # B6946 $15.00 # # B6921 $5.00 # B6946 $5.00 #

B6922 $10.00 # # B6947 $15.00 # # B6922 $10.00 # B6947 $15.00 #

B6923 $10.00 # # B6948 $15.00 # # B6923 $10.00 # B6948 $7.00 #

B6924 $8.00 # # B6949 $10.00 # # B6924 $5.00 # B6949 $5.00 #

B6925 $10.00 # # B6950 $15.00 # # B6925 $5.00 # B6950 $15.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B6951 $18.00 # # B6976 $18.00 # # B6951 $5.00 # B6976 $5.00 #

B6952 $15.00 # # B6977 $10.00 # # B6952 $5.00 # B6977 $5.00 #

B6953 $15.00 # # B6978 $15.00 # # B6953 $5.00 # B6978 $7.00 #

B6954 $20.00 # # B6979 $15.00 # # B6954 $5.00 # B6979 $5.00 #

B6955 $20.00 # # B6980 $15.00 # # B6955 $5.00 # B6980 $10.00 #

B6956 $12.00 # # B6981 $10.00 # # B6956 $5.00 # B6981 $10.00 #

B6957 $15.00 # # B6982 $15.00 # # B6957 $5.00 # B6982 $5.00 #

B6958 $15.00 # # B6983 $15.00 # # B6958 $5.00 # B6983 $5.00 #

B6959 $15.00 # # B6984 $20.00 # # B6959 $5.00 # B6984 $10.00 #

B6960 $15.00 # # B6985 $10.00 # # B6960 $5.00 # B6985 $10.00 #

B6961 $15.00 # # B6986 $15.00 # # B6961 $5.00 # B6986 $5.00 #

B6962 $15.00 # # B6987 $15.00 # # B6962 $5.00 # B6987 $7.00 #

B6963 $12.00 # # B6988 $18.00 # # B6963 $5.00 # B6988 $10.00 #

B6964 $15.00 # # B6989 $12.00 # # B6964 $7.00 # B6989 $10.00 #

B6965 $15.00 # # B6990 $15.00 # # B6965 $5.00 # B6990 NADA #

B6966 $12.00 # # B6991 $15.00 # # B6966 $5.00 # B6991 $7.00 #

B6967 $10.00 # # B6992 $10.00 # # B6967 $10.00 # B6992 NADA #

B6968 $10.00 # # B6993 $15.00 # # B6968 $5.00 # B6993 $5.00 #

B6969 $10.00 # # B6994 $15.00 # # B6969 $5.00 # B6994 $5.00 #

B6970 $12.00 # # B6995 $15.00 # # B6970 $5.00 # B6995 $5.00 #

B6971 $20.00 # # B6996 $10.00 # # B6971 $5.00 # B6996 $5.00 #

B6972 $20.00 # # B6997 $15.00 # # B6972 $5.00 # B6997 $7.00 #

B6973 NADA # # B6998 $20.00 # # B6973 NADA # B6998 $5.00 #

B6974 NADA # # B6999 NADA # # B6974 NADA # B6999 NADA #

B6975 $18.00 # # B7000 NADA # # B6975 $5.00 # B7000 NADA #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B7001 NADA # # B7028 $5.00 # # B7001 NADA # B7028 $10.00 #

B7002 NADA # # B7029 $10.00 # # B7002 NADA # B7029 $10.00 #

B7003 NADA # # B7030 $15.00 # # B7003 $10.00 # B7030 $5.00 #

B7004 $12.00 # # B7031 $15.00 # # B7004 $5.00 # B7031 $5.00 #

B7005 $15.00 # # B7032 $15.00 # # B7005 $5.00 # B7032 $5.00 #

B7006 $15.00 # # B7033 $15.00 # # B7006 $5.00 # B7033 $5.00 #

B7007 NADA # # B7034 NADA # # B7007 NADA # B7034 NADA #

B7008 $15.00 # # B7035 $10.00 # # B7008 $7.00 # B7035 $5.00 #

B7009 $15.00 # # B7036 NADA # # B7009 $5.00 # B7036 NADA #

B7010 $18.00 # # B7037 $10.00 # # B7010 $7.00 # B7037 $5.00 #

B7011 $10.00 # # B7038 $10.00 # # B7011 $5.00 # B7038 $10.00 #

B7012 $10.00 # # B7039 $15.00 # # B7012 $5.00 # B7039 $5.00 #

B7013 NADA # # B7040 $20.00 # # B7013 NADA # B7040 $5.00 #

B7014 $15.00 # # B7041 $15.00 # # B7014 $5.00 # B7041 NADA #

B7015 $15.00 # # B7042 $10.00 # # B7015 $7.00 # B7042 $10.00 #

B7016 $12.00 # # B7043 $15.00 # # B7016 $5.00 # B7043 $5.00 #

B7017 $15.00 # # B7044 $15.00 # # B7017 $5.00 # B7044 $5.00 #

B7018 $10.00 # # B7045 $15.00 # # B7018 $10.00 # B7045 $5.00 #

B7020 $18.00 # # B7046 $15.00 # # B7020 $5.00 # B7046 $5.00 #

B7022 $15.00 # # B7047 $18.00 # # B7022 $5.00 # B7047 $5.00 #

B7023 $15.00 # # B7048 $12.00 # # B7023 $5.00 # B7048 $5.00 #

B7024 $10.00 # # B7049 $12.00 # # B7024 $10.00 # B7049 $5.00 #

B7025 $10.00 # # B7050 $12.00 # # B7025 $10.00 # B7050 $7.00 #

B7026 $15.00 # # B7051 $18.00 # # B7026 $5.00 # B7051 $5.00 #

B7027 $15.00 # # B7052 $10.00 # # B7027 $5.00 # B7052 $10.00 #

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B7053 $15.00 # # B7079 $15.00 # # B7053 $5.00 # B7079 $5.00 #

B7054 $20.00 # # B7080 $15.00 # # B7054 $5.00 # B7080 $5.00 #

B7055 $7.00 # # B7081 $15.00 # # B7055 $5.00 # B7081 $7.00 #

B7056 $10.00 # # B7082 $12.00 # # B7056 $5.00 # B7082 $5.00 #

B7057 $15.00 # # B7083 $12.00 # # B7057 $5.00 # B7083 $5.00 #

B7058 $15.00 # # B7084 $15.00 # # B7058 $7.00 # B7084 $5.00 #

B7059 $12.00 # # B7085 $15.00 # # B7059 $10.00 # B7085 $5.00 #

B7060 $15.00 # # B7086 $12.00 # # B7060 $5.00 # B7086 $5.00 #

B7061 $7.00 # # B7087 $18.00 # # B7061 $5.00 # B7087 $10.00 #

B7062 $15.00 # # B7088 $15.00 # # B7062 $5.00 # B7088 $5.00 #

B7063 $18.00 # # B7089 $15.00 # # B7063 $5.00 # B7089 $5.00 #

B7064 $15.00 # # B7090 $18.00 # # B7064 $5.00 # B7090 $5.00 #

B7065 $10.00 # # B7091 $15.00 # # B7065 $5.00 # B7091 $5.00 #

B7066 $10.00 # # B7092 $15.00 # # B7066 $10.00 # B7092 $5.00 #

B7067 $10.00 # # B7093 $15.00 # # B7067 $10.00 # B7093 $5.00 #

B7068 $15.00 # # B7094 $20.00 # # B7068 $5.00 # B7094 $5.00 #

B7069 $15.00 # # B7095 $15.00 # # B7069 $5.00 # B7095 $5.00 #

B7070 $20.00 # # B7096 $20.00 # # B7070 NADA # B7096 $5.00 #

B7071 $15.00 # # B7097 NADA # # B7071 NADA # B7097 NADA #

B7072 $15.00 # # B7099 $20.00 # # B7072 $5.00 # B7099 $5.00 #

B7073 $18.00 # # B7100 $20.00 # # B7073 $5.00 # B7100 $5.00 #

B7074 $18.00 # # B7101 $10.00 # # B7074 $5.00 # B7101 $7.00 #

B7075 $24.00 # # B7104 $15.00 # # B7075 $10.00 # B7104 $10.00 #

B7076 $20.00 # # B7109 $10.00 # # B7076 NADA # B7109 $10.00 #

B7077 $15.00 # # B7111 $12.00 # # B7077 $5.00 # B7111 $7.00 #

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B7112 $15.00 # # B7137 $15.00 # # B7112 $5.00 # B7137 $5.00 #

B7113 $18.00 # # B7138 $12.00 # # B7113 $5.00 # B7138 $5.00 #

B7114 $18.00 # # B7139 $12.00 # # B7114 $5.00 # B7139 $5.00 #

B7115 $18.00 # # B7140 $15.00 # # B7115 $5.00 # B7140 $5.00 #

B7116 $12.00 # # B7141 $12.00 # # B7116 $5.00 # B7141 $7.00 #

B7117 $15.00 # # B7142 $15.00 # # B7117 $5.00 # B7142 $5.00 #

B7118 $10.00 # # B7143 $12.00 # # B7118 $5.00 # B7143 $5.00 #

B7119 $12.00 # # B7144 $20.00 # # B7119 $5.00 # B7144 $5.00 #

B7120 $12.00 # # B7145 $20.00 # # B7120 $10.00 # B7145 $5.00 #

B7121 $12.00 # # B7146 $15.00 # # B7121 $5.00 # B7146 $5.00 #

B7122 $12.00 # # B7147 $12.00 # # B7122 $5.00 # B7147 $5.00 #

B7123 $15.00 # # B7148 $12.00 # # B7123 $5.00 # B7148 $5.00 #

B7124 $15.00 # # B7149 $20.00 # # B7124 $5.00 # B7149 $5.00 #

B7125 $12.00 # # B7150 $20.00 # # B7125 $5.00 # B7150 $5.00 #

B7126 $12.00 # # B7151 $12.00 # # B7126 $5.00 # B7151 $5.00 #

B7127 $10.00 # # B7152 $15.00 # # B7127 $5.00 # B7152 $5.00 #

B7128 $12.00 # # B7153 $20.00 # # B7128 $5.00 # B7153 $5.00 #

B7129 $20.00 # # B7154 $20.00 # # B7129 $5.00 # B7154 $5.00 #

B7130 $20.00 # # B7155 $12.00 # # B7130 $5.00 # B7155 $5.00 #

B7131 $20.00 # # B7156 $10.00 # # B7131 $5.00 # B7156 $10.00 #

B7132 $10.00 # # B7157 $15.00 # # B7132 $10.00 # B7157 $5.00 #

B7133 $12.00 # # B7158 NADA # # B7133 $5.00 # B7158 $5.00 #

B7134 $12.00 # # B7159 $18.00 # # B7134 $5.00 # B7159 $5.00 #

B7135 $20.00 # # B7160 $18.00 # # B7135 $5.00 # B7160 $5.00 #

B7136 $15.00 # # B7161 $15.00 # # B7136 $5.00 # B7161 $5.00 #

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B7162 $20.00 # # B7187 $12.00 # # B7162 NADA # B7187 $5.00 #

B7163 $20.00 # # B7188 $15.00 # # B7163 $5.00 # B7188 $5.00 #

B7164 $12.00 # # B7189 $12.00 # # B7164 $5.00 # B7189 $5.00 #

B7165 $12.00 # # B7190 $12.00 # # B7165 $5.00 # B7190 $5.00 #

B7166 $20.00 # # B7191 $20.00 # # B7166 $5.00 # B7191 $5.00 #

B7167 $10.00 # # B7192 $15.00 # # B7167 $10.00 # B7192 $5.00 #

B7168 $15.00 # # B7193 $12.00 # # B7168 $5.00 # B7193 $5.00 #

B7169 $20.00 # # B7194 $12.00 # # B7169 NADA # B7194 $5.00 #

B7170 $20.00 # # B7195 $15.00 # # B7170 NADA # B7195 $10.00 #

B7171 $20.00 # # B7196 $15.00 # # B7171 $5.00 # B7196 $10.00 #

B7172 $12.00 # # B7197 $10.00 # # B7172 $5.00 # B7197 $10.00 #

B7173 $20.00 # # B7198 $15.00 # # B7173 $5.00 # B7198 $5.00 #

B7174 $12.00 # # B7199 $12.00 # # B7174 $5.00 # B7199 $5.00 #

B7175 $15.00 # # B7200 $12.00 # # B7175 $7.00 # B7200 $5.00 #

B7176 $12.00 # # B7201 $10.00 # # B7176 $5.00 # B7201 $5.00 #

B7177 $12.00 # # B7202 $15.00 # # B7177 $5.00 # B7202 $5.00 #

B7178 $20.00 # # B7203 $7.00 # # B7178 $5.00 # B7203 $5.00 #

B7179 $12.00 # # B7204 $10.00 # # B7179 $5.00 # B7204 $5.00 #

B7180 $12.00 # # B7205 $15.00 # # B7180 $5.00 # B7205 $7.00 #

B7181 $20.00 # # B7206 $15.00 # # B7181 $5.00 # B7206 $7.00 #

B7182 $12.00 # # B7207 $18.00 # # B7182 $5.00 # B7207 $5.00 #

B7183 $10.00 # # B7208 $18.00 # # B7183 $5.00 # B7208 $7.00 #

B7184 $20.00 # # B7209 $12.00 # # B7184 $5.00 # B7209 $5.00 #

B7185 $15.00 # # B7210 $10.00 # # B7185 $5.00 # B7210 $5.00 #

B7186 $12.00 # # B7211 $15.00 # # B7186 $5.00 # B7211 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B7213 $18.00 # # B7244 $15.00 # # B7213 $5.00 # B7244 $5.00 #

B7214 $15.00 # # B7245 $15.00 # # B7214 $10.00 # B7245 $5.00 #

B7218 $15.00 # # B7246 $15.00 # # B7218 $5.00 # B7246 $5.00 #

B7219 $10.00 # # B7247 $10.00 # # B7219 $5.00 # B7247 $7.00 #

B7220 $15.00 # # B7248 $12.00 # # B7220 $5.00 # B7248 $7.00 #

B7221 $10.00 # # B7249 $15.00 # # B7221 $5.00 # B7249 $5.00 #

B7222 $10.00 # # B7250 $15.00 # # B7222 $7.00 # B7250 $5.00 #

B7223 $15.00 # # B7251 $12.00 # # B7223 $5.00 # B7251 $5.00 #

B7224 $15.00 # # B7252 $12.00 # # B7224 $5.00 # B7252 $5.00 #

B7225 $20.00 # # B7253 $15.00 # # B7225 $10.00 # B7253 $5.00 #

B7226 $18.00 # # B7254 $15.00 # # B7226 $5.00 # B7254 $5.00 #

B7227 $18.00 # # B7255 NADA # # B7227 $7.00 # B7255 $7.00 #

B7228 $15.00 # # B7256 $10.00 # # B7228 $5.00 # B7256 $5.00 #

B7229 $12.00 # # B7257 $15.00 # # B7229 $5.00 # B7257 $7.00 #

B7230 $10.00 # # B7258 $15.00 # # B7230 $5.00 # B7258 $5.00 #

B7231 $15.00 # # B7259 $15.00 # # B7231 $5.00 # B7259 $5.00 #

B7234 $10.00 # # B7260 $20.00 # # B7234 $5.00 # B7260 $5.00 #

B7235 $15.00 # # B7261 $12.00 # # B7235 $5.00 # B7261 $7.00 #

B7236 $15.00 # # B7262 $12.00 # # B7236 $5.00 # B7262 $5.00 #

B7237 $18.00 # # B7263 $15.00 # # B7237 $5.00 # B7263 $7.00 #

B7238 $12.00 # # B7264 $8.00 # # B7238 $5.00 # B7264 $5.00 #

B7240 NADA # # B7265 $8.00 # # B7240 NADA # B7265 $5.00 #

B7241 $15.00 # # B7266 $8.00 # # B7241 $5.00 # B7266 $5.00 #

B7242 $20.00 # # B7267 $8.00 # # B7242 $5.00 # B7267 $5.00 #

B7243 $10.00 # # B7268 $7.00 # # B7243 $5.00 # B7268 $5.00 #

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

B7269 NADA # # B7301 $15.00 # # B7269 NADA # B7301 $5.00 #

B7270 $7.00 # # B7303 $15.00 # # B7270 $5.00 # B7303 $5.00 #

B7271 $15.00 # # B7304 $10.00 # # B7271 $7.00 # B7304 $10.00 #

B7272 $15.00 # # B7305 $15.00 # # B7272 $7.00 # B7305 $7.00 #

B7273 $15.00 # # B7308 $15.00 # # B7273 $5.00 # B7308 $5.00 #

B7274 $10.00 # # B7309 $18.00 # # B7274 $5.00 # B7309 $5.00 #

B7275 $8.00 # # B7310 $18.00 # # B7275 $5.00 # B7310 $5.00 #

B7276 $10.00 # # B7313 $15.00 # # B7276 $5.00 # B7313 $10.00 #

B7277 $10.00 # # B7314 $15.00 # # B7277 $10.00 # B7314 $7.00 #

B7278 $20.00 # # B7315 $15.00 # # B7278 $10.00 # B7315 $7.00 #

B7279 $15.00 # # B7316 $20.00 # # B7279 $7.00 # B7316 $10.00 #

B7280 $10.00 # # B7317 $10.00 # # B7280 $5.00 # B7317 $10.00 #

B7281 $15.00 # # B7318 $20.00 # # B7281 $7.00 # B7318 $5.00 #

B7283 $15.00 # # B7319 $18.00 # # B7283 $7.00 # B7319 $5.00 #

B7284 $15.00 # # B7320 $18.00 # # B7284 $7.00 # B7320 $5.00 #

B7285 $18.00 # # B7321 $15.00 # # B7285 $10.00 # B7321 $5.00 #

B7286 $10.00 # # B7322 $18.00 # # B7286 $5.00 # B7322 $5.00 #

B7288 $15.00 # # B7323 $15.00 # # B7288 $7.00 # B7323 $5.00 #

B7290 $15.00 # # B7324 NADA # # B7290 $5.00 # B7324 $5.00 #

B7291 $15.00 # # B7325 $18.00 # # B7291 $5.00 # B7325 $10.00 #

B7292 $10.00 # # B7326 $10.00 # # B7292 $5.00 # B7326 $10.00 #

B7297 $15.00 # # B7330 $10.00 # # B7297 $7.00 # B7330 $10.00 #

B7298 $15.00 # # B7331 $15.00 # # B7298 $5.00 # B7331 $5.00 #

B7299 NADA # # B7332 $12.00 # # B7299 $5.00 # B7332 $7.00 #

B7300 $18.00 # # B7333 $18.00 # # B7300 $5.00 # B7333 $5.00 #

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B7334 $18.00 # # * * * * B7334 $5.00 # * * *

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CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

BA1 $15.00 15 15 BA26 $15.00 15 15 BA1 $5.00 15 BA26 $5.00 15

BA2 $15.00 15 15 BA27 $15.00 15 15 BA2 $5.00 15 BA27 $5.00 15

BA3 $15.00 15 15 BA28 $15.00 15 15 BA3 $5.00 15 BA28 $5.00 15

BA4 $15.00 15 15 BA29 $15.00 15 15 BA4 $5.00 15 BA29 $5.00 15

BA5 $15.00 15 15 BA30 $15.00 15 15 BA5 $5.00 15 BA30 $5.00 15

BA6 $15.00 15 15 BA31 $15.00 15 15 BA6 $5.00 15 BA31 $5.00 15

BA7 $15.00 15 15 BA32 $15.00 15 15 BA7 $5.00 15 BA32 $5.00 15

BA8 $15.00 15 15 BA33 $15.00 15 15 BA8 $5.00 15 BA33 $5.00 15

BA9 $15.00 15 15 BA34 $15.00 15 15 BA9 $5.00 15 BA34 $5.00 15

BA10 $15.00 15 15 BA35 $15.00 15 15 BA10 $5.00 15 BA35 $5.00 15

BA11 $15.00 15 15 BA36 $15.00 15 15 BA11 $5.00 15 BA36 $5.00 15

BA12 $10.00 15 15 BA37 $15.00 15 15 BA12 $5.00 15 BA37 $5.00 15

BA13 $15.00 15 15 BA38 $15.00 15 15 BA13 $5.00 15 BA38 $5.00 15

BA14 $15.00 15 15 BA39 $15.00 15 15 BA14 $5.00 15 BA39 $5.00 15

BA15 $15.00 15 15 BA40 $15.00 15 15 BA15 $5.00 15 BA40 $5.00 15

BA16 $15.00 15 15 BA41 $15.00 15 15 BA16 $5.00 15 BA41 $5.00 15

BA17 $15.00 15 15 BA42 $15.00 15 15 BA17 $5.00 15 BA42 $5.00 15

BA18 $15.00 15 15 BA43 $15.00 15 15 BA18 $5.00 15 BA43 $5.00 15

BA19 $15.00 15 15 BA44 $15.00 15 15 BA19 $5.00 15 BA44 $5.00 15

BA20 $15.00 15 15 BA45 $15.00 15 15 BA20 $5.00 15 BA45 $5.00 15

BA21 $15.00 15 15 BA46 $15.00 15 15 BA21 $5.00 15 BA46 $5.00 15

BA22 $15.00 15 15 BA47 $15.00 15 15 BA22 $5.00 15 BA47 $5.00 15

BA23 $15.00 15 15 BA48 $15.00 15 15 BA23 $5.00 15 BA48 $5.00 15

BA24 $15.00 15 15 BA49 $15.00 15 15 BA24 $5.00 15 BA49 $5.00 15

BA25 $15.00 15 15 BA50 $15.00 15 15 BA25 $5.00 15 BA50 $5.00 15

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BA51 $15.00 15 15 BA76 $15.00 15 15 BA51 $5.00 15 BA76 $5.00 15

BA52 $12.00 15 15 BA77 $10.00 15 15 BA52 $5.00 15 BA77 $5.00 15

BA53 $15.00 15 15 BA78 $12.00 15 15 BA53 $5.00 15 BA78 $5.00 15

BA54 $15.00 15 15 BA79 $15.00 15 15 BA54 $5.00 15 BA79 $5.00 15

BA55 $15.00 15 15 BA80 $15.00 15 15 BA55 $5.00 15 BA80 $5.00 15

BA56 $15.00 15 15 BA81 $15.00 15 15 BA56 $5.00 15 BA81 $5.00 15

BA57 $15.00 15 15 BA82 $12.00 15 15 BA57 $5.00 15 BA82 $5.00 15

BA58 $15.00 15 15 BA83 $15.00 15 15 BA58 $5.00 15 BA83 $5.00 15

BA59 $15.00 15 15 BA84 $15.00 15 15 BA59 $5.00 15 BA84 $5.00 15

BA60 $15.00 15 15 BA85 $15.00 15 15 BA60 $5.00 15 BA85 $5.00 15

BA61 $10.00 15 15 BA86 $15.00 15 15 BA61 $5.00 15 BA86 $5.00 15

BA62 $15.00 15 15 BA87 $15.00 15 15 BA62 $5.00 15 BA87 $5.00 15

BA63 $15.00 15 15 BA88 $15.00 15 15 BA63 $5.00 15 BA88 $5.00 15

BA64 $15.00 15 15 BA89 $15.00 15 15 BA64 $5.00 15 BA89 $5.00 15

BA65 $15.00 15 15 BA90 $15.00 15 15 BA65 $5.00 15 BA90 $5.00 15

BA66 $12.00 15 15 BA91 $15.00 15 15 BA66 $5.00 15 BA91 $5.00 15

BA67 $15.00 15 15 BA92 $12.00 15 15 BA67 $5.00 15 BA92 $5.00 15

BA68 $15.00 15 15 BA93 $15.00 15 15 BA68 $5.00 15 BA93 $5.00 15

BA69 $15.00 15 15 BA94 $15.00 15 15 BA69 $5.00 15 BA94 $5.00 15

BA70 $15.00 15 15 BA95 $15.00 15 15 BA70 $5.00 15 BA95 $5.00 15

BA71 $12.00 15 15 BA96 $15.00 15 15 BA71 $5.00 15 BA96 $5.00 15

BA72 $15.00 15 15 BA97 $15.00 15 15 BA72 $5.00 15 BA97 $5.00 15

BA73 $15.00 15 15 BA98 $15.00 15 15 BA73 $5.00 15 BA98 $5.00 15

BA74 $10.00 15 15 BA99 $15.00 15 15 BA74 $5.00 15 BA99 $5.00 15

BA75 $15.00 15 15 BA100 $10.00 15 15 BA75 $5.00 15 BA100 $5.00 15

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BA101 $15.00 15 15 BA126 $15.00 15 15 BA101 $5.00 15 BA126 $5.00 15

BA102 $15.00 15 15 BA127 $15.00 15 15 BA102 $5.00 15 BA127 $5.00 15

BA103 $15.00 15 15 BA128 $15.00 15 15 BA103 $5.00 15 BA128 $5.00 15

BA104 $15.00 15 15 BA129 $15.00 15 15 BA104 $5.00 15 BA129 $5.00 15

BA105 $10.00 15 15 BA130 $15.00 15 15 BA105 $5.00 15 BA130 $5.00 15

BA106 $15.00 15 15 BA131 $15.00 15 15 BA106 $5.00 15 BA131 $5.00 15

BA107 $15.00 15 15 BA132 $15.00 15 15 BA107 $5.00 15 BA132 $5.00 15

BA108 $15.00 15 15 BA133 $15.00 15 15 BA108 $5.00 15 BA133 $5.00 15

BA109 $12.00 15 15 BA134 $15.00 15 15 BA109 $5.00 15 BA134 $5.00 15

BA110 $10.00 15 15 BA135 $15.00 15 15 BA110 $5.00 15 BA135 $5.00 15

BA111 $15.00 15 15 BA136 $10.00 15 15 BA111 $5.00 15 BA136 $5.00 15

BA112 $15.00 15 15 BA137 $15.00 15 15 BA112 $5.00 15 BA137 $5.00 15

BA113 $15.00 15 15 BA138 $15.00 15 15 BA113 $5.00 15 BA138 $5.00 15

BA114 $12.00 15 15 BA139 $15.00 15 15 BA114 $5.00 15 BA139 $5.00 15

BA115 $15.00 15 15 BA140 $15.00 15 15 BA115 $5.00 15 BA140 $5.00 15

BA116 $15.00 15 15 BA141 $15.00 15 15 BA116 $5.00 15 BA141 $5.00 15

BA117 $15.00 15 15 BA142 $15.00 15 15 BA117 $5.00 15 BA142 $5.00 15

BA118 $12.00 15 15 BA143 $15.00 15 15 BA118 $5.00 15 BA143 $5.00 15

BA119 $12.00 15 15 BA144 $15.00 15 15 BA119 $5.00 15 BA144 $5.00 15

BA120 $10.00 15 15 BA145 $15.00 15 15 BA120 $5.00 15 BA145 $5.00 15

BA121 $15.00 15 15 BA146 $15.00 15 15 BA121 $5.00 15 BA146 $5.00 15

BA122 $15.00 15 15 BA147 $10.00 15 15 BA122 $5.00 15 BA147 $5.00 15

BA123 $15.00 15 15 BA148 $12.00 15 15 BA123 $5.00 15 BA148 $5.00 15

BA124 $12.00 15 15 BA149 $15.00 15 15 BA124 $5.00 15 BA149 $5.00 15

BA125 $15.00 15 15 BA150 $8.00 15 15 BA125 $5.00 15 BA150 $5.00 15

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BA151 $15.00 15 15 BA176 $15.00 15 15 BA151 $5.00 15 BA176 $5.00 15

BA152 $10.00 15 15 BA177 $15.00 15 15 BA152 $5.00 15 BA177 $5.00 15

BA153 $15.00 15 15 BA178 $15.00 15 15 BA153 $5.00 15 BA178 $5.00 15

BA154 $15.00 15 15 BA179 $15.00 15 15 BA154 $5.00 15 BA179 $5.00 15

BA155 $15.00 15 15 BA180 $15.00 15 15 BA155 $5.00 15 BA180 $5.00 15

BA156 $15.00 15 15 BA181 $15.00 15 15 BA156 $5.00 15 BA181 $5.00 15

BA157 $15.00 15 15 BA182 $15.00 15 15 BA157 $5.00 15 BA182 $5.00 15

BA158 $15.00 15 15 BA183 $15.00 15 15 BA158 $5.00 15 BA183 $5.00 15

BA159 $8.00 15 15 BA184 $15.00 15 15 BA159 $5.00 15 BA184 $5.00 15

BA160 $15.00 15 15 BA185 $15.00 15 15 BA160 $5.00 15 BA185 $5.00 15

BA161 $15.00 15 15 BA186 $15.00 15 15 BA161 $5.00 15 BA186 $5.00 15

BA162 $15.00 15 15 BA187 $15.00 15 15 BA162 $5.00 15 BA187 $5.00 15

BA163 $15.00 15 15 BA188 $15.00 15 15 BA163 $5.00 15 BA188 $5.00 15

BA164 $15.00 15 15 BA189 $15.00 15 15 BA164 $5.00 15 BA189 $5.00 15

BA165 $15.00 15 15 BA190 $15.00 15 15 BA165 $5.00 15 BA190 $5.00 15

BA166 $15.00 15 15 BA191 $15.00 15 15 BA166 $5.00 15 BA191 $5.00 15

BA167 $15.00 15 15 BA192 $15.00 15 15 BA167 $5.00 15 BA192 $5.00 15

BA168 $15.00 15 15 BA193 $15.00 15 15 BA168 $5.00 15 BA193 $5.00 15

BA169 $15.00 15 15 BA194 $15.00 15 15 BA169 $5.00 15 BA194 $5.00 15

BA170 $15.00 15 15 BA195 $15.00 15 15 BA170 $5.00 15 BA195 $5.00 15

BA171 $8.00 15 15 BA196 $15.00 15 15 BA171 $5.00 15 BA196 $5.00 15

BA172 $15.00 15 15 BA197 $15.00 15 15 BA172 $5.00 15 BA197 $5.00 15

BA173 $15.00 15 15 BA198 $15.00 15 15 BA173 $5.00 15 BA198 $5.00 15

BA174 $15.00 15 15 BA199 $15.00 15 15 BA174 $5.00 15 BA199 $5.00 15

BA175 $10.00 15 15 BA200 $15.00 15 15 BA175 $5.00 15 BA200 $5.00 15

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BA201 $15.00 15 15 BA227 $15.00 15 15 BA201 $5.00 15 BA227 $5.00 15

BA202 $15.00 15 15 BA228 $15.00 15 15 BA202 $5.00 15 BA228 $5.00 15

BA203 $15.00 15 15 BA229 $15.00 15 15 BA203 $5.00 15 BA229 $5.00 15

BA204 $15.00 15 15 BA230 $15.00 15 15 BA204 $5.00 15 BA230 $5.00 15

BA205 $15.00 15 15 BA231 $8.00 15 15 BA205 $5.00 15 BA231 $5.00 15

BA206 $15.00 15 15 BA232 $10.00 15 15 BA206 $5.00 15 BA232 $5.00 15

BA207 $15.00 15 15 BA233 $15.00 15 15 BA207 $5.00 15 BA233 $5.00 15

BA208 $15.00 15 15 BA234 $10.00 15 15 BA208 $5.00 15 BA234 $5.00 15

BA209 $15.00 15 15 BA235 $15.00 15 15 BA209 $5.00 15 BA235 $5.00 15

BA210 $15.00 15 15 BA236 $15.00 15 15 BA210 $5.00 15 BA236 $5.00 15

BA211 $15.00 15 15 BA237 $10.00 15 15 BA211 $5.00 15 BA237 $5.00 15

BA212 $15.00 15 15 BA238 $15.00 15 15 BA212 $5.00 15 BA238 $5.00 15

BA213 $15.00 15 15 BA239 $15.00 15 15 BA213 $5.00 15 BA239 $5.00 15

BA214 $15.00 15 15 BA240 $12.00 15 15 BA214 $5.00 15 BA240 $5.00 15

BA215 $15.00 15 15 BA241 $10.00 15 15 BA215 $5.00 15 BA241 $5.00 15

BA216 $15.00 15 15 BA242 $10.00 15 15 BA216 $5.00 15 BA242 $5.00 15

BA217 $15.00 15 15 BA243 $12.00 15 15 BA217 $5.00 15 BA243 $5.00 15

BA218 $15.00 15 15 BA244 $15.00 15 15 BA218 $5.00 15 BA244 $5.00 15

BA219 $15.00 15 15 BA245 $15.00 15 15 BA219 $5.00 15 BA245 $5.00 15

BA220 $15.00 15 15 BA246 $15.00 15 15 BA220 $7.00 15 BA246 $5.00 15

BA222 $15.00 15 15 BA247 $10.00 15 15 BA222 $7.00 15 BA247 $5.00 15

BA223 $15.00 15 15 BA248 $15.00 15 15 BA223 $5.00 15 BA248 $5.00 15

BA224 $12.00 15 15 BA249 $10.00 15 15 BA224 $5.00 15 BA249 $5.00 15

BA225 $15.00 15 15 BA250 $15.00 15 15 BA225 $5.00 15 BA250 $5.00 15

BA226 $15.00 15 15 BA251 $10.00 15 15 BA226 $5.00 15 BA251 $5.00 15

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BA252 $15.00 15 15 BA277 $10.00 15 15 BA252 $5.00 15 BA277 $5.00 15

BA253 $15.00 15 15 BA278 $15.00 15 15 BA253 $5.00 15 BA278 $5.00 15

BA254 $15.00 15 15 BA279 $15.00 15 15 BA254 $5.00 15 BA279 $5.00 15

BA255 $15.00 15 15 BA280 $15.00 15 15 BA255 $5.00 15 BA280 $5.00 15

BA256 $10.00 15 15 BA281 $15.00 15 15 BA256 $5.00 15 BA281 $5.00 15

BA257 $15.00 15 15 BA282 $15.00 15 15 BA257 $5.00 15 BA282 $5.00 15

BA258 $15.00 15 15 BA283 $15.00 15 15 BA258 $5.00 15 BA283 $5.00 15

BA259 $10.00 15 15 BA284 $15.00 15 15 BA259 $5.00 15 BA284 $5.00 15

BA260 $10.00 15 15 BA285 $12.00 15 15 BA260 $5.00 15 BA285 $5.00 15

BA261 $12.00 15 15 BA286 $15.00 15 15 BA261 $5.00 15 BA286 $5.00 15

BA262 $15.00 15 15 BA287 $15.00 15 15 BA262 $5.00 15 BA287 $5.00 15

BA263 $8.00 15 15 BA288 $10.00 15 15 BA263 $5.00 15 BA288 $5.00 15

BA264 $8.00 15 15 BA289 $15.00 15 15 BA264 $5.00 15 BA289 $5.00 15

BA265 $12.00 15 15 BA290 $12.00 15 15 BA265 $5.00 15 BA290 $5.00 15

BA266 $10.00 15 15 BA291 $15.00 15 15 BA266 $5.00 15 BA291 $5.00 15

BA267 $15.00 15 15 BA292 $12.00 # # BA267 $5.00 15 BA292 $5.00 #

BA268 $15.00 15 15 BA293 $15.00 # # BA268 $5.00 15 BA293 $5.00 #

BA269 $15.00 15 15 BA294 $15.00 # # BA269 $5.00 15 BA294 $5.00 #

BA270 $15.00 15 15 BA295 $15.00 # # BA270 $5.00 15 BA295 $5.00 #

BA271 $10.00 15 15 BA296 $15.00 # # BA271 $5.00 15 BA296 $5.00 #

BA272 $10.00 15 15 BA297 $15.00 # # BA272 $5.00 15 BA297 $5.00 #

BA273 $15.00 15 15 BA298 $15.00 # # BA273 $5.00 15 BA298 $5.00 #

BA274 $10.00 15 15 BA299 $10.00 # # BA274 $5.00 15 BA299 $5.00 #

BA275 $10.00 15 15 BA300 $12.00 # # BA275 $5.00 15 BA300 $5.00 #

BA276 $10.00 15 15 BA301 $15.00 # # BA276 $5.00 15 BA301 $5.00 #

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BA302 $15.00 # # BA327 $12.00 # # BA302 $5.00 # BA327 $5.00 #

BA303 $15.00 # # BA328 $15.00 # # BA303 $5.00 # BA328 $5.00 #

BA304 $15.00 # # BA329 $15.00 # # BA304 $5.00 # BA329 $5.00 #

BA305 $15.00 # # BA330 $15.00 # # BA305 $5.00 # BA330 $5.00 #

BA306 $12.00 # # BA331 $15.00 # # BA306 $5.00 # BA331 $5.00 #

BA307 $15.00 # # BA332 $15.00 # # BA307 $5.00 # BA332 $5.00 #

BA308 $15.00 # # BA333 $12.00 # # BA308 $5.00 # BA333 $5.00 #

BA309 $8.00 # # BA334 $15.00 # # BA309 $5.00 # BA334 $5.00 #

BA310 $10.00 # # BA335 $15.00 # # BA310 $5.00 # BA335 $5.00 #

BA311 $15.00 # # BA336 $15.00 # # BA311 $5.00 # BA336 $5.00 #

BA312 $10.00 # # BA337 $15.00 # # BA312 $5.00 # BA337 $5.00 #

BA313 $15.00 # # BA338 $12.00 # # BA313 $5.00 # BA338 $5.00 #

BA314 $12.00 # # BA339 $15.00 # # BA314 $5.00 # BA339 $5.00 #

BA315 $15.00 # # BA340 $15.00 # # BA315 $5.00 # BA340 $5.00 #

BA316 $10.00 # # BA341 $15.00 # # BA316 $5.00 # BA341 $5.00 #

BA317 $8.00 # # BA342 $10.00 # # BA317 $5.00 # BA342 $5.00 #

BA318 $15.00 # # BA343 $15.00 # # BA318 $5.00 # BA343 $5.00 #

BA319 $15.00 # # BA344 $15.00 # # BA319 $5.00 # BA344 $5.00 #

BA320 $15.00 # # BA345 $15.00 # # BA320 $5.00 # BA345 $5.00 #

BA321 $15.00 # # BA346 $15.00 # # BA321 $5.00 # BA346 $5.00 #

BA322 $15.00 # # BA347 $15.00 # # BA322 $5.00 # BA347 $5.00 #

BA323 $10.00 # # BA348 $15.00 # # BA323 $5.00 # BA348 $5.00 #

BA324 $15.00 # # BA349 $15.00 # # BA324 $5.00 # BA349 $5.00 #

BA325 $15.00 # # BA350 $10.00 # # BA325 $5.00 # BA350 $5.00 #

BA326 $10.00 # # BA351 $15.00 # # BA326 $5.00 # BA351 $5.00 #

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BA352 $12.00 # # BA377 $15.00 # # BA352 $5.00 # BA377 $5.00 #

BA353 $10.00 # # BA378 $15.00 # # BA353 $5.00 # BA378 $5.00 #

BA354 $12.00 # # BA379 $15.00 # # BA354 $5.00 # BA379 $5.00 #

BA355 $15.00 # # BA380 $10.00 # # BA355 $5.00 # BA380 $5.00 #

BA356 $15.00 # # BA382 $12.00 # # BA356 $5.00 # BA382 $5.00 #

BA357 $15.00 # # BA383 $15.00 # # BA357 $5.00 # BA383 $5.00 #

BA358 $15.00 # # BA384 $15.00 # # BA358 $5.00 # BA384 $5.00 #

BA359 $15.00 # # BA385 $15.00 # # BA359 $5.00 # BA385 $5.00 #

BA360 $15.00 # # BA386 $15.00 # # BA360 $5.00 # BA386 $5.00 #

BA361 $15.00 # # BA387 $15.00 # # BA361 $5.00 # BA387 $5.00 #

BA362 $15.00 # # BA388 $12.00 # # BA362 $5.00 # BA388 $5.00 #

BA363 $15.00 # # BA389 $15.00 # # BA363 $5.00 # BA389 $5.00 #

BA364 $10.00 # # BA390 $15.00 # # BA364 $5.00 # BA390 $5.00 #

BA365 $15.00 # # BA391 $15.00 # # BA365 $5.00 # BA391 $5.00 #

BA366 $15.00 # # BA392 $10.00 # # BA366 $5.00 # BA392 $5.00 #

BA367 $15.00 # # BA393 $15.00 # # BA367 $5.00 # BA393 $5.00 #

BA368 $15.00 # # BA394 $15.00 # # BA368 $5.00 # BA394 $5.00 #

BA369 $15.00 # # BA395 $15.00 # # BA369 $5.00 # BA395 $5.00 #

BA370 $15.00 # # BA396 $10.00 # # BA370 $5.00 # BA396 $5.00 #

BA371 $15.00 # # BA397 $15.00 # # BA371 $5.00 # BA397 $5.00 #

BA372 $15.00 # # BA398 $15.00 # # BA372 $5.00 # BA398 $5.00 #

BA373 $10.00 # # BA399 $15.00 # # BA373 $5.00 # BA399 $5.00 #

BA374 $10.00 # # BA400 $15.00 # # BA374 $5.00 # BA400 $5.00 #

BA375 $10.00 # # BA401 $15.00 # # BA375 $5.00 # BA401 $5.00 #

BA376 $15.00 # # BA402 $15.00 # # BA376 $5.00 # BA402 $5.00 #

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BA403 $12.00 # # BA428 $10.00 # # BA403 $5.00 # BA428 $7.00 #

BA404 $15.00 # # BA429 $10.00 # # BA404 $5.00 # BA429 $5.00 #

BA405 $15.00 # # BA430 $10.00 # # BA405 $5.00 # BA430 $5.00 #

BA406 $15.00 # # BA431 $10.00 # # BA406 $5.00 # BA431 $5.00 #

BA407 $15.00 # # BA432 $15.00 # # BA407 $5.00 # BA432 $5.00 #

BA408 $15.00 # # BA433 $10.00 # # BA408 $5.00 # BA433 $5.00 #

BA409 $15.00 # # BA434 $15.00 # # BA409 $5.00 # BA434 $5.00 #

BA410 $12.00 # # BA435 $15.00 # # BA410 $5.00 # BA435 $5.00 #

BA411 $15.00 # # BA436 $12.00 # # BA411 $5.00 # BA436 $5.00 #

BA412 $15.00 # # BA437 $15.00 # # BA412 $5.00 # BA437 $5.00 #

BA413 $10.00 # # BA438 $10.00 # # BA413 $7.00 # BA438 $5.00 #

BA414 $15.00 # # BA439 $15.00 # # BA414 $7.00 # BA439 $5.00 #

BA415 $10.00 # # BA440 $12.00 # # BA415 $5.00 # BA440 $5.00 #

BA416 $12.00 # # BA441 $10.00 # # BA416 $5.00 # BA441 $5.00 #

BA417 $15.00 # # BA442 $15.00 # # BA417 $5.00 # BA442 $5.00 #

BA418 $15.00 # # BA443 $15.00 # # BA418 $5.00 # BA443 $5.00 #

BA419 $15.00 # # BA444 $15.00 # # BA419 $5.00 # BA444 $5.00 #

BA420 $12.00 # # BA445 $15.00 # # BA420 $5.00 # BA445 $5.00 #

BA421 $15.00 # # BA446 $12.00 # # BA421 $5.00 # BA446 $5.00 #

BA422 $15.00 # # BA447 $10.00 # # BA422 $5.00 # BA447 $5.00 #

BA423 $15.00 # # BA448 $15.00 # # BA423 $5.00 # BA448 $5.00 #

BA424 $12.00 # # BA449 $15.00 # # BA424 $5.00 # BA449 $5.00 #

BA425 $10.00 # # BA450 $15.00 # # BA425 $7.00 # BA450 $5.00 #

BA426 $15.00 # # BA451 $12.00 # # BA426 $5.00 # BA451 $5.00 #

BA427 $15.00 # # BA452 $15.00 # # BA427 $7.00 # BA452 $5.00 #

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BA453 $8.00 # # BA478 $15.00 # # BA453 $5.00 # BA478 $5.00 #

BA454 $8.00 # # BA479 $15.00 # # BA454 $5.00 # BA479 $5.00 #

BA455 $12.00 # # BA480 $15.00 # # BA455 $5.00 # BA480 $5.00 #

BA456 $8.00 # # BA481 $15.00 # # BA456 $5.00 # BA481 $5.00 #

BA457 $15.00 # # BA482 $15.00 # # BA457 $5.00 # BA482 $5.00 #

BA458 $10.00 # # BA483 $15.00 # # BA458 $5.00 # BA483 $5.00 #

BA459 $15.00 # # BA484 $12.00 # # BA459 $5.00 # BA484 $5.00 #

BA460 $15.00 # # BA485 $15.00 # # BA460 $5.00 # BA485 $5.00 #

BA461 $15.00 # # BA486 $15.00 # # BA461 $5.00 # BA486 $5.00 #

BA462 $15.00 # # BA487 $15.00 # # BA462 $5.00 # BA487 $5.00 #

BA463 $15.00 # # BA488 $15.00 # # BA463 $5.00 # BA488 $5.00 #

BA464 $12.00 # # BA489 $8.00 # # BA464 $5.00 # BA489 $5.00 #

BA465 $15.00 # # BA490 $15.00 # # BA465 $5.00 # BA490 $5.00 #

BA466 $15.00 # # BA491 $15.00 # # BA466 $5.00 # BA491 $5.00 #

BA467 $15.00 # # BA492 $15.00 # # BA467 $5.00 # BA492 $5.00 #

BA468 $15.00 # # BA493 $15.00 # # BA468 $5.00 # BA493 $5.00 #

BA469 $15.00 # # BA494 $15.00 # # BA469 $5.00 # BA494 $5.00 #

BA470 $15.00 # # BA495 $15.00 # # BA470 $5.00 # BA495 $5.00 #

BA471 $10.00 # # BA496 $15.00 # # BA471 $5.00 # BA496 $7.00 #

BA472 $10.00 # # BA497 $15.00 # # BA472 $5.00 # BA497 $5.00 #

BA473 $15.00 # # BA498 $15.00 # # BA473 $5.00 # BA498 $5.00 #

BA474 $15.00 # # BA499 $10.00 # # BA474 $5.00 # BA499 $5.00 #

BA475 $15.00 # # BA500 $10.00 # # BA475 $5.00 # BA500 $5.00 #

BA476 $15.00 # # BA501 $10.00 # # BA476 $5.00 # BA501 $7.00 #

BA477 $15.00 # # BA502 $10.00 # # BA477 $5.00 # BA502 $7.00 #

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CÓDIGOS DE CUBIERTAS / COPAGOS

191 08/13/2015

VISITAS SIQUIÁTRICAS Y COLATERALES TERAPIAS DE GRUPO

CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED VISITAS COL. CUBIERTA COA/DED TERAPIAS CUBIERTA COA/DED TERAPIAS

BA503 $10.00 # # * * * * BA503 $7.00 # * * *

BA504 $10.00 # # * * * * BA504 $7.00 # * * *

BA505 $10.00 # # * * * * BA505 $7.00 # * * *

BA506 $15.00 # # * * * * BA506 $7.00 # * * *

BA507 $15.00 # # * * * * BA507 $7.00 # * * *

BA508 $15.00 # # * * * * BA508 $7.00 # * * *

BA509 $15.00 # # * * * * BA509 $7.00 # * * *

BA510 $15.00 # # * * * * BA510 $7.00 # * * *

BA511 $10.00 # # * * * * BA511 $7.00 # * * *

BA512 $10.00 # # * * * * BA512 $7.00 # * * *

BA513 $10.00 # # * * * * BA513 $7.00 # * * *

BA514 $10.00 # # * * * * BA514 $7.00 # * * *

BA515 $10.00 # # * * * * BA515 $7.00 # * * *

BA516 $15.00 # # * * * * BA516 $7.00 # * * *

BA517 $15.00 # # * * * * BA517 $5.00 # * * *

BA518 $15.00 # # * * * * BA518 $5.00 # * * *

BA519 $15.00 # # * * * * BA519 $5.00 # * * *

BA520 $15.00 # # * * * * BA520 $5.00 # * * *

BA521 $15.00 # # * * * * BA521 $5.00 # * * *

BA522 $10.00 # # * * * * BA522 $5.00 # * * *

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