premier plan

Transcription

premier plan

MED PLAN
2016
™
Affordable Health Solutions
PREMIER PLAN
Provider Directory
Florida Office of Insurance Regulation: Med Plan, LLC
Date of Insurance: July 27, 2010 N 10-800522755
MEMCOM-MEMHND-001
V08/12/2016
305-262-1610
w w w. f l o r i d a m e d p l a n . c o m
1
Dear Member,
Welcome to our plan. These are the membership cards for you and your family. When visiting your Physicianor Specialist you must present your Med Plan
membership card with a picture ID so that your eligibility can be verified at time of your visit. If you have any problem or need our assistance, please feel free to
contact us 305-262-1610. We will be periodically updating our network of suppliers and services and we will send you this update via email.
Thank you for trusting Med Plan to protect your family’s health.
Estimado Asociado:
Deseamos darle la bienvenida a Med Plan. Incluido con este documento se encuentra su Tarjeta de Identificación para usted y su familia. Recuerde que siempre
que vaya a hacer uso de ella debe de portar una identificación con foto para que el médico o proveedores puedan identificarlo. Si Ud. tiene alguna dificultad o
necesita asistencia con nuestros proveedores en citas o algo más por favor llámenos 305-262-1610. Periódicamente estaremos actualizando nuestra red de
proveedores y servicios, le haremos llegar esta información vía correo.
Gracias por confiar en Med Plan para proteger su salud y la de su familia.
5 / Membership Agreement / Acuerdo de Membrecia
6 / Welcome Letter / Carta de Bienvenida
67 / Diagnostic and Radiology / Diagnostico y Radiologia
7 / Terms and Conditions / Términos y Condiciones
68 / Diagnostic Services Fee Schedule
8 / How to Use Your Card? / ¿Cómo usar su tarjeta?
71 / Perinatal Medicine / Medicina Perinatal
10 / MedPlan / MedCare Clinis
11/ Medicos Primarios
21 / Gynecology & Obstetrics / Ginecologia y Obstetricia
72 / Ancillary Services / Servicios Auxiliares
72 / Transportation/ Transportacion
74 / Orthopedic Supplies/ Suplementos Ortopedicos
23 / Pediatrics / Pediatria
24 / Primary and Specialist Provider Fee Schedule / Precios de los servicios
26 / Medical Centers / Centros Medicos
77 / Hearing Aids/ Suplementos Auditivos
77 / Home Health / Servicios a domicilio
28 / Specialist Physicians Locations / Direcciones de los Medicos Especialistas
77 / Physical Therapy / Terapia Fisica
37 / Neurological Studies Fee Schedule / Estudios neurológicos
78 / Alternative Medicine / Medicina Alternativa
40 / Urgent Care Centers / Centros de Cuidados de Urgencia
78 / Diabetes Supply Services / Suplementos para la Diabetes
42 / Dental Services / Servicios Dentales
79 / Pharmacy Services / Servicios Farmaceuticos
44 / General Dentistry Fee Schedule / Servicios de Odontologia General
88 / Cosmetic Services Fee Schedule / Precios Cosmetologia
51 / Dental Specialties Fee Schedule / Servicios Dentales por Especialidad
52 / Optical Services / Servicios Opticos
56 / Clinical Laboratories / Laboratorios Clinicos
2
Disclaimer of Liability
In consideration of the monthly payment fees to be paid to Med Plan by you or on your behalf, Med Plan agrees to arrange for the delivery of health care services in
accordance with and subject to the terms of the Agreement entered into between you or on your behalf, and Med Plan. Med Plan, in so arranging for the delivery of health
care services and supplies, does not directly provide these services nor supply them. Rather, Independent Contractors provide these services and supplies. The health
care providers listed in this directory are not employees or agents of MedPlan. MedPlan shall not be liable for any negligent act or omission committed by any of the
providers listed in this directory, or any of their employees or agents who may, from time to time provide medical services to you. MedPlan expressly disclaims any agency
relationship, actual or implied, with any health care provider. MedPlan does not exercise any control or direction over the medical judgement or clinical decisions of any
health care provider listed in this directory and does not interfere with the physician patient relationship between you and any health care provider. It is important for you
to know when you enroll in MedPlan that the continued participation of any one doctor, hospital or other provider cannot be guaranteed. This directory is current as of date
of publication. Some plan providers may have been added or removed from this list after this directory was printed. To get the most up-to-date information about MedPlan
providers in your area, you can visit www.floridamedplan.com or call our Customer Service Department at 844-200-1222, Monday through Friday, 9:00 am to 6:00 pm.
The fact that a provider is listed does not guarantee that they are still in the network or accepting new patients. The “Plan Providers” listed in this directory have agreed to provide
you with your health care coverage at fixed discounted from their usual and customary pricing rate. Members are limited to only those providers that are affiliated to the MedPlan
Network of Providers. Participating physicians and other providers listed in this directory or on our website www.floridamedplan.com are not agents, employees or partners of
MedPlan or any of its subsidiaries. MedPlan is not a medical services provider, a medical insurance plan nor an HMO. MedPlan does not control nor endorse the judgement
or clinical treatment recommendations made by the physicians or other providers listed in our directory, or in our website www.floridamedplan.com nor those that you chose to
select. All MedPlan providers are independent contractors. You may go to any of our plan providers listed in this directory; however some services may require a prescription
or medical treatment plan provided by a licensed medical physician. If you have been going to one plan provider, you are not required to continue going to that same provider.
Excepcion de Responsabilidad civil
MedPlan, en consideración al pago de su membrecía, está de acuerdo en ofrecerle el acceso a la red de proveedores establecida que prestan sus servicios a nuestros miembros.
MedPlan coordinará su primera cita con el proveedor que usted elija dentro del directorio. MedPlan no asigna a ningún proveedor. Es responsabilidad del miembro elegir el
médico que le prestará los servicios. MedPlan no ofrece los servicios médicos directamente, sino a través de proveedores independientes que proveen estos servicios y sus
suplementos. Los proveedores que aparecen en este directorio no son empleados o agentes de MedPlan. Los empleados o agentes de MedPlan no deben ser responsables
legalmente por alguna negligencia o acto de omisión cometida en cualquier momento por algún proveedor que aparezca en este directorio. MedPlan específicamente no se
responsabiliza en ningún momento y no tiene ninguna relación de agencia con ningún proveedor médico. MedPlan no ejerce ningun control o dirección respecto a un criterio
médico o decisión clínica de algún proveedor del directorio ni interfiere en la relación entre el paciente y su médico. Es importante que al convertirse en miembro de Med
Plan, la persona sepa que no se le garantiza la continua participación de un doctor, hospital, u otro proveedor. Este directorio está vigente desde el día en que fue publicado.
Es muy posible que a partir de ese dia se hayan agregado o eliminado de la lista algunos proveedores. Para obtener una información actualizada de los proveedores en
su area, visítenos en www.floridamedplan.com o llame a nuestro Departamento de Servicio al Cliente, al 844-200-1222, de Lunes a Viernes de 9:00 am a 6:00 pm.
El hecho de que un proveedor se encuentre en la lista no garantiza que todavía se encuentre en la red o que participe consultando nuevos pacientes. Los proveedores
listados en este directorio han acordado en proveerles a los miembros de Med Plan sus servicios de cuidado a su salud con una tarifa fija que representa un Ahorro sobre
la tarifa regular. Usted puede ir a cualquiera de nuestros proveedores en este directorio y no necesita ser referido por el médico primario que le atiende para visitar a un
especialista dentro de la red, pero los servicios, de exámenes de laboratorio, radiología o diagnóstico sí requieren de una orden por parte del doctor para completar estos
procedimientos. Si usted ha ido a uno de nuestros proveedores y no se siente satisfecho con sus servicios, usted no está en la obligación de seguir visitándolo. Los
miembros están limitados a los proveedores que están afiliados a la red de MedPlan. Los proveedores participantes en este directorio o en www.floridamedplan.com no
son agentes, empleados o socios de MedPlan, ni ninguno de sus subsidios. MedPlan no es un proveedor de servicios médicos, ni tampoco un plan de seguros médicos ni
un HMO. MedPlan no apoya los diagnósticos ni los tratamientos médicos dados por los proveedores participantes en la red de MedPlan listados en este directorio, ni en
www.floridamedplan.com, ni los proveedores escogidos por nuestros miembros
3
Providers Are Independent
Providers are listed in this directory by the type of provider. Within each provider type, providers are listed by COUNTY. You can also visit www.floridamedplan.com or call
Customer Care Department at 844-200-1222. Our providers are paid on a contracted discount fee-for-service basis by you at the time the service is rendered.
If you use Non-Plan providers, understand that Non-Plan providers are not part of MedPlan network. In that case, you will have to pay the provider their usual and customary fees
which are significantly higher than the contracted rate MedPlan has with its in-network providers. care or services you get from non-plan providers will NOT be covered. MedPlan
services are limited to the counties that MedPlan has providers and services contracted in. Any services provided outside MedPlan service areas will not be at the contract price.
You have the right to get timely access to plan providers and to all discounts covered by the plan. Timely access means that you can get appointments and services within a
reasonable period of time. You have the right to get full information from your providers when you go for medical care. You have the right to participate fully in decisions about
your healthcare. You have the right to refuse care.
MedPlan does not limit its members from visiting any provider contracted by MedPlan. You can visit any provider or service without any limitation or need for referral.
Services such as Dental and Optical can be accessed directly by the member at anytime without providing notification to your PCP.
The following directory is constantly changing and is therefore subject to change without notice. For current and update providers information please visit our website:
www.floridamedplan.com
Los proveedores son independientes
Los proveedores en este directorio han sido clasificados según tipo de proveedor. Cada especialidad ha sido clasificada en sus respectivos condados. Visítenos en www.
floridamedplan.com o llámenos al Departamento de atención al cliente al 844-200-1222. Nuestros proveedores tienen que ser pagados por usted a la hora de recibir sus
servicios. MedPlan tiene varios tipos de acuerdos contractuales con los proveedores que son comunes en los planes médicos.
Si usted usa un proveedor que no forma parte de la red de MedPlan, usted no recibirá la tarifa negociada y tendrá que pagar la tarifa completa que exija ese proveedor. Los
descuentos de MedPlan no se aplican si usted viaja fuera de las areas de servicios.
Usted tiene derecho al acceso de la red de nuestros proveedores y a todos los descuentos disponibles en el plan. Esto significa que usted puede obtener citas y servicios en un
tiempo razonable. Usted tiene derecho a recibir de su proveedor toda la información referente a su cuidado o tratamiento médico, a participar completamente en las decisiones
sobre su salud, y al derecho de rehusar su tratamiento médico.
MedPlan no limita a sus miembros a visitar a cualquier proveedor que pertenezca a su red. Usted puede visitar a cualquier proveedor o servicio sin ningún tipo de limitación o
necesidad de derivación.
Esto evitará la duplicación de los servicios solicitados, o más importante aún, que al miembro no se le prescriba un medicamento que puede estar contraindicado con otro
medicamento ordenado por un proveedor desconocido. Tambien tenga en cuenta que debido a la naturaleza de los sistemas de prestación de asistencia sanitaria, a veces
es necesario tener una prestación escrita o plan de tratamiento médico a fin de que los servicios prestados por determinados proveedores de MedPlan estén prescritos
correctamente.
El siguiente directorio está sujeto a modificaciones constantes y puede cambiar sin previo aviso. Para más información actualizada visítenos en www.floridamedplan.com
4
Membership Agreement
MED PLAN LLC
Attn: Compliance Department
3155 NW 77th Ave, Doral, Fl. 33122
For assistance and plan information call: 844-200-1222. or plan information, to change your method of payment, to add family members or for any other assistance please call the customer
service number located on the back of your membership card. All documents contained herein (i.e. Terms and Conditions and Member Benefits) are hereby attached to and made a part of
the Membership Agreement. Disclosures:
1. This plan is not a health insurance policy.
2. This plan provides discounts at certain health care providers for medical services.
3. This plan does not make payments directly to the providers of medical services.
4. The plan member is obligated to pay for all health care services but will receive a discount from those
health care providers who have contracted with the discount plan organization.
Terms and Agrements:
To terminate or cancel the member agreement please call the number above or send a written cancellation notice to the Discount Medical Plan Organization at the address provided above.
This agreement will not be cancelled for non-payment. If the discount medical plan organization cancels a membership for any reason other than nonpayment of fees by the member, the
discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member. If you cancel for any reason within 30 days after the effective date, you will
receive a full refund of paid membership fee, excluding the $30 one-time application fee. The lost or misplacement Of this card will have an additional fee of $5.75 payable to MedPlan.
Legal Notice:
Med Plan is not an insurance company. Med Plan offers discounts on some health providers for their medical services. Med Plan does not make direct payments to the providers of medical
services. The members of Med Plan are required to pay for all the health care services, but will have a discount on the health providers contracted.
Acuerdo de Membrecia
Para información del plan, para cambiar la forma de pago, para agregar miembros de la familia o cualquier otro tipo de asistencia llame al Departamento de Atencion al cliente situado en
la parte superior de su tarjeta de membrecia: 844-200-1222. Todos los documentos incluidos (beneficios de los miembros, términos y condiciones de estos) se mostrará en estas páginas y
forma parte del Acuerdo de Membrecía. Para cancelar su membrecía, por favor llame al número indicado anteriormente y envíe una notificacion con su puño y letra explicando los motivos
de su cancelación al Departamento de Servicio al Cliente de MedPlan.
Por favor envíe las tarjetas de membrecía de cada miembro junto con la carta de cancelación, esta carta debemos recibirla antes de los 30 días despues que se afilió a la Compañía. Este
acuerdo puede ser cancelado por no pagar su mensualidad. Si el Departamento de Servicios al Cliente de MedPlan cancela su membrecía por cualquier razón que no sea el pago de su
mensualidad MedPlan le hará el reembolso con la suma de los días no utilizados.
Proceso de cancelación:Si usted cancela su membrecía por cualquier razón dentro de los 30 días siguientes a la fecha de efectividad, usted recibirá un rembolso completo de su pago,
excepto la cuota de inscripción de $30.00. La perdida o extravió de la tarjeta tendra un costo adicional de $5.75 pagadero a MedPlan
Aviso Legal
Med Plan no es un seguro médico. Med Plan proporciona descuentos con los proveedores de la salud que han sido contratados. Med Plan no efectúa pagos directamente a los proveedores
de los servicios médicos. Los miembros de Med Plan están obligados a pagar por todos los servicios Médicos, pero recibirán un descuento de los provedores de salud que han sido
contratados.
5
Welcome
We are pleased to welcome you to Med Plans Premier Plus benefits program. You can enjoy savings on your health care needs by using your new membership card, which is
enclosed in your new member packet. For your convenience we have enclosed with your membership kit a complete directory of all Med Plans contracted participating providers. Our Member Services Department is also available during business hours to assist you in locating additional providers in your area. Just call our toll-free number located
on the back of you membership card, or you may go to the internet at www.floridamedplan.com at any time day or night. If your favorite provider is not already on our program,
you may nominate them to Members Services for additional follow-up.
Please keep in mind that your membership is NOT insurance, so it is simple and easy to use. You can begin using Med Plans complete list of services immediately as many
times as needed without need of prior approvals. When you present your card with your
ID to a participating provider you will have immediately access to the exclusive pricing Med Plan members receive at time of service.
We also understand that your family’s health is your number one priority, so all legal dependents you have enrolled as part of your plan will receive their own card that they need
to take with them to access the same pricing and services. If for any reason you are not satisfied with this program or are having problems in accessing services, pleased call
the number on the back of your card for prompt response to any issue. We encourage our new members to please take a moment to familiarize yourself with the instructions in
this booklet so that you can better understand how Med Plan works and what is required to access the different services.
Please remember the more informed you are, the better your experience with Med Plan will be and the more often you will take advantage of the tremendous serves and
exclusive pricing that Med Plan offers you. Remember your Health is the most precious gift you have. Let Med Plan help protect it.
BIenvenido
Nos complace darle la bienvenida a un programa de beneficios de primer nivel. Puede disfrutar de ahorros en sus necesidades de salud mediante el uso de su nueva tarjeta
de membrecía, que se incluye en su paquete de nuevo miembro. Para su comodidad, le proporcionamos una guía de proveedores contratados por Med Plan que incluyen,
direcciones y números de teléfono. Nuestro Departamento de Servicios también está disponible durante horas de oficina para ayudarle a encontrar proveedores en su área y
ayudarlos a conseguir una cita o usted puede visitar nuestro sitio Web: www.floridamedplan.com a cualquier hora del día o llamar al (305) 262-1610 en horas laborables.
Si su Doctor favorito no pertenece a nuestra Red, usted puede llamar a Med Plan al Departamento de Relación con proveedores y nosotros lo vamos a contactar, haciendo todo
lo posible por lograr que se una a nuestra Red y continúe brindándole los servicios que usted se merece a través de nuestro Plan Médico.
Med Plan en ningún caso le garantiza el resultado de esta Gestión.
Por favor, tenga en cuenta que su membrecía NO ES UN SEGURO MEDICO, por lo que es simple y fácil de usar. Usted puede usar la tarjeta inmediatamente y tantas veces
como sea necesario. Al presentar su tarjeta a usted se le aplicará inmediatamente la tarifa de descuento en el momento del pago del servicio.
En Med Plan, sabemos que la salud de su familia es su prioridad. Todos los dependientes legales podrán utilizar su tarjeta de membrecía, o solicitar tarjetas adicionales en caso
de pérdida para usted o algún miembro de la familia con su propio nombre, simplemente llamando al Departamento de Servicios al cliente. (305) 262-1610 Si por alguna razón
usted no está satisfecho con este plan, llame al número en la parte posterior de su tarjeta para su reclamo.
¡PORQUE SU SATISFACCION ESTA GARANTIZADA!
6
Terms And conditions
1 - Primary member is defined as the person who is responsible for the monthly payments for membership fees and is of legal age. The primary member, spouse, and all legal
dependents listed on the enrollment application can access the services and exclusive pricing at Med Plan Contracted service providers.
2 - Participating provider may be added or removed from the respective network in which they are associated with. These changes are made in best interest of our members.
Updated Provider information will be made available online at www.floridamedplan.com
3 - Companies contracted to provide benefits and services in this program are not a licensed insurer, health maintenance organization (HMO), or any other underwriters of
healthcare services. No portion of any provider fees will be reimbursed or otherwise paid.
4 - The exclusive Med Plan pricing contained herein may not be used in conjunction with any other medical plan or discount program. All listed or quoted prices are current prices
from participating providers and subject to change without notice. From time to time, certain providers may offer products and /or services to the general public at prices lower
than the prices available through this program. In such event, members will be charged the lowest price.
5 - Providers are subject to change without notice and programs may vary in some states. This is a discount membership program only, not insurance, and may be discounted
or modified at anytime.
6 - Savings are based upon the provider’s normal fees. Actual savings will vary depending upon location and specific services or products purchased.
7 - This discount medical plan does not warrant professional services, nor is it responsible for the quality of care provided by participating providers.
8 - (30) Day Money Back Guarantee: If you cancel for any reason within 30 days, you will receive a full refund. Nonrefundable one time fees will be disclosed at time of application.
9 - All applicable limitations, exclusions and exceptions of the discount medical plan benefits are listed with each benefit description.
Terminos y condiciones
1 - El titular es definido como miembro principal, siendo el responsable de los pagos mensuales y debe ser mayor de edad. Dicho titular, el cónyuge y todos los dependientes
legales adicionales contaran automáticamente con los mismos beneficios que se ofrecen en el plan.
2 - En cualquier momento, un proveedor participante puede ser eliminado de la red de Med Plan. Estos cambios se realizan para beneficio de nuestros miembros. Usted
encontrará esta información acualizada en el sitio web www.floridamedplan.com
3 - Las compañías proveedoras de servicios asociadas a nuestro plan no son aseguradoras, organizaciones de la salud (HMO) o evaluadores de servicios de salud. Cualqueir
honorario que usted les pague a estas compañías no le será reembolsado.
4 - Los descuentos que figuran en este documento no pueden ser utilizados en combinación con cualquier otro plan de descuento médico o programa de descuentos. Todos los
precios cotizados son los precios actuales de los proveedores participantes y están sujetos a cambios sin previo aviso. De vez en vez, algun proveedor puede ofrecer productos
y / o servicios al público en general a precios inferiores a los precios disponibles en este programa. En tal caso, se cobrará el precio más bajo.
5 - Los proveedores están sujetos a cambios sin previo aviso, los programas pueden variar en algunos términos. Este es un programa de membrecía de descuentos, no un
seguro medico, y puede ser cancelado o modificado en cualquier momento.
6 - Los ahorros se basan en las tasas normales del proveedor. Los ahorros reales variarán dependiendo de la localización de los servicios específicos o productos comprados.
7 - Este plan médico de descuentos no ofrece garantía por la calidad de los servicios profesionales brindados por los proveedores participantes.
8 - Garantía de Reembolso por 30 Días: Si cancela por cualquier razón en un plazo de 30 días, usted recibirá un reembolso completo de su mensualidad. Tasa no reembolsable
se revelará en el momento de aplicación.
9 - Las limitaciones, exclusiones o excepciones que apliquen dentro este plan médico de descuentos se enumeran en la descripción de cada servicio.
7
How to use your membership card.
1. Keep your membership card with you at all times so it will be easily accessible to present at provider locations. Please note that you must present your membership card so
that the status of you membership can be verified before services are provided and to qualify for Med Plan exclusive price at contracted provider locations.
2. When visiting your dental or vision center you must present your Med Plan membership card with a picture ID so that your eligibility can be verified at time of your visit to
receive the exclusive pricing offered to Med Plan members
3. Med Plan has sent all persons covered in your plan their own membership cards. Each card has its own ID number and must be shown to the provider so that the status of
you membership can be verified before services are provided. If the dependent is a minor then it is the responsibility of the “minors” parent or legal guardian to accompany the
minor to all provider visits and services.
4. To locate participating providers in your area, please refer to the Provider Directory provided in your “Membership Kit”. This directory contains information on all Med Plan
contracted providers including pricing for all covered services. Since providers and services are being added monthly, Med Plan has created a website for our members to view
all of their membership information which includes updates and new services. To access this information online please call Med Plans “Member Service Department” and ask
for them to email you your username and password. For additional provider locations, call the appropriate number on the back of your card or visit: www.floridamedplan.com
5. Please remember that Payment for all services must be made directly to the provider at time of service.
6. If you have any questions on how to use your membership, call our Member Services departments at the toll-free number listed on your card for prompt, friendly service.
7. We are located at 3155 NW 77 Ave, Doral FL 33122
(305) 262-1610. Our Offices are open Monday through Friday
9:00 a.m. to 5:00 p.m.
Como usar su tarjeta de miembro?
Cuando usted visite su centro dental o de vision usted pagará una tarifa fija preferencial que ha sido establecida para los miembros de MedPlan. Las Tarifas establecidas
aparecen en este libro que ha sido incluido dentro del paquete de membrecía que usted recibió. Por favor refiérase a la sección que corresponda dentro de este directorio.
Todos los servicios prestados en cualquier centro usted los pagará directamente en el momento de recibir los servicios.
Solo los médicos y demás proveedores de la red que brindan sus servicios a nuestros miembros, honraran las tasas establecidas. Los proveedores de la red tienen en su poder
las mismas tarifas que usted tiene, esto le asegura que lo que usted pagará no puedan ser alterados.
MedPlan no le asigna ningún proveedor, usted es libre de elegir dentro del directorio. La información detallada para localizar a un proveedor, dirección, número telefónico, tarifa
etc. se encuentra dentro del directorio médico que usted recibió. Usted puede obtener esta información en cualquier momento visitando nuestra página web:
www.floridamedplan.com
Para coordinar su primera cita con un proveedor de la red usted puede elegir cualquiera de las siguientes opciones:
a) Llame directamente al proveedor que usted haya elegido.
b) Llame a nuestro departamento de atención al cliente y solicite que se le coordine la cita con el centro que usted haya elegido. En ese caso tenga a mano el nombre del centro
para que la asistencia sea efectiva y rápida en función de sus necesidades.
Nos encontramos en 3155 NW 77 Ave, Doral FL 33122
(305) 262-1610.
Nuestras oficinas estan abieras de Lunes a Viernes de 9:00 a.m. to 5:00 p.m.
8
Primary Physicians and Specialists
All services rendered at your primary care physicians office or Specialist will be paid directly to the provider at fix rates that are completely disclosed inside
this book. These prices are exclusive to Med Plan members and represent an average savings of 70% percent off the Providers Usual and customary fees.
All prices cover service provided at your Physicians office which can include, routine X-rays, EKG’s, Ultrasounds and many other services. Services vary
from provider to providers depending on equipment each Physician or Specialist practice elects to provide. It’s unlimited the access to Primary Care and
Specialist Visits. No prior approval is needed. Physician and Specialists address and phone numbers are located inside your Membership kit or on our
website www.floridamedplan.com. To schedule an appointment please call the provider you have chosen from the directory. If you need assistance or
cannot find a provider near you please call our Customer Service Department for assistance at 844-200-1222.
Only approved and contracted Med Plan Physicians and Specialists will honor the exclusive prices as defined in the Pricing Guide included in your
membership kit.
Any Diagnostic studies, Laboratory test, Prescription Medication or services ordered by a Med Plan contracted Physician or Specialist must be performed
or completed by a Med Plan approved and contracted provider. This will insure that the service and its price are within the scope of the agreements Med
Plan has in place with its approved service providers. If you need assistance in coordinating these services please feel free to contact our Customer
Service Department at 844-200-1222.
Note: If your favorite physician is not already a participating provider, Call our Provider Relation Department to nominate him or her. Have the physicians
name, address, and telephone number available when you call.
Medicos primarios y especialistas
Todas las tasas aplican a los servicios prestados en la oficina de los médicos que pueden incluir, rutina de Rayos X, electrocardiogramas, ecografías
y muchos otros servicios. Los servicios pueden estar disponibles o no, dependiendo el equipo médico o especialista que usted pueda elegir. Tenga
en cuenta que no todos reúnen las mismas condiciones de equipamiento dentro de su consulta médica. Usted cuenta con visitas médicas ilimitadas y
además tendrá la libertad de visitar a cualquier médico especialista sin la necesidad de ser referido por su médico primario.
Cualquier estudio de Diagnóstico, Examen de Laboratorio, Medicamentos recetados u otro servicio deberá ser indicado por un proveedor que haya sido
aprobado o contratado por MedPlan. Esto asegura que el servicio que usted va a recibir y la tasa que va a pagar esta dentro de los acuerdos que MedPlan
ha establecido con los proveedores de la red.
Nota: Si su doctor favorito aun no es participante de nuestra red y desea que se integre para que pueda continuar con sus servicios y adaptar nuestras
tarifas preferenciales, por favor contacte a nuestro departamento de Relación con Proveedores y ofrezca información precisa del doctor (Nombre,
Dirección y Teléfono de su oficina) nosotros nos sentiremos complacidos en contactarlo a mayor brevedad posible y lo invitaremos a que se una a nuestra
Red.
9
MED PLAN CLINICS / MEDCARE CLINICAS DE MED PLAN / MEDCARE
1ST VISIT :$25 - FOLLOW UP: $20
•
•
•
•
•
4767 NW 183 St Miami Gardens FL. 33055
Phone: (305) 266-2929
4218 East 4th Ave Hialeah, FL. 33013
Phone: (305) 266-2929
1149 SW 27 Ave Miami Fl. 33135
Phone: (305) 266-2929
900 W 49th St, Suite 308
Hialeah, Fl. 33012
Phone: (305) 266-2929
7200 N.W. 7th St, FIRST FLOOR
Miami, Fl. 33126
Phone: (305) 266-2929
11825 SW 26th St Miami, FL 33175
Phone: (305) 266-2929
900 W 49 ST Suite 101 Hialeah, FL. 33012
Phone: (305) 266-2929
7200 N.W. 7th St, 2ND FLOOR
Miami, Fl. 33126
Phone: (305) 266-2929
10982 SW 184th St Miami, FL. 33157
Phone: (305) 266-2929
Primary Physician / Médico Primario
Laboratory / Laboratorio
Ultrasound / Ultrasonido
X-Rays / Rayos X
Electrocardiogram / Electrocardiograma
CALL NOW FOR AN APPOINTMENT
LLAME HOY PARA UNA CITA
ESCOJA SU IDIOMA Y MARQUE EL
#2 / COSTUMER SERVICE
10
305.262.1610
Primary Care Physicians / Médicos Primarios
Esperanza A. Nuñez, M.D.
(General Practice)
(Glez and Gonzalez Medical Center)
3804 NW 167th Street
Opalocka, Fl. 33054
Phone: (305) 624-2700
1st Visit :$40 - Follow Up: $20
Abraham A. Benchabatt, M.D.
(General Practice)
MD Health Care and Rehabilitation
14750 NW 77 Ct # 106
Miami Lakes, Fl. 33016
Phone: (305) 698-4000
Armando Segui, M.D.(General Practice)
(Ambert Medical Center)
15495 Eagle Nest Ln, Suite 100
Phone: (305) 556-0021
Jose Avila, M.D. (General Practice)
(Century Medical Group)
11300 NW 87th Court, Suite 141
Hialeah Gardens, Fl. 33018
Phone: (305) 392-0257
Miami - Dade
Lucky Flores, M.D.
(General Practice)
8206 NW 103 St
Hialeah Gardens, Fl. 33016
Phone: (305) 827-0208
Gonzalo Gonzalez, M.D.
(General Practice)
(Elite Health & Rehabilitation)
1949 W 68th St Hialeah, Fl. 33014
Phone: (305) 698-0806
Maria Cadima, RNPA
(General Practice)
1949 W 68th St Hialeah, Fl. 33014
Phone: (305) 698-0806
Pilar Delgado, M.D.
(General Practice)
5590 W. 20 ave Suite 100
Hialeah, Fl. 33016
Phone: (305) 828-3997
Miguel A. Chamah, M.D.
(General Practice)
1800 West 68th St, Suite 127
Hialeah, Fl. 33014
Phone: (305) 820-0903
Felix A. Rodriguez, M.D.
(General Practice)
(American Family Health Center)
1840 W. 49 St, Suite 425
Hialeah, Fl. 33012
Phone: (305) 231-8996
Felix Penate, M.D. (General Practice)
1949 W 68th St
Hialeah, Fl. 33014
Phone: (305) 698-0806
Odalys Frontela, M.D. F.A.C.P
(General Practice)
801 West 48th St,
Suite A Hialeah, Fl. 33012
Phone: (305) 698-7172
11
Otneil Hernandez, D.N.P
(Family Practice)
1275 West. 47 Pl. Suite 422
Hialeah, Fl. 33012
Phone (305) 676-2300
Juan J. Salinas, M.D.
(General Practice)
4212 W 16 Ave Hialeah, Fl. 33012
Phone: (305) 821-5525
Sebastian Padron, M.D.
Prime Care Medical Center
(General Practice)
4305 East 8 ave, Suite E
Hialeah, Fl. 33013
Phone: (305) 769-5601
Miami - Dade
Conchita Jackson, M.D.
(General Practice) (Vida Health Centers)
881 E 2nd Ave Hialeah, Fl. 33010
Phone: (305) 882-1100
Jon Hemstreet, M.D.
(General Practice)
(7th Ave. Medical Plaza)
10071 NW 7 ave Miami, Fl. 33150
Phone: (305) 403-7777
Johanne Zephir, M.D. (General Practice)
(7th Ave. Medical Plaza)
10071 NW 7 ave Miami, Fl. 33150
Phone: (305) 403-7777
12
Hector Rodriguez, M.D.
(General Practice)
(Acevedo Medical Group)
2525 NW 54th St.Miami, Fl. 33142
Phone: (305) 633-9090
Gretell Trullenque, M.D.
(General Practice)
2525 NW 54th St. Miami, Fl. 33142
Phone: (305) 633-9090
Gamaliel Mattos, M.D. (General Practice)
4001 NW 97 ave #101
Doral, Fl. 33178
Phone: (305) 418-2233
Miami - Dade
Noel E. Lezama, M.D.
(General Practice)
Florida Medical Center
1501 NW 36 St Miami, Fl. 33142
Phone: (786) 378-8200
Juan Delgado, M.D.
(Family Practice)
(St. John Medical Center)
161 NW 29th St Miami, Fl. 33127
Phone: (305) 576-0231
Conchita Jackson, M.D.
(General Practice)
(Private Medical Center)
10 N.W. 42th Ave, Suite 300 Miami, Fl. 33126
Phone: (305) 774-0742
Raul A. Tamayo, M.D.
(General Practice)
(RT Professional Inc)
7374 NW 35 Terr # 102
Miami, Fl. 33122
Phone: (305) 418-8990
Valdemir Santos, M.D.
(General Practice)
(All Future Medical Center)
7376 NW 35 Terr # 104
Miami, Fl. 33122
Phone: (305) 805-6903
Jose Pena, M.D. (General Practice)
10 NW 42th Avenue, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Lazaro Miguel Garcia, M.D.P.A
(General Practice)
3626 NW 7 St Miami, Fl. 33125
Phone: (305) 643-4343
Andres Cazau, M.D. (General Practice)
10 NW 42th Avenue, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Jesús J. Cid, M.D.
(General Practice)
711 NW 23 ave # 301 Miami, Fl. 33125
Phone: (305) 643-4797
Jorge Martinez, M.D.
(General Practice)
161 NW 29th St Miami, Fl. 33127
Phone: (305) 576-0231
Mauricio Vargas, M.D. (General Practice)
10 N.W. 42th Ave, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Aleida Hernandez , M.D.
(General Practice)
1380 NE Miami Gardems Drive # 212
Nort Miami Beach, Fl. 33179
Phone: (305) 692.9009
13
Miami - Dade
Arles Perdomo M.D
(General Practice)
7959 NW 2 St Miami, Fl. 33126 Phone: (305) 267-6060
Orlando Leyva, M.D. (General Practice)
(Sunshine Medical Care)
3990 West Flagler St. # 406
Miami, Fl. 33134
Phone: (305) 456-3879
Raidel Oviedo, M.D.
(General Practice)
1701 West Flagler St #215
Miami, Fl. 33135
Phone (305) 418-0524
Angel Lazo, M.D. (General Practice)
8080 West Flagler St Suite 2B
Miami, Fl. 33144
Phone: (305) 266-6400
Ariel Duran Mondragon, M.D.
(General Practice)
(Selecta Physical Therapy)
2140 West Flagger St, Ste 112
Miami Fl. 33135
Phone: (786) 953-6735
Luis E. De Armas, M.D.
(General Practice)
11373 W Flagler St. # 212
Miami, Fl. 33174
Phone: (305) 220-7730
John A. Padron, M.D.
(General Practice)
8370 W. Flagler St, Suite 120
Miami, Fl. 33144
Phone: (305) 222-8365
Leonardo Marquez, M.D.
(General Practice)
J.O. Medical Center, Inc.
2260 SW 8th St, Suite 200 Miami, Fl. 33135
Phone: (305) 642-7704
14
Maria Valdivia, M.D.
(General Practice)
(International Medical Center)
1393 SW 1th ST Suite 320
Miami, Fl. 33135
Phone: (305) 644-0977
Eduardo Almaguer, M.D.
(General Practice)
330 S.W 27th Ave # 404 Miami, Fl.
33135
Phone: (305) 644-9798
Sebastian Padron, M.D.
(General Practice)
4141 SW 6th St Miami, Fl. 33125
Phone: (305) 443-5031
Miami - Dade
Cindy Martinez Vladimir Santos M.D.
(General Practice) (Salud Medical Center)
1338 SW 8th Street Miami, Fl. 33135
Phone: (305) 854-4443
Alberto Gonzalez-Gomez, M.D.
(General Practice)
7968 SW 8th ST Miami, Fl. 33144
Phone: (786) 332-2093
Fausto Castillo M.D
(General Practice)
Las Mias Medical Center INC
Phone: (305) 448-8557
Myriam Lacayo, M.D. (General Practice)
The Children Medical Center Group, Inc
8300 SW 8 St, Suite # 302 Miami, Fl. 33144
Phone: (305) 225-4434
Ramon Hernandez M.D.
(Family Medicine)
Phone: (305) 448-8557
Adolfo R. Martínez, M.D.
(General Practice)
8480 SW 8th Street. Miami, Fl. 33144
Phone: (305) 264-1131
Maria Lourdes Zeno, M.D.
(General Practice)
Best Medical Care, Inc
920 SW 82th ave Miami, Fl. 33144
Phone: (305) 262-3999
Herbert R. Slavin, M.D. (General Practice)
(Leda Medical Center, Inc)
7105 SW 8th ST, #206
Miami, Fl. 33144
Phone (305) 262-4801/03
Josefina Hernández, M.D.
(General Practice)
8480 SW 8th Street. Miami, Fl. 33144
Phone: (305) 264-1131
Mario R. Villoch, M.D.
(General Practice)
(AV Medical Center)
2075 SW 27 ave Suite 101
Miami, Fl. 33145
Phone: (305) 856-6081
(Las Mias Medical Center INC)
15
Lazaro Martinez. M.D. (General Practice)
9600 SW 8 St, Suite 30 Miami, Fl. 33174
Phone: (786) 312-0333
Hilda M Brito M.D. (General Practice)
12260 SW 8th Street, Suite 224
Miami, Fl. 33184
Phone: (305) 220-6917
Rodolfo Binker, M.D. (General Practice)
6700 SW 21 St Miami, Fl. 33155
Phone: (305) 266-0006
Miami - Dade
Jorge Paoli- Bruno MD
(La Salud)
Mario A Jimenez, M.D.
(General Practice)
(Kendall South Medical Center)
2433 SW 147 ave Miami, Fl. 33185
Phone (305) 388-1118
(Family Medicine)
8415 SW 24th St # 203 Miami, Fl. 33155
Phone: (305) 559-2121
Valdemir Santos, M.D.(General Practice)
(ACN Physician Group)
7490 SW 23 ST #201 Miami, Fl. 33155
Phone: (786) 953-8221
Ramon Sastre, M.D. (General Practice)
(AM Medical Center)
8900 Coral Way #203 Miami, Fl. 33165
Phone: (305) 225-3545
Carlos J. Bello M.D (General Practice)
7171 Coral Way, Suite 307
Miami, Fl. 33155
Phone: (786) 502-8449
Maria Margolles, M.D.
(General Practice)
(AM Medical Center)
Phone: (305) 225-3545
Rosabel M Bencomo, M.D.
6020 BirdRoad Miami, Fl. 33155
Phone: (786) 222-8807
Blanca N. Gonzalez, M.D.
(General Practice)
Phone: (786)-334-6170
Sara Llerena, M.D. (General Practice)
(Kendall South Medical Center))
2433 SW 147 ave Miami, Fl. 33185
Phone (305) 388-1118
Rodolfo Vega, M.D. (General Practice)
(Vega Medical Center)
3720 SW 107 ave Miami, Fl. 33165
Phone: (305) 554-4270
16
Blanca Gonzalez, M.D.
(General Practice)
United Medical of South Florida
14750 SW 26 St #213
Miami, Fl. 33185
Phone: (786) 476-7314
Miami - Dade
Jorge Santander, M.D. (General Practice)
4080 SW 84 ave Suite D
Miami, Fl. 33155
Phone: (305) 223-1140
Alicia Chilito, M.D.
7000 SW 97 Ave Suite # 104
Miami, Fl. 33173
Phone: (305) 269-1988
Julio C. Rosales, M.D.
(General Practice)
Kendall Medical Plaza
11880 SW 40 St # 120 Miami, Fl. 33175
Phone: (305) 225-7330
Hector S. Rodriguez, M.D.
(General Practice) Ana J. Solis, M.D.
(X-Press Medical Center)
9995 SW 72 St, #202 Miami Fl. 33173
Phone: (786)-289-0759
Juan Falcon, M.D. (General Practice)
(Anchor Medical Center)
12781 SW 40 St # H Miami, Fl. 33175
Phone: (305) 229-3990
Julio C. Rosales, M.D.
(General Practice)
(Hammocks Medical Center)
Phone: (305) 383-3848
Tomas Wharton, M.D.
(General Practice)
311 NE 8 St #110 Homestead, Fl. 33030
Phone: (305) 712-2250
Juan Blemil Fdez. M.D, P.A.
(General Practice)
Phone: (305) 227-6497
Maria C. Cubillas, M.D.
(General Practice)
27543 S. Dixie Hwy
Homestead, Fl. 33032
Phone: (305) 246-0047
Eduardo Medrano, M.D.
(General Practice) (All Family Care Inc.)
38 Northwest 8th Street
Phone: (305) 246-0460
17
Anselmo H. Humaran, M.D.
(General Practice) (0-99 years)
11474 Quail Roost Dr. Miami, Fl. 33157
Phone: (305) 232-2066
Jose de Jesus Gomez Cortes, M.D.
(Redland Medical Center)
(General Practice)
19744 SW 177 ave Miami, Fl. 33187
Phone: (786) 701-3618
Miami - Dade
Josefa L. Binker, M.D. (Family Practice)
70 NW 8 St Homestead, Fl. 33030
Phone: (305) 242-5225
Marta Delgado, M.D. (General Practice)
(Homestead Medical Clinic, M.D)
43 NE 15th St Homestead, Fl. 33030
Phone: (786) 243-1909
Ruben J Nunez M.D. (General Practice)
15260 SW 280 Street Suite 116
Phone: (786) 504-8732
John G. Gutleber, M.D. (General Practice)
139 N.E 15th Street Homestead, Fl. 33033
Phone: (305) 247-1213
Maria Delgado, M.D. (General Practice)
(Homestead Medical Clinic, M.D)
43 NE 15th St Homestead, Fl. 33030
Phone: (786) 243-1909
Orlando E Leiva M.D. (General Practice)
15260 SW 280 Street Suite 116
Phone: (786) 504-8732
18
(Johnson Medical Center) (General Practice)
7900 NW 33 St #101 Hollywood, Fl. 33024
Phone: (954) 962-5300
Emmauel Eloi, M.D. (General Practice)
(Sunshine Medical & Chiropractic Care Inc)
2764 W Oakland Park blvd #B
Oakland park Fl 33311
Phone: (954) 766-4233
Ruben Nuñez, M.D. Florida Primary Health
LLC) (General Practice)
5890 Stirling Rd S-6 Holliwood , Fl. 33021
Phone: (954) 606-5656
1st Visit:$40 - Follow Up:$40
Silvia Soto, M.D. (General Practice)
(Miramar Medical Center)
11904 Miramar Parkway Miramar, Fl. 33025
Phone: (954) 639-7560
1st Visit: $ 40.00 - Follow Up: $ 40.00
Elsa Pichardo Matos, M.D. (General Practice)
(Sunset Strip Medical Center)
4269 N.W 88 ave Sunrise, Fl. 33351
Phone: (954) 578-0200
Broward
Eugene Gregorie, M.D
(General Practice)
4141 NW 5th Street, Ste 100
Plantation, Fl. 33317
Phone: (954) 486-6866
Clemente Wilson, M.D.
(Johnson Medical Center)
(General Practice)
7900 NW 33 St #101
Hollywood, Fl. 33024
Phone: (954) 962-5300
MIlena Osorio-Smith, M.D.
(Colony Spring Medical Center)
(General Practice)
7737 North University Dr. #107
Tamarac, Fl. 33321
Phone: (954) 720-0056
Ricardo Zamora, M.D.
Colony Spring Medical Center)
(General Practice)
7737 North University Dr. #107
Tamarac, Fl. 33321
Phone: (954) 720-0056
19
Herbert Pardell, DO.
Emeril Health Medical Center
(General Practice)
3990 Sheridan Street Ste 101
Hollywood, FL 33021
Phone: (954) 987-4455
Jeanne - Elyse Cedeño, M.D.
(Children and Adults) (General Practice)
1601 N. Palm ave, Suite 102 B
Pembroke Pines, Fl. 33026
Phone: (754) 273-6278
Mark Leeds, D.O. PA.
(General Practice)
3290 NE 33 ST
Fort Lauderdale, Fl. 33308
Phone: (954) 776-6226
Mon-Fri 9am to 5pm
1st Visit:$40.00 - Follow Up:$40.00
Rafael N. Hernandez, M.D.
(Johnson Medical Center) (General Practice)
Phone: (954) 962-5300
Bob M. Gairaj, M.D. (General Practice)
(Boca Family Practice)
7280 West Palmetto Park Rd Suite # 104
Boca Raton, Fl. 33433
Phone: (561) 391-6552
Jose E. Blandon, M.D.
(General Practice) (Basic Gynecology)
(Johnson Medical Services)
2531 N Dixie Hwy Lake Worth, Fl. 33460
Phone: (561) 469-6409
Marilyn Belizaire Innocent M.D.
(General Practice)
220 S. Dixie Hwy #4 Lakeworth, Fl. 33460
Phone: (561) 429-5086
Palm Beach
Paul Murry, M.D. (General Practice)
(Boca Family Practice)
7280 West Palmetto Park Rd Suite # 104 Boca Raton, Fl. 33433
Phone: (561) 391-6552
Alfonso Ramirez, M.D.
(General Practice)(Basic Gynecology)
(Johnson Medical Services)
Phone: (561) 469-6409
Mario F. Guillen M.D.
(General Practice)
6300 S. Dixie Hwy #101
West Palm Beach, Fl. 33405
Phone: (561) 296-1116
Rafael Ubeda, M.D. (General Practice)
(Basic Gynecology) (Johnson Medical Services)
Phone: (561) 582-0330
Joseph Pierre-Paul Cadet M.D.
Polyclinic de Palm Beach (General Practice)
5333 West Atlantic Ave #405 Delray Beach, Fl. 33346
Phone: (561) 276-3000
Ricardo Zamora, M.D.(General Practice)
(Colony Spring Medical Center of Palm
Beach)
130 JFK Drive Suite 131Atlantis, Fl. 33462
Phone: (561) 439-7070
Israel Machin M.D.
(General Practice)
1511 Forrest Hill Blvd # 3
Phone: (561) 433-3556
Collier
Martha Fernandez, M.D.
(General Practice)
SW Florida Regional
Medical Center
5580 19th Court SW Unit 2
Naples, Fl. 34116
Phone: (239) 304-2471
Alfonso Garcia, M.D. (General Practice)
Del Prado Medical Center.
2500 Del Prado Blvd South Cape Coral Fl. 33954
Phone: (239) 772-1194 / 1195
20
Lee
Gynecology & Obstetrics / Ginecología y Obstetricia
Miami - Dade
OFERTA ESPECIAL DE PAPANICOLAU EN LAS CLINICAS DE MED PLAN
Los examenes de Papanicolau se efectuaran en la Clinica de MED-PLAN ( 7200 NW 7 St Suite # 202) y en la clinica de MED PLAN, MED
CARE de Little Havana( 1149 SW 27 Ave.). El costo, que incluye la toma de la muestra asi como el resultado de la Patologia es de :
Liquid $ 50.00 usd
/
Slide $ 35.00 usd. Llamar a los Centros para appointment o al Call Center.
Esperanza A. Nuñez M.D. (GYN)
(Glez. and Glez. Medical Center)
3804 NW 167th Street. Opa-Locka, Fl. 33054
Phone: (305) 624-2700
Matias Guerra M.D. (OB-GYN).
(ST. John Medical Center)
161 NW 29th Street Miami, Fl. 33121
Phone: (305) 576-0231
Eduardo Lavado, M.D. (OB-GYN)
4160 W. 16 Avenue, Ste 406
Hialeah, Fl. 33012
Phone: (305) 822-4561
Josefa L. Binker, M.D. (GYN)
70 NW 8 St Homestead, Fl. 33030
Phone: (305) 242-5225
Conchita Jackson, M.D.(GYN))
10 NW 42 Ave Suite 300 Miami, Fl. 33126
Phone: (305) 774-0742
Ramon Hechavarria, M.D.(GYN)
Phone: (305) 774-0742
Tomas Seville, M.D. (OB-GYN).
(Las Mias Medical Center INC)
Phone: (305) 448-8557 / 397-7230
Emilio Blanco, M.D. (OB) - (GYN)
(Vida Health Centers)
881 East 2nd Ave Hialeah Fl. 33010
Phone: (305) 882-1100
Esperanza A. Nuñez M.D. (OB)-(GYN)
1840 W 49th ST Ste # 420 Hialeah, Fl. 33012
Phone: (305) 823-3000
Julio A. Diaz-Jane, M.D. (OB) - (GYN)
777 E 25 St # 201,Hialeah Fl. 33013
Phone: (305) 822-8123
Rolando Padro, M.D. (GYN)
15439 SW 137 Avenue Miami, Fl. 33177
Phone: (305) 259-5570
Carlos M. Verdeza, M.D. (GYN)
2475 NW 95 Ave #2 Doral Miami, Fl. 33172
Phone: (305) 553-8033
Gynecology & Obstetrics / Ginecología y Obstetricia
Liliam C. Garcia MD
Teresa Acosta- Avila NRAP
(Clinic Center Inc)
3800 W 12 Ave Hialeah, Fl. 33012
Phone: (305) 557-7777
Gonzalo Gonzalez M.D
Jireh Medical Center Corp
7900 NW 33 St # 101,Hollywood
FL. 33024 Phone: (954) 962-5300
21
Broward
Martha Fernandez M.D
7900 NW 33 St # 101,Hollywood
FL. 33024 Phone: (954) 962-5300
Paquete de Maternidad
Proveedor
Parto Normal
Parto Cesárea
Consulta Dr. Eduardo Lavado
$1,600.00*
$1,900.00*
Hialeah Hospital
$4,050.00**
$5,100.00***
•
•
* Incluye:
Todas las visitas
Postparto
Pediatrics / Pediatría
•
•
•
•
** Incluye:
Hospitalizacion (2 noches)
Pathology
Neonatal
Epidural
Miami - Dade
•
•
•
•
•
*** Incluye:
Hospitalizacion (3 noches)
Pathology
Neonatal
Anesthesia
Surgical Assistant
Olabisi Oyadiran, M.D.
18425 NW 2 Ave, PH 7
Miami Gardens, Fl. 33169
Phone: (305) 625-4100
Miriam Estévez, M.D.
St. John medical Center
161 NW 29th ST Miami, Fl. 33127
Phone: (305) 576-0231
Armando Segui, M.D.
(Ambert Medical Center)
15495 Eagle Nest Ln, Suite 100
Phone: (305) 305-556-0021
Jorge L. Alsina, M.D.
4980 W. 10 Ave. Suite, 204
Hialeah, Fl. 33012
Phone: (305) 556-4447
Ivette Valle, M.D.
Phone: (305) 576-0231
Eduardo Díaz, M.D.
5703 NW 7 ST Miami, Fl. 33126
Phone: (305) 267-3462
Juan Del Sol, M.D.
Phone: (305) 576-0231
Johanne Zephir, M.D.
(7th Ave. Medical Plaza) (0 and Up)
10071 NW 7 Ave Miami, Fl. 33150
Phone: (305) 403-7777
Armando Acevedo, M.D.
2525 NW 54th Street. Miami, Fl. 33142
Phone: (305) 633-9090
John Hemstreet, M.D.
(7th Ave. Medical Plaza) (0 and Up)
10071 NW 7 Ave, Miami, Fl. 33150
Phone: (305) 403-7777
Rodolfo Sidron, M.D.
7285 W Flagler St Miami, Fl. 33144
Phone: (786) 388-9877
Rodolfo B. Ferretti M.D.
3228 NW 7 St Miami, Fl. 33125
Phone: (305) 642-5090
Luis E. De Armas, M.D.
11373 W Flagler St. # 212 Miami, Fl. 33174
Phone: (305) 220-7730
Hilda M. Brito, M.D.
12260 SW 8th Street, Suite 224Miami, Fl. 33184
Phone: (305) 220-6917
Juan Ruiz, M.D.
8900 SW 24 ST #204 Miami, Fl. 33165
Phone: (305) 554-6666
22
Miami - Dade
Antonio J. Reyes. M.D. (General Practice)
1350 SW 57 ave, Suite 314 Miami, Fl. 33144
Phone: (305) 267-2182
Maria I. Delgado, M.D.(Homestead Medical Clinic PA)
43 NE 15th Homestead, Fl. 33030
Phone: (786) 243-1909
Myriam Lacayo, M.D.
The Children Medical Center Group, Inc
8300 SW 8 St, Suite # 302 Miami, Fl. 33144
Phone: (305) 225-4434
Lazaro de la C. Nunez, M.D.
(Medical Health and Research Inc)
6854 W Flagler St Miami Fl. 33144
Phone: (786) -310-7697
Pedro C. Reimon, M.D. (Child Obesity Specialist)
13155 SW 42nd Street Ste 106 Miami Fl. 33175
Phone: (305) 220-1310
Marta Delgado, M.D.
(Homestead Medical Clinic PA)
43 NE 15th Homestead, Fl. 33030
Phone: (786) 243-1909
Francisco Martinez, M.D.
15122 SW 72th St Miami, Fl. 33193
Phone: (305) 383-3848
Dorses Goosby, M.D. (Pediatric Ass. of Florida)
151 N.W 11th St. Ste E-202
Phone: (305) 245-3220
Otneil Hernandez, D.N.P
(Family Practice)
Hialeah, Fl. 33012
Milady Fernandez, M.D.
(All Family Care Inc.)
38 Northwest 8 Street Homestead, Fl. 33030
Phone: (305) 246-0460
Alfredo Machado, M.D.
(Pediatric Ass. of Florida)
151 N.W 11th St. Ste E-202 Homestead, Fl. 33030
Phone: (305) 245-3220
Gloria López, M.D.
747 Ponce de Leon Blv, Ste 607
Coral Gables, Fl. 31334
Phone: (305) 443-2324
Rodolfo B. Ferretti M.D.
7765 SW 87 Avenue Suite 209 Miami, Fl. 33173
Phone: (305) 595-0429
Ruben Nuñez, M.D.
Florida Primary Health LLC)
(General Practice)
5890 Stirling Rd S-6
Holliwood , Fl. 33021
Phone: (954) 606-5656
Broward
Phone (305) 676-2300
Ausberto Hidalgo, M.D.
Pines Professional Campus
302 NW 179th St, Suite 103 Pembroke Pines
Fl. 33029
Phone: (954) 442-8888 Services / Servicios:
Pediatrics1st Visit :$40 - Follow Up: $40
23
PHYSICIAN AND SPECIALIST PROVIDER FEE SCHEDULE
Family and General Practice Consultation Fees
Codes
Injections
Inicial Office Visit
$40.00
J0780
Compazine 10 mg Cost
Cost +$10.00
Follow-Up OfficeVisit
$20.00
J1100
Decadron up to 5mg Cost
Cost +$10.00
J1030
Depo-Medrol 40 mg
Cost +$10.00
Specialist Physician Practice Consultation Fees
Med Plan
Initial Office Visit
$60.00
J1040
Depo-Medrol 80 mg
Cost +$10.00
Follow-Up Office Visit
$40.00
J2480
Terramycin up 50 mg
Cost +$10.00
J3120
Testosterone to 100 mg
Cost +$10.00
Pediatric / Pediatrician
Initial Office Visit
$40.00
J3410
Vistaril to 25 mg
Cost +$10.00
Follow-Up Office Visit
$30.00
J3420
Vitamin B12 to1000 mg
Cost +$10.00
J1670
Tetanun (Globulin)
Cost +$10.00
J3180
Tetanun Toxoid Cost
Cost +$10.00
J0500
Bentyl
Cost +$10.00
J3450
Tigan
Cost +$10.00
J1885
Tiradol
Cost +$10.00
J1200
Benadryl
Cost +$10.00
Codes
Pulmonary
94060
Bronchospasm Eval
$12.50
94664
Nebulizer Treatment
$12.50
94665
Nebulizer Subsequent
$12.50
94010
Spirometry
$12.50
94060
Spirometry W bronco sp.
$12.50
94070
Prolonged Broncho sp.
$12.50
94200
Maximum Breathing cap.
$12.50
94240
Func. Resd. Cap.
$12.50
94250
Exp. Gas Collecion
$12.50
Codes
Cardiovascular
93000
ECG
Med Plan
$10.00
93307
Echo
$90.00
93320
Echo Doppler
$90.00
93325
Color Flow Doppler
$25.00
93324
Holter Monitor 24 hr
$55.00
Codes
Diagnostics US
76705
Abdomen / Single
$70.00
76700
Abdomen / Complete
$70.00
76645
Breast
$70.00
76856
Pelvic
$70.00
76873
Prostate
$70.00
76770
Kidney / Renal
$70.00
76536
Thyroid
$70.00
93923
US Arterial Upper-lower
$70.00
93925
Duplex Scan Arterial
$70.00
93965
US venous extremity
$70.00
93970
Duplex scan venous
$70.00
Med Plan
Med Plan
MP . P/S . FS 01/13
All immunizations will follow CDC protocols for age requirements. (See attached). Persons under the age of 19 years are elegible for Free Vaccines offered by VFC
Program. Med Plan providers will charge our members $10.00 for the administration of each vaccine only.
24
Codes
X Ray Procedures
Codes
Therapies
73600
Ankle 2 views
Med Plan
$25.00
97010
Hot Pack Therapy
$10.00
71010
Chest PA Only
$25.00
97010
Cold Pack Therapy
$10.00
71020
Chest PA & LA
$25.00
97012
Tractional Mechanical
$10.00
73070
Elbow 2 Views
$25.00
97014
EMS (High Frequence)
$10.00
73620
Foot 2 Views
$25.00
97018
Paraffin Bath
$10.00
73090
Forearm 2 Views
$25.00
97022
Whirpool
$10.00
73120
Hand 2 Views
$25.00
97026
Infrared
$13.20
73500
Hip 1 Views
$25.00
97035
Ultrasound
$10.00
73510
Hip 2 views
$25.00
97039
Vibratory massage
$17.50
73520
Hip Bilateral
$25.00
97110
Therapeutic Exercise
$57.00
73060
Humerus 2 views
$25.00
97112
Neuromuscular Re-Education
$63.00
74020
KUB 2 Views
$25.00
97124
Massage
$47.00
72110
Lumbo Sacral Spine
$25.00
97139
Hydro massage
$17.00
71100
Ribs 2 views
$25.00
97140
Manual Therapy
$65.00
73020
Shoulder 1 views
$25.00
97140
Manual Traction
$65.00
73030
Shoulder 2 views
$25.00
E0217
Water Circulating Cold
$91.00
73590
Tibia 2 views
$25.00
E0218
Water Circulating Hot
$91.00
73100
Wrist 2 views
$25.00
97535
Self/Home Care
73560
Calcaneus
$25.00
Codes
Other Procedures
73550
Femur
$25.00
69210
Ear Lavage
$5.00
73140
Finger(s)
$25.00
88150
PAP Smear
$35.00
72040
Cervical Spine
$25.00
72070
Thoracic Spine
$25.00
73562
Knee
$25.00
70220
Sinus
$25.00
70260
Skull Series
$25.00
70160
Nasal Bones
$25.00
70110
Mandible
$25.00
70200
Orbits
$25.00
25
Med Plan
$41.00
Med Plan
Medical Centers / Centros médicos
Miami - Dade
Gonzalez and Gonzalez.
3804 NW 167th Street. Opa-Locka Fl. 33054
Phone: (305) 624-2700
Services / Servicios:
Psychiatrist, Psiquiatry, Gynecology
WMC Health Group LLC
1380 NE Miami Garden Drive # 210
Nort Miami Beach Fl. 33179
Phone: (305) 692-9009
Servicios:
General & Internal Medicine
Vida Health Medical Center.
881 East 2 Ave Hialeah, Fl. 33010
Phone: (305) 882-1100
Surgery, Gastroenterology,
Gynecology and Psychiatry
Hammocks Medical Center.
15122 SW 72 Street. Miami Fl. 33193
Phone: (305) 383-3848 / Services / Servicios:
Pediactrics
Delgado Pediatrics After Hours PA.
7815 SW 24th Street, Suite 106 Miami, Fl. 33155
Phone: (305) 262-2467
Services / Servicios: Pediactric
Private Medical Center.
10 NW 42th Ave. Suite 300 Miami, Fl. 33126
Phone: (305) 774-0742
Services / Servicios:Ginecology Pediatric,Cardiology,
Dermathology, Internal Medicine.
Homeland Health Solutions
447 North Krome Avenue Homestead, Fl. 33030
General Medicine, Internal Medicine
Pediatrics Ass. of South Florida.
151 N.W 11th Street, Suite E-202 Homestead, Fl. 33030
Phone: (305) 245-3220
Services / Servicios: Pediactrics
Ambert Medical Center.
15495 Eagle Nest Ln Suite 100 Miami Lakes, Fl. 33016
Phone: (305) 556-0021
Felicidad Medical Center.
4410 W 16 Ave # 55 Hialeah, Fl.33012
Phone: (305) 824.8559
Services / Servicios: Pediactrics/ General Medicine /
Internal Medicine / Psychology
26
Las Mias Medical Center INC
Phone: (305) 448-8557
Gynecology Ophthalmology
St. John Clinic Medical Center.
161 NW 29th Street. Miami, Fl. 33127
Phone: (305) 576-0231
Services / Servicios:Pediatric, Podiatric, Cardiovascular
Gynecology, Orthopedic
All Family Care Inc.
38 NW 8th Street. Homestead, Fl. 33030
Phone: (305) 246-0460
Homestead Medical Clinic PA.
125 NE 8th Street, Suite 6 Homestead, Fl. 33030
Phone: (786) 243-1909
Clinic Center
3800 W 12 Ave, Hialeah FL. 33012
Phone: (305) 557-7777
Services / Servicios: General Medicine / Gynecology /
Endocrinology/ Physical Therapy
Salud Medical Center
1338 SW 8 St, Miami FL. 33135
Phone: (305) 854.4443
Services / Servicios: General Medicine / Gynecology /
Physical Therapy
Broward
Miramar Medical Center. 11904 Miramar Parkway Miramar, Fl. 33025 Phone: (954) 639-7560
Services / Servicios: Medicina Interna, General Medicine, Rayos X Cardiology, Endocrinology Ultrasound
Sunset Strip Medical Center.
4269 N.W.88 ave Sunrise Fl. 33351
Phone: (954) 578-0200
Services / Servicios: General Medicine, Gynecology
Emeril Health Medical Center.
4330 Sheridan Street, Suite 102 Hollywood, Fl. 33021
Phone: (954) 987- 4455
Services / Servicios: Internal Medicine
Urgent Care Center. (UrgentMed)
2337 S. University Drive Davie, Fl. 33324
Phone: 954-423-9234 / French, Italian & Creole
Services / Servicios: General Medicine
Broward Medical Center of Davie.
255 SE 14 St Suite C-1 Ft. Lauderdale, Fl. 33316
Phone: (954) 321-9826
Services / Servicios: Cardiology
302 NW 179th St, Suite 103 Pembroke Pines Fl. 33029
Phone: (954) 442-8888 Services / Servicios: Pediatrics
Phone: (954) 962-5300
Services / Servicios: General Medicine, Gynecology, Pediatrics,
Internal Medicine, Podiatry
Pines Care Medical Center, LLC.
301 NW 103 Ave, # 235 Pembroke Pines, Fl. 33026
General Medicine Internal Medicine
Pediatrics by the Sea
285 SE 5th ave Delray Beach Fl. 33483
Phone: (561) 272-8991
Services / Servicios: Pediatrics
Palm Beach
Johnson Medical Service
2531 N. Dixie Hwy Lakeworth Fl. 33460
Phone: (561) 469-6409
Services / Servicios:General Medicine, Pediatrics, Ophthalmology
Lee / Cape Coral
2500 Del Prado Blvd South Cape Coral Fl. 33954
Phone: (239) 772-1194 / 1195
Services / Servicios: Multi Specialist Practice General Medicine,
Gynecology, Podiatry Podiatría, Physical Therapy
27
SPECIALIST PHYSICIANS / ESPECIALISTAS
Miami-Dade
Alergist /Alergista
Vicente A. Chavarria, M.D
1840 W. 49th Street, Suite 515 Hialeah, Fl. 33012
Phone: (305) 670-7006 1st Visit :$80 - Follow Up: $50
Cardiology / Cardiólogo
Anesthesiology / Anestesiólogo
Vicente A. Chavarria, M.D
7400 N. Kendall Dr., Suite 204 Miami, Fl. 33156
Phone: (305) 670-7006 1st Visit :$80 - Follow Up: $50
Manuel A. Barbeito, M.D. (Pain Management)
(South Florida Institute of Pain Management)
9370 Sunset Dr. Suite A-150 Miami, Fl. 33173
Phone: (305) 663-6681
Miami-Dade
Michelle Malow, M.D.
161 NW 29 Street. Miami, Fl. 33127
Phone: (305) 576-0231
Mauricio Vargas, M.D. (7 years and Up)
Phone: (305) 774-0742
Mario R. Villoch, M.D. (AV Medical Center)
2075 SW 27 ave #101 Miami, Fl. 33145
Phone: (305) 856-6081
Manuel A. Franco, MD
600 NW 35 ave, Suite 202 Miami, Fl. 33125
(Phone: (305) 631-9875
28
Francisco Dieguez, M.D.
1435 West 49 Place, Suite 500 Hialeah, Fl. 33012
Phone: (305) 575-1776
Miami-Dade
Cardiology / Cardiología Palm Beach
Chiropractor / Quiropráctico
Miami - Dade
Dennis Kogut, DC.
9999 NE 2nd ave Ste # 303
Miami Shores, Fl. 33138
Phone: (305) 978-7680
Yolaris Garcia, DC.
11730 Biscayne Blv. #104
North Miami, Fl. 33181
Phone: (305) 981-0899
J. Macandrew Richardson, D.C.
Palmetto Lakes Medical Center
2604 West 84th St
Hialeah, Fl. 33016
Phone: (786) 452-1265
Maria Del Campillo, DC.
3625 NW 82nd Ave. Suite 320
Doral, Fl. 33166
Phone: (305) 593-1555
Arturo Garcia, DC. Iris M. Garcia, D.C
Danay Gonzalez, D.C
Miami Back Center
3785 NW 82 ave #315
Miami, Fl. 33166
Phone: (305) 303-9306
Aixa Goodrich, D.C.
7990 SW 117 Ave Suite 205
Miami, Fl. 33183
Phone: (305) 271-7447
William Rojas, D.C
1890 SW 87th ave #104 Miami, Fl. 33155
Phone: (305) 264-8955
29
Jan Scott Buchholz, D.C.
(Hands On Healthcare)
2901 West Oakland Park Blvd, Suite A-23
Ft. Lauderdale, Fl. 33311
Phone: (954) 731-8097
Broward
David Shwartz, D.C.
SFL Medical & Wellness Clinic)
5931 S. University Dr.
Davie, Fl. 33328
Phone: (954) 252-3339
Palm Beach
Milagros Alvarez, DC.
Miami Back Center
2290 10 ave North #404 E
Lakeworth, Fl. 33461
Phone: (561) 633-1026
Lee
Charles Wolter, D.C.
(Region Medical Center)
3900 Broadway Unit 1 Bldg A
Fort Myers, Fl. 33976
Phone: (239) 288-5413
Fax: (239) 288-5418
Collier
Gerardo Martinez, D.C.
Naples Health Care, Inc.
4947 Tamiami Trail North Suite 206
Naples, Fl. 34103
Phone: (239) 304-9290
30
Cosmetic Surgery / Cirugía Cosmética
Miami - Dade
Carlos J Bello, M.D (Board certified plastic surgeon)
(Juventus Cosmetic Center)
920 SW 82 Ave
Miami, Fl. 33144
Phone: (305) 262-3999
Rafael Antún, M.D.
(Board certified plastic surgeon)
920 SW 82 Ave
Miami, Fl. 33144
Phone: (305) 262-3999
Julio L Arronte, M.D.
920 SW 82 Ave
Miami, Fl. 33144
Phone: (305) 262-3999
Jorge L Acosta, M.D.
920 SW 82 Ave
Miami, Fl. 33144
Phone: (305) 262-3999
Dermatology / Dermatología
Miami - Dade
Jose E. Mendez, D.O.
1435 W 49 Place # 702
Hialeah, Fl. 33121
Phone: (305) 828-7504
Jaime Garcia, M.D.
935 West 49 St #107
Hialeah, Fl. 33012
Phone: (305) 827-2268
Gonzalo Estevez del Cristo, M.D.
44 East 5th St
Hialeah, Fl. 33010
Phone: (305) 888-9786
Mauricio Vargas, M.D.
10 NW 42 Ave Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Maria Cartaya, M.D.
7805 Coral Way, Suite 131
Miami, Fl. 33175
Phone: (305) 261-4474
Hector Wiltz, M.D.
11760 SW 40th Street Ste 451
Miami Fl. 33175
Phone: (305) 227-9233
Hector Wiltz, M.D.
(Eric W. Bussear M.P.H, PA-C)
151 NW 11 Street, Suite W-201
Homestead Fl. 33030
Phone: (305) 245-1332
31
Dermatology / Dermatología
Broward
Jose E. Mendez, M.D.
12600 Pembroke Road # 312
Miramar, Fl. 33027
Phone: (954) 431-7681
Endocrinology / Endocrinología
Carlos Barrera, M.D.
7190 SW 87 Ave, Suite 306
Miami, Fl. 33173
Phone: (305) 274-4339
Miami - Dade
Juan A. Enriquez, M.D.
(Clinic Center Inc)
3800 W 12 Ave
Hialeah, Fl. 33012
Phone: (305) 557-7777
Noel Lezama, M.D.
(Clinic Center Inc)
3800 W 12 Ave
Hialeah, Fl. 33012
Phone: (305) 557-7777
Broward
Emilio Castañeda
(Miramar Medical Center)
11904 Miramar Parkway
Miramar, Fl. 33025
Phone: (954) 639-7560
32
Carlos Barrera, M.D.
151 NW 11th Street, Ste 102-B
Phone: (305) 274-4339
Palm Beach
Emilio Castañeda M.D.
Guadalupe Medical Center
4469 S. Congress Ave, Ste 106
Phone: (561) 642-0268
ENT / Otorrino
Miami - Dade
Maria T. llopiz, M.D.
(Otolaryngologist ENT / Otorrino)
330 SW 27 ave Suite 603
Miami Fl. 33155
Phone: (305) 649-5455
Gastroenterology / Gastroenterólogo
Orlando Torres, M.D.
4791 W 4 ave
Hialeah, Fl. 33012
Phone: (305) 825-0500
Fax: (305) 825-5557
Servicios: All Included
Endoscopía $ 530.00
Colonoscopía $ 675.00
Sigmoidoscopía $ 400.00
Miami - Dade
Carlos A. Selema, M.D.
747 Ponce de Leon #510
Phone: (305) 443-2611
Juan Sarol, M.D.
(Vida Health Centers)
881 E 2nd ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
33
Juan C. Sarol, M.D.
87 E 49 St
Hialeah, Fl. 33013
Phone: (786) 536-5001
Internal Medicine / Medicina Interna
Miami - Dade
Mayre Urdaneta, M.D.
8060 NW 155th Street Ste 201
Phone: (305) 826-0606
Mauricio Vargas, M.D.
10 NW 42 Ave Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Margarita del Val, M.D.
(MD Health Care and Rehabilitation)
14750 NW 77 Ct # 106
Phone: (305) 698-4000
Felix A. Rodriguez, M.D.
(American Family Health Center)
1840 W. 49 St, Ste 425
Hialeah, Fl. 33012
Phone: (305) 231-8996
Humberto Hernandez, M.D.
900 W 49 St Suite 448
Hialeah, Fl. 33012
Phone: (305) 885-3111
10550 NW 77 Ct #303
HIaleah Gardens 33016
Phone: (305)-863-2233
Odalys Frontela, M.D. F.F.C.P
801 West 48th Street, Suite A
Hialeah, Fl. 33012
Phone: (305) 698-7172
Otneil Hernandez, DNP, ARNP.
Hialeah, Fl. 33012
Phone (305) 676-2300
Juan Sarol, M.D.
87 E 49 ST
Hialeah, Fl. 33013
Phone: (786) 536-5001
Noel E. Lezama, M.D.
Florida Medical Center
1501 Nw 36 St
Miami, Fl. 33142
Phone: (786) 378-8200
(Medical Health and Research Inc)
6854 W Flagler St
Miami Fl. 33144
Phone: (786) -310-7697
Alejandro de la Cruz, M.D.
13214 SW 8 St
Miami Fl. 33184
Phone: (305) 831-2789
34
Maray Rocher, M.D.
87 E 49 ST
Hialeah, Fl. 33013
Phone: (786) 536-5001
Juan Miguel Fernandez, M.D.
2322 NW 28 St
Miami, Fl. 33142
Phone: (305) 633-3667
Fax: (305) 633-3664
Miami - Dade
Silvia M, Robalino, M.D.
Ambert Medical Canter
15495 Eagle Nest Ln #100
Phone: (305) 556-0021
Joseph Thevenin, M.D.
9635 SW 181 Terrace.
Miami, Fl. 33157
Phone: (305) 238-8561
José Padrón, M.D.
Miami, Fl. 33133
Phone: (305) 569-0010
Mario R. Villoch, M.D.
(AV Medical Center)
2075 SW 27 ave #101
Miami, Fl. 33145
Phone: (305) 856-6081
Ramses Vega, M.D.
3720 SW 107 ave
Miami, Fl. 33165
Phone: (305) 554-4270
Juan Miguel Fernandez, M.D.
9600 SW 8 St #30
Miami, Fl. 33174
Phone: (305) 633-3667
Jorge R. Coll, M.D.
(Sunshine Medical Care)
Miami, Fl. 33134
Phone: (305) 456-3879
Patricia Castrellon, M.D.
(General Practice)
1380 NE Miami Gardems Drive # 212
Nort Miami Beach, Fl. 33179
Phone: (305) 692.9009
Broward
(Jireh Medical Center Corp)
7900 NW 33 St #101
Phone: (954) 962-5300
Herbert Pardell, DO.
Emeril Health Medical Center
3990 Sheridan Street, Suite 101
Phone: (954) 987-4455
Martha Fernandez, M.D.
(Jireh Medical Center Corp)
7900 NW 33 St #101
Phone: (954) 962-5300
Emilio A. Pando, M.D.
12781 Miramar Parkway #206
Miramar, Fl. 33027
Phone: (954) 450-0228
Emilio Castañeda, M.D.
Miramar Medical Center
Miramar, Fl. 33025
Phone: (954) 639-7560
Karen Prida, M.D.
(General & Internal Medicine)
Pines Care Medical Center, LLC
501 NW 103 Ave, # 235
Phone: (954) 251-1497
35
Carlos Vallin, M.D.
Miramar Medical Center
Miramar, Fl. 33025
Phone: (954) 639-7560
Santiago Cardenas ,M.D.
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Jayner Moya, M.D.
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Palm Beach
Jean-Luc Michel, M.D.
1800 Forest Hill Blvd Suite B-9
Phone: (561) 968-7288
Fax: (561) 968-7488
Immacula Michel, M.D.
1800 Forest Hill Blvd Suite B-9
Phone: (561) 968-7288
Fax: (561) 968-7488
Mario F. Guillen M.D.
6300 S. Dixie Hwy #101
Phone: (561) 296-1116
Emilio Castañeda M.D.
Guadalupe Medical Center
4469 S. Congress Ave, Ste 106
Phone: (561) 642-0268
Internal Medicine
Collier
Alfonso Garcia, M.D.
Naples Health Care, Inc.
Naples, Fl. 34103
Phone: (239) 304-9290
Internal Medicine
Rodolfo Freyre, M.D.
12264 Tamiami Trail East, Suite 203
Naples, Fl. 34113
Phone: (239) 304-9071
Lee
Alfonso Garcia, M.D.
2500 Del Prado Blvd South
Cape Coral Fl. 33954
Phone: (239) 772-1194 / 1195
36
Jose Francisco Perez, M.D.
12264 Tamiami Trail East, Suite 203
Naples, Fl. 34113
Phone: (239) 304-9071
Nephrology / Nefrología
Jorge L. Posada, M.D.
747 Ponce de Leon Blvd # 605
Phone: (305) 445-4535
Miami - Dade
Neurology / Neurologia
Luis Garcia-Mayol, M.D.
747 Ponce de Leon Blvd # 605
Phone: (305) 445-4535
Miami - Dade
Martha Bustamante, M.D
4160 W. 16 Ave. Suite 100
Hialeah, Fl. 33012
Phone: (305) 826-5655
Diagnostic Center of Neurological Studies
Sonia V. Tolgyesy, M.D.
(Kendall South Medical Center)
2433 SW 147 ave
Miami, Fl. 33185
Phone (305) 388-1118
Neurology Mobile System Associates, Inc
7374 SW 93 ave, Suite 201 Miami, Fl. 33173
Phone: 305-270-7771
See procedures and fee schedule of this center only in the chart below
PROCEDURE
Soft-Tissue
Ultrasound
Neurological
Studies
MP. NS .FS 01/13
DESCRIPTION
CPT ODES
Cervical Soft Tissue
Spinal Canal & Contents
Extremities Leg / Arm
NCS Upper Motor
NCS Upper Motor + F-Wave
NCS Upper Sensory
NCS Lower Motor
NCS Lower Motor + F-Wave
NCS Lower Senory
EEG - Electroencephalogram
BAER - Brainstem Auditory Evoked Response
VER - Visual Evoked Response
VEP - Visual Evoked Potential
EMG - 1 Extremity
EMG - 2 Extremities
EMG - 3 Extremities
EMG - 4 Extremities
Orbucularis Ocull - Blink
76536
76800
76880
95900
95903
95904
95900
95903
95904
95819
92585
92280
95930
95860
95861
95863
95864
95933
37
Fees
$100.00
$100.00
$100.00
$125.00
$125.00
$125.00
$125.00
$125.00
$125.00
$150.00
$125.00
$125.00
$125.00
$130.00
$180.00
$225.00
$275.00
Ophthalmology / Oftalmología
Salomon Esquenazi, M.D.
Andrés E. Cortés, M.D.
(Laser & Cataract Institute)
202 East 49 Street. Hialeah, Fl. 33013
Phone: (305) 442-0066
Miami - Dade
Osvaldo Caffa M.D.
(Ophthalmology)
900 West 49th Street, Ste 300
Hialeah, Fl. 33012
Phone: (305) 823-6525
Joel Aronowicz M.D.
(Ophthalmology)
900 West 49th Street, Ste 300
Hialeah, Fl. 33012
Phone: (305) 823-6525
Orthopedics / Ortopedia
Carlos Roig, M.D.
(Orthopedic Medicine & Surgery)
161 NW 29 Street,
Miami, Fl. 33127
Phone: (305) 576-0231
Alejandro de la Cruz, M.D.
13214 SW 8 St
Miami Fl. 33184
Phone: (305) 831-2789
Salomon Esquenazi, MD
Andrés E. Cortés, M.D.
2441 SW 37 Avenue. Miami, Fl. 33145
Phone: (305) 442-0066
Miami - Dade
Gustavo Torres, M.D.
900 West 49th Street, Suite 450
Hialeah, Fl. 33012
Phone: (305) 821-4020
Ignacio Calvo, M.D.
777 East 25 Street, Suite 508
Hialeah, Fl. 33013
Phone: (305) 696-7772
Rigoberto Reguero, M.D.
5450 SW 8th St, Ste 203
Phone: (305) 649-1700
Ignacio Calvo, M.D.
1800 SW 27 Ave, Ste 400
Miami, Fl. 33145
Phone: (305) 856-7411
Podiatry / Podiatría
Manuel Frade, M.D.P.A
8080 West Flagler St, Ste 1B
Miami, Fl. 33144
Phone: (305) 262-8280
Arnaldo V. Lopez, M.D.
1545 S.W 1St Street, Suite 200
Miami, Fl. 33135
Phone: (305) 541-3230
Jose L Ponce de Leon, M.D.
(Orthopedic / Ortopédico)
3501 SW 107 ave
Miami, Fl. 33165
Phone: (305) 229-1227
Miami - Dade
Luis Eiver, D.P.M
Hialeah Foot Center.
4410 West 16 Ave #53
Hialeah, Fl. 33012
Phone: (305) 558-7437
Nguyen Phu, D.P.M.
3661 S. Miami Ave. Suite 309
Miami, Fl. 33133
Phone: (305) 854-6600
Richard Mallia, D.P.M.
161 NW 29 Street.
Miami, Fl. 33127
Phone: (305) 576-0231
Yanssel Delgado, D.P.M.
5590 W 20 Ave Suite # 404
Hialeah, Fl. 33016
Phone: (305) 819-9240 / 9239
Oscar Barreto, D.P.M.
(D.P.M., F.A.C.F.A.S).
7975 NW 154th Street, Ste 390
Phone: (305) 825-5633
Juliette Perez, D.P.M.
(Perfect Feet Care Podiatry Center)
13651 SW 26th Street.
Miami, Fl. 33175
Phone: (305) 225-4277
Michel L. Bertelle, D.P.M.
(Perfect Feet Care Podiatry Center)
13651 SW 26th Street.
Miami, Fl. 33175
Phone: (305) 225-4277
Flavia Inesta, D.P.M.
1797 SW 3 ave
Miami, Fl. 33129
Phone: (305) 856-4454
Juliette Perez, D.P.M. Joanna Arroyo-Rivera, D.P.M.
922 North Crome Ave 922 North Crome Ave Homestead, Fl. 33030
Homestead, Fl. 33030 Phone: (305) 246-4440
Phone: (305) 246-4440
Arnulfo Mansur, MD
202 East 49 Street.
Hialeah, Fl. 33013
Phone: (305) 442-0066
Joaquin Fernandez, D.P.M.
605 SW 57 Avenue.
Miami, Fl. 33144
Phone: (305) 269-8223
Riquel Gonzalez, D.P.M
Private Medical Center.
10 NW 42th Ave. Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Juliette Perez, D.P.M.
Joanna Arroyo-Rivera, D.P.M.
Richard Mallia, D.P.M
4410 W 16 ave #53 Hialeah, Fl. 33012 4410 W 16 ave #53 Hialeah, Fl. 33012 (Sunshine Medical Care)
Phone: (305) 558-7437
Phone: (305) 558-7437
Miami, Fl. 33134
Phone: (305) 456-3879
38
Podiatry / Podiatría / Broward
Podiatry / Podiatría / Collier
Gilberto J. Acosta, D.P.M
(Johnson Medical Center)
7900 NW 33 St #101
Phone: (954) 962-5300
Psychiatry / Psiquiatría
Miami - Dade
Jose C. Lopez-Escobar, M.D.(Florida Medical Center)
1501 NW 36 St Miami, Fl. 33142
Phone: (786) 378-8200
Psychology / Psicología - Miami - Dade
Mercedes Llenin, M.D.
5600 SW 135 Ave,
Suite 116, Miami, Fl. 33183
Phone: (305) 387-7850
Psychology - Lee / Cape Coral
Humberto Hernandez, M.D.
(Pulmonary Medicine)
900 W 49 St Suite 448
Hialeah, Fl. 33012
Phone: (305) 885-3111
Urology / Urología
Psychology - Broward
Calixto Garcia, M.D.
Phone: (239) 772-1194 / 1195
Pulmonology / Neumología - Miami - Dade
Psychology - Collier
Carlos Pérez, M.D. (Vida Health Centers)
881 E 2nd aveHialeah, Fl. 33010
Phone: (305) 882-1100
Evelyn Lopez Brignom, M.D. (Adults and Children )
12001 SW 128 cort, Miami, Fl. 33186
Phone: (786) 429-1215 / 305.244.2035
Amelie Bethart-Tejera PH,D
5600 SW 135 Ave, Suite 116,
Miami, Fl. 33183
Phone: (305) 387-7850
Calixto Garcia, M.D.
Naples Health Care Inc.
4947 Tamiami Trail North
Suite 206 Naples Fl. 34103
Phone: (239) 304-9290
Luis Sabogal, M.D.
(Urology / Urología)
1800 SW 27 Avenue, Suite 402
Miami, Fl. 33145
Phone: (305) 445-2404
Podiatry / Podiatría / Lee / Cape Coral
Riquel Gonzalez, D.P.M.
Nelson Gonzalez, D.P.M. (Podiatry)
(Podiatry)
35 Barkley Circle #2
Fort Myers Fl. 33907
Phone: (239) 362-0527
Phone: (239) 772-1194 / 1195
Angel Garcia, D.P.M.
Naples Health Care Inc.
Naples Fl. 34103
Phone: (239) 304-9290
Maria Moncayo, M.D.
10406 Taft St
Phone: (954) 436-3880
Surgery / Cirugía
Miami - Dade
Consulta de Orientación Quirúrgica
Dr. Félix Dolorit (Surgery Coordinator).
3400 Coral Way 5to piso
Coral Gables Fl. 33145
Phone:(305) 771-5928 / 786-443-0068
Consulta de Coordinación FREE.
Miami - Dade
Eduardo Guzman, M.D.
(Urology / Urología)
1800 SW 27 Avenue, Ste 402
Miami, Fl. 33145
Phone: (305) 445-2404
Luis F. Maggiolo, M.D. (Urlogy / Urología)
747 Ponce de Leon Blvd # 502 Coral Gables, Fl. 33134
Phone: (305) 444-2858
39
Juan B Suarez, M.D. (Urology / Urología)
5450 SW 8th St #204 Miami, Fl. 33134
Phone: (305) 443-8041
URGENT CARE CENTERS
At Med Plans contracted Urgent Care Centers, you’ll find experienced professionals who firmly believe everyone deserves access to affordable medical care.
If you or a family member is experiencing life-threatening illness or injury-such as major head trauma, chest pain, severe abdominal pain, or loss of consciousness – you
should go directly to an Emergency Room (ER). See the list below for guidance on what situations require ER treatment.
• Falls from greater than 7 feet
• Loss of consciousness
• Infants less than 6 months of age or with a temperature greater than 103 degrees
• Pregnancy bleeding or complications
• Life-threatening allergic reactions
• Severe burns
• Severe choking (cannot breathe or talk)
• Severe abdominal pain
• Signs or symptoms of stroke or heart attack
• Amputation of a body part
• Near drowning
• Electrical shock
• Open or angulated fractures
CENTROS DE URGENCIAS
Med Plan tiene contratados “Centros de Cuidado de Urgencias” donde usted encontrará un servicio rápido, económico y eficiente ofrecido por profesionales experimentados
que creen firmemente que todos merecen tener acceso a la atención médica.
Si usted o algún miembro de la familia está sufriendo una enfermedad potencialmente mortal o lesiones - como: Traumatismos craneales importantes, Dolor torácico, Dolor
abdominal intenso o pérdida de la conciencia debe ir directamente a una sala de emergencias (ER). Vea la lista a continuación para obtener orientación sobre las situaciones
que requieren un tratamiento (ER).
• Caídas de más de 7pies de altura.
• Pérdida de conciencia.
• Los bebés menores de seis meses de edad o con una temperatura superior a 103 grados.
• Sangrado o complicaciones de embarazo.
• Reacciones alérgicas que puedan poner en peligro la vida
• Quemaduras graves
• Asfixia severa que le impide respirar o hablar
• Dolor abdominal severo
• Signos o síntomas de derrame cerebral o ataque al corazón
• Pérdida o desmembramiento de una parte del cuerpo
• Si usted está a punto de ahogarse
• Una descarga eléctrica
• Fracturas abiertas o anguladas
40
Urgent Care Centers / Centros de Urgencia
Urgent Care Fee Schedule
Tier One (Basic Visit) includes:
$60.00
•
Any and all levels of service, including initial visits and established patient visits.
•
Instant test(s) performed at the center.
- Urine dip.
- Instant strep
- Mono
- Flu
- Pregnancy
- Hemoccult
- Glucose
- HIV
Tier Two (Intermediate Visit) includes:
$120.00
•
Tier One (Basic Visit) above PLUS
- X-Rays of single body area performed in the center.
- Injection of pain meds or antibiotics.
- Vaccine administration (vaccine charged as exclusion below)
- Venipuncture or specimen collection for any lab outside reference lab (lab test
charged as exclusion below)
Tier Three (Advanced Visit) includes:
•
Tier Two (Intermediate Visit) PLUS
•
Single procedures performed in the center including but not limited to:
- Nebulizer treatment
- Laceration repair.
- Burn dress/debride
- Foreign body removal
- Cast / Splint application
- IV Therapy
- EKG
Urgent Care Center (UrgentMed)
2337 S. University Drive Davie, Fl 33324
Phone: (954) 423-9234
HOURS OF OPERATION:
MON – FRI 9:00AM – 9:30PM
SAT – SUN 9:00AM – 5:00PM
$145.00
Campbell Urgent Care.
1855 NE 8th Street.
Phone: (305) 242-8025
Fax: (305) 245-1839
HOURS OF OPERATION:
SAT – SUN 10:00AM – 4:00PM
Elite Health & Rehabilitation.
1949 W. 68th St
Hialeah, Fl. 33014
Phone: (305) 698-0806
Fax: (305) 698-2325
Language: English / Spanish
HOURS OF OPERATION:
MON – FRI 8:AM – 6:00PM
SAT – 8:00AM – 2:00PM
Med Clinic Health Care
10800 NW 58th St.
Doral Fl. 33178
Phone: (305) 477-4475
Fax: (305) 477-4487
HOURS OF OPERATION:
SAT 9:00AM – 4:00PM
Miami - Dade
WMC Health Group LLC
1380 NE Miami Garden Drive # 210
Nort Miami Beach Fl. 33179
Phone: (305) 692-9009 / Servicios:
General & Internal Medicine
INSTITUTE OF PREVENTY
MEDICINE
Hialeah, Fl. 33012
Phone (305) 676-2300
MON- SAT
Felicidad Medical Center.
4410 W 16 Ave # 55 Hialeah,
Fl.33012
Phone: (305) 824.8559
MON - FRI
8am / 11 pm
Sat- 8 am - 2pm
Sun- On call
Urgent Family Care
5673 SW 137 Ave
Miami , Fl. 33183
Phone: (305) 385.3949
MON - FRI
8am / 8 pm
Sat- 9 am - 3pm
Broward
302 NW 179 ave # 103,
Pembroke Pines, Fl 33029
Phone: (954) 442-8380
HOURS OF OPERATION:
SAT – SUN 9:00AM – 6:00PM
SBM Rehab Medical Center
6300 S . Dixie Hwy # 101 West Palm Beach, FL 33405
Phone: (561) 296-1116
HOURS OF OPERATION:
41
Palm Beach
Dentistry
Med Plan offers exclusive pricing to all our members consisting of:
•
Simple Cleanings that include Oral Examination, X-Rays, Topical anesthesia, for only $49 (Code 1110). For persons under the age of 16 this service is provided for
$35 (Code 1120). All minors will receive topical fluoride treatment included with their cleaning.
•
Deep cleanings are provided at $60 per quadrant (Code 4341) which include oral examination, complete x-rays, and anesthesia. This service does not include
panoramic x-rays. All minors will receive topical fluoride treatment included with their cleaning.
DEEP CLEANING PROCEDURE MAY REQUIRE THE USE OF ARESTIN AS PART OF THIS SERVICE. THE PATIENT MAY BE PROVIDED AN ALTERNATIVE ORAL
ANTIBIOTIC AT A LESSER COST.
-------------------------------------------------------------------------------------------------------------------------------------------------------------Los proveedores de servicios dentales asociados a MedPlan están ofreciendo precios exclusivos a nuestros miembros. Entre los más destacados están:
•
Limpieza Simple que incluye Examen Oral, Rayos X, Anesthesia, todo por el precio de $49.00 para adultos (Código 1110) y $35.00 para menores de 16 años (Código
1120). En el caso de los menores de 16 años se le incluye también la aplicación de fluoride anticarie.
•
Limpieza Profunda en una dentadura completa por $60.00 el cuadrante (Código 4341). Si la dentadura está incompleta el precio a pagar será de $45.00 (Código
4342). Dicha limpieza incluye Examen Oral, Rayos X (no panorámicos), Anesthesia. En el caso de los menores de 16 años se le incluye también la aplicación de
fluoride anticarie.
EL USO DE ANTIBIOTICO ARESTIN EN EL PROCEDIMIENTO DE LA LIMPIEZA ES DECISION PERSONAL DEL PACIENTE. EL PACIENTE TIENE COMO
ALTERNATIVA EL USO DE OTRO ANTIBIOTICO RECOMENDADO POR EL DENTISTA.
Dentistry / Odontología
Dentist (Miami-Dade)
Med Dental Associated Inc.
7200 NW 7St Suite 333
Miami, Fl. 33126
Phone: 305-264-0063
Maria J. Alvarez, DDS.
Dental Group of South Florida II
11336 SW 184 St
Miami, Fl. 33157
Phone: (305) 251-4262
Ronald Askowitz DDS.
Beautiful Smile LLC
1871 NE 163rd St
North Miami Beach, Fl. 33162
Phone: (305) 945-7030
Hialeah Dental Care
4240 W 16 ave
Hialeah, Fl. 33012
Phone: (305) 823-1882
Life Dental Care Corp.
123 N Powerline Rd.
Deerfield Beach, Fl. 33442
Phone: (954) 429-8840
World Dental Care Corp
1370 East 4 Ave
Hialeah, Fl. 33010
Phone: (305) 888-1458
Broward
Pines Dental Care Inc.
17868 NW 2 ST
Phone: (954) 538-0047
Ronald Askowitz DDS.
2303 Hollywood Blv #14
Hollywood Florida, 33020
Phone: (954) 367-5671
Ernesto Quezada, DDS.
Dental Group of South Florida II
11336 SW 184 St
Miami, Fl. 33157
Phone: (305) 251-4262
Dentistry / Odontología
Dental Group of South Florida
101 West Ward Dr
Miami Springs, Fl. 33166
Phone: (305) 885-1357
Mario Hernandez, DDS.
1870 Forrest Hill Blv Suite 103
Lake Clarke Shores, Fl. 33406
Phone: (561) 585-5891
42
Palm Beach
MP. D. FS 01/13
Dentistry Fee Schedule
DENTAL SERVICES OFFERED TO MED PLAN MEMBERS ONCE A YEAR AT NO CHARGE
ONLY AT
Servicios dentales gratis una vez al año sólo para miembros de Med Plan
7200 NW 7 ST, SUITE 333
MIAMI, FL 33126 PHONE: (305) 264-0063
ADA CODES
D 0150
D 0210
D 1110
D 2330
D 1203
D 1204
D 7110
D 9972
DESCRIPTION
Comprehensive Oral Evaluation (1 anually)
Full Mouth X-Rays (1 anually)
Simple Prophylaxis (1 anually)
Single Restoration One Surface (1 anually)
Topical Application of Fluoride - Child (1 anually)
Topical Application of Fluoride - Adult (1 anually)
Simple Tooth Extraction (1 anually)
Blanqueamiento (1 Cada 2 Años ) Whitening (1 every to years )
FEE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$150.00
ADA CODES
D 2330
D 2331
D 2332
D 2335
D 7110
D 3310
D 3320
D 3330
D 2952
D 2750
D 2740
D 4341*
D 4342
D 5110
D 5120
D 5213
D 5214
General Dentistry Fee Schedule
DESCRIPTION
Single Restoration Per Surface
Resin Based Composite Filling Two Surface Anterior
Resin Based Composite Filling - Three Surfaces Anterior
Resin Based Composite Filling - Four or more surfaces anterior
Simple Extraction
Root Canal Anterior
Root Canal – Bicuspid
Root Canal - Molar
Cast post/core in addition to crown
Crown porcelain fused to high noble metal
Crown porcelain ceramic
Periodontal scaling and root planing/quad
Periodontal scaling and root planing - 1 to 3 teeth per quadrant
Complete denture - Maxillary
Complete Denture - Mandibular
Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases
Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases
FEE
$45.00
$55.00
$65.00
$75.00
$60.00
$350.00
$450.00
$550.00
$120.00
$395.00
$450.00
$60.00
$45.00
$375.00
$375.00
$395.00
$395.00
IMPORTANT NOTICE
New members will be able to access these services in Med Dental from the third month of their membership. Los
miembros podrán disfrutar de estos servicios en Med Dental a partir del tercer mes de su afiliación
If you have a dental emergency and need to see a dentist, please visit any dental clinic
listed in the previous page. Med Dental does not provide emergency dental assistance
to Med Plan Members.
Si a usted se le presenta alguna emergencia dental, visite cualquiera de las clinicas dentales en
la pagina anterior. Med Dental no ofrece servicios dentales de emergencia a nuestros miembros.
43
ADA CODES
D0120
D0140
D0150
D0160
D0170
D0180
D0210
D0220
D0230
D0240
D0250
D0260
D0270
D0272
DESCRIPTION
PERIODIC ORAL EXAM
LIMITED ORAL EVALUATION-PROBLEM FOCUSED
COMPREHENSIVE ORAL EVAL-NEW OR ESTABLISHED PATIENT
DETAILED & EXTENSIVE EVAL-PROBLEM FOCUSED
RE-EVALUATION-LIMITED, PROBLEM FOCUSED
COMPREHENSIVE PERIODONTAL EVALUATION
RADIOGRAPHY/DIAGNOSTIC DENTISTRY
X-RAY - INTRAORAL - COMPLETE SERIES (INCLUDING BITEWINGS)
X-RAY - INTRAORAL - PERIAPICAL FIRST FILM
X-RAY - INTRAORAL - PERIAPICAL EACH ADDITIONAL FILM
X-RAY - INTRAORAL - OCCLUSAL FILM
X-RAY - EXTRAORAL - FIRST FILM
X-RAY - EXTRAORAL - EACH ADDITIONAL FILM
X-RAY - BITEWING- SINGLE FILM
X-RAY - BITEWING - 2 FILMS
MP. D. FS 01/13
44
FEE
$20.00
$15.00
NO CHARGE
NO CHARGE
$15.00
$15.00
$30.00
$15.00
$5.00
$5.00
NO CHARGE
NO CHARGE
$5.00
$5.00
ADA CODES
D0330
D0340
D0350
D0460
D0470
D1110
D1120
D1203
D1204
D1310
D1320
D1330
D1351
D1510
D1515
D1520
D1525
D1550
D2330
D2331
D2332
D2335
D2391
D2392
D2393
D2394
D2410
D2420
D2430
D2510
D2520
D2530
DESCRIPTION
NOT TO BE TAKEN IF 274 WAS DONE W/IN PRIOR 6 MOS
PANORAMIC FILM
CEPHALOMETRIC FILM, NON-ORTHODONTIC
DIAGNOSTIC PHOTOGRAPHS
PULP VITALITY TEST
DIAGNOSTIC CASTS
PREVENTIVE DENTISTRY TO BE TAKEN IF 274 WAS DONE W/IN PRIOR 6 MOS
ROUTINE PROPHYLAXIS ADULT (ONCE EVERY 6 MONTHS)
ROUTINE PROPHYLAXIS - CHILDREN UNDER 16 YRS (ONCE EVERY 6 MONTHS)
TOPICAL APPLICATION OF FLOURIDE FOR CHILDREN UNDER 16
TOPICAL APPLICATION OF FLOURIDE FOR ADULTS
NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE
TOBBACO COUNSELING FOR CONTROL & PREVENTION OF ORAL DISEASES
ORAL HYGIENE INSTRUCTIONS
APPLICATION OF SEALANT PER TOOTH - CHILDREN UNDER 16
SPACE MAINTAINER - FIXED
SPACE MAINTAINER - FIXED
SPACE MAINTAINER - REMOVABLE
SPACE MAINTAINER - REMOVABLE
RE-CEMENTATION OF SPACE MAINTAINER
RESIN-BASED COMPOSITE - 1 SURFACE, ANTERIOR
RESIN-BASED COMPOSITE - 2 SURFACES, ANTERIOR
RESIN-BASED COMPOSITE - 3 SURFACES, ANTERIOR
COMPOSITED RESIN - 4 OR MORE SURFACES
RESIN - BASED COMPOSITE - 1 SURFACE, POSTERIOR
RESIN-BASED COMPOSITE - 2 SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - 3 SURFACES, POSTERIOR
RESIN-BASED COMPOSITE - 4 OR + SURFACES, POSTERIOR
GOLD FOIL - 1 SURFACE
GOLD FOIL - 2 SURFACES
GOLD FOIL - 3 SURFACES
INLAY - METALLIC - 1 SURFACE
INLAY - METALLIC - 2 SURFACES
INLAY - METALLIC - 3 OR MORE SURFACES
45
FEE
$25.00
$75.00
$20.00
$10.00
$25.00
$49.00
$35.00
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
$15.00
$120.00
$175.00
$160.00
$250.00
$25.00
$45.00
$55.00
$65.00
$75.00
$60.00
$70.00
$80.00
$90.00
$75.00
$95.00
$125.00
$300.00
$320.00
$340.00
ADA CODES
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664
D2710
D2720
D2721
D2722
D2740
D2750
D2751
D2752
D2780
D2781
D2782
D2783
D2790
D2791
D2792
D2799
D2910
D2920
DESCRIPTION
PREVENTIVE DENTISTRY
ONLAY - METALLIC - 2 SURFACES
ONLAY - METALLIC - 3 SURFACES
ONLAY - METALLIC - 4 OR MORE SURFACES
INLAY - PORCELAIN/CERAMIC - 1 SURFACE
INLAY - PORCELAIN/CERAMIC - 2 SURFACES
INLAY - PORCELAIN/CERAMIC - 3 OR MORE SURFACES
ONLAY - PORCELAIN/CERAMIC - 2 SURFACES
ONLAY - PORCELAIN/CERAMIC - 3 SURFACES
ONLAY - PORCELAIN/CERAMIC - 4 OR MORE SURFACES
INLAY - RESIN - BASED COMPOSITE - 1 SURFACE
INLAY - RESIN - BASED COMPOSITE - 2 SURFACES
INLAY - RESIN - BASED COMPOSITE - 3 OR MORE SURFACES
ONLAY - RESIN - BASED COMPOSITE - 2 SURFACES
ONLAY - RESIN - BASED COMPOSITE - 3 SURFACES
ONLAY - RESIN - BASED COMPOSITE - 4 OR MORE SURFACES
CROWN - RESIN (INDIRECT)
CROWN - RESIN WITH HIGH NOBLE METAL
CROWN - RESIN WITH PREDOMINNATLY BASE METAL
CROWN - RESIN WITH NOBLE METAL
CROWN - PORCELAIN/CERAMIC SUBSTRATE
CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL
CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
CROWN - PORCELAIN FUSED TO NOBLE METAL
CROWN - 3/4 CAST HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASE METAL
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN - FULL CAST HIGH NOBEL METAL
CROWN - FULL CAST PREDOMINANTLY BASE METAL
CROWN - FULL CAST NOBLE METAL
PROVISIONAL CROWN
RECEMENT INLAY
RECEMENT CROWN
46
FEE
$325.00
$330.00
$355.00
$325.00
$350.00
$375.00
$395.00
$415.00
$445.00
$195.00
$250.00
$275.00
$250.00
$275.00
$290.00
$210.00
$455.00
$405.00
$425.00
$450.00
$395.00
$495.00
$495.00
$530.00
$410.00
$520.00
$550.00
$699.00
$525.00
$580.00
$50.00
$25.00
$25.00
ADA CODES
D2930
D2931
D2932
D2933
D2940
D2950
D2951
D2952
D2953
D2954
D2955
D2957
D2960
D2961
D2962
D2970
D2980
D3110
D3120
D3220
D3221
D3230
D3240
D3310
D3320
D3330
D3331
D3346
D3347
D3348
D3950
DESCRIPTION
PREVENTIVE DENTISTRY
PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH
PREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH
PREFABRICATED RESIN CROWN
PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW
SEDATIVE FILLING
CORE BUILDUP, INCLUDING ANY PINS
PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION
CAST POST & CORE IN ADDITION TO CROWN
EACH ADDITIONAL CAST POST - SAME TOOTH
PREFABRICATED POST & CORE IN ADDITION TO CROWN
POST REMOVAL (NOT IN CONJUNTION WITH ENDODONTIC THERAPY)
EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH
LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE
LABIAL VENEER (RESIN LAMINATE) - LABORATORY
LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY
TEMPORARY CROWN (FRACTURED TOOTH)
CROWN REPAIR/ When crown and/or bridgework exceeds six(6) consecutive units, there will be an additional
charge of $30.00 per unit.
ENDODONTIC SERVICES
PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION)
PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION)
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION)
PUPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH
PUPAL THERAPY (RESORB FILLING) - ANTERIOR, PRIMARY
PUPLAM THERAPY (RESORBABLE FILLING) - POSTERIOR, PRIMARY
ROOT CANAL THERAPY - ANTERIOR
ROOT CANAL THERAPY - BICUSPID
ROOT CANAL THERAPY - MOLAR
TREATMENT OF ROOT CANAL OBSTRUCTION, NON-SURGICAL ACCESS
RETREAT, PREV RCT - ANTERIOR
RETREAT, PREV RCT - BICUSPID
RETREAT, PREV RCT - MOLAR
CANAL PREPARATION AND FITTING OF PREFORMED DOWEL OR POST
47
FEE
$95.00
$95.00
$95.00
$145.00
$40.00
$85.00
$20.00
$120.00
$105.00
$125.00
$30.00
$30.00
$205.00
$260.00
$425.00
$50.00
$95.00
$25.00
$25.00
$75.00
$95.00
$80.00
$90.00
$350.00
$450.00
$550.00
$85.00
$495.00
$595.00
$695.00
$75.00
D5411
D5421
D5422
D5510
D5520
D5610
D5620
D5630
D5640
D5650
D5660
D5710
D5711
D5720
D5721
D5730
D5731
D5740
ADJUSTMENT - COMPLETE DENTURE - MANDIBULAR
ADJUSTMENT - PARTIAL DENTURE - MAXILLARY
ADJUSTMENT - PARTIAL DENTURE - MANDIBULAR
REPAIR BROKEN COMPLETE DENTURE BASE
REPLACE BROKEN TOOTH - COMPLETE DENTURE (EACH TOOTH)
REPAIR DENTURE RESIN BASE
REPAIR CAST FRAMEWORK
REPAIR OR REPLACE BROKEN CLASP
REPAIR BROKEN TEETH - PER TOOTH
ADD TOOTH TO EXISTING PARTIAL DENTURE
ADD CLASP TO EXISTING PARTIAL DENTURE
REBASE COMPLETE MAXILLARY DENTURE
REBASE COMPLETE MANDIBULAR CENTURE
REBASE MAXILLARY PARTIAL DENTURE
REBASE MANDIBULAR PARTIAL DENTURE
RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)
RELINE PARTIAL COMPLETE MAXILLARY DENTURE (CHAIRSIDE)
48
$20.00
$20.00
$20.00
$75.00
$70.00
$50.00
$55.00
$55.00
$45.00
$65.00
$75.00
$195.00
$195.00
$175.00
$175.00
$85.00
$85.00
$65.00
D6241
D6242
D6245
D6740
D6750
D6751
D6752
D6780
D6781
D6782
D6783
D6790
D6791
D6792
D6930
D6950
D6970
D6971
PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL
PONTIC - PORCELAIN FUSED TO NOBLE METAL
PONTIC - PORCELAIN/CERAMIC
CROWN - PORCELAIN/CERAMIC
CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL
CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASED METAL
CROWN - PORCELAIN FUSED TO NOBLE METAL
CROWN - 3/4 CAST HIGH NOBLE METAL
CROWN - 3/4 CAST PREDOMINANTLY BASED METAL
CROWN - 3/4 CAST NOBLE METAL
CROWN - 3/4 PORCELAIN/CERAMIC
CROWN - FULL CAST HIGH NOBLE METAL
CROWN - FULL CAST PREDOMIANTLY BASED METAL
CROWN - FULL CAST NOBLE METAL
RECEMENT FIXED PARTIAL DENTURE
PRECISION ATTACHMENT
CAST POST & CORE ADDITION TO FIXED PARTIAL DENTURE RETAINER
CAST POST AS PART OF A FIXED PARTIAL DENTURE RETAINER
49
$400.00
$400.00
$595.00
$595.00
$495.00
$495.00
$495.00
$530.00
$510.00
$520.00
$510.00
$495.00
$495.00
$495.00
$40.00
$150.00
$125.00
$125.00
ADA CODES
D6972
D6973
D6975
D7110
D7140
D7310
D7320
D7510
D9215
D9230
D9630
D9940
D9950
D9951
D9952
DESCRIPTION
PROSTHODONTICS - FIXED
PREFABRICATED POST & CORE IN ADDITION TO FIXED PARTIAL DENTURE
CORE BUILD UP FOR RETAINER, INCLUDING PINS
COPING - METAL
ORAL SURGERY
SINGLE TOOTH EXTRACTION
EXTRACTION OF ERUPTED TOOTH OR EXPOSED ROOT
ALVEOLOPLASTY WITH EXTRACTIONS - PER QUADRANT
ALVEOLOPLASTY WITHOUT EXTRACTIONS - PER QUADRANT
INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE
LOCAL ANESTHESIA
MISCELLANOUS SERVICES
ANALGESIA NITROUS OXIDE PER 1/2 hour
ORAL IRRIGATION/OTHER DRUGS/MEDICAMENT PER QUAD
OCCLUSAL GUARD
OCCLUSAL ANALYSIS - MOUNTED CASE
OCCLUSAL ADJUSTMENT - LIMITED
OCCLUSAL ADJUSTMENT - COMPLETE
50
FEE
$125.00
$95.00
$95.00
$70.00
$70.00
$95.00
$130.00
$55.00
NO CHARGE
$20.00
$10.00
$195.00
$75.00
$25.00
$150.00
ADA CODES
ED3310
ED3320
ED3330
ED3346
ED3347
ED3348
D4210
D4249
D4260
D4263
D4264
D4266
D4275
D7953
D7960
D7210
D7220
D7230
D7240
D7241
D7250
D7285
D7286
D8080
D8090
D6010
D6010/D6059
D0000
D0000
DENTAL SPECIALTIES FEE SCHEDULE
DESCRIPTION
ENDODONTIC SERVICES
ROOT CANAL THERAPY - ANTERIOR
ROOT CANAL THERAPY - BICUSPID
ROOT CANAL THERAPY - MOLAR
RETREAT, PREV RCT - ANTERIOR
RETREAT, PREV RCT - BICUSPID
RETREAT. PREV RCT - MOLAR
PERDIODONTIC SERVICES
GINGIVECTOMY 4 OR + PER QUADRANT
CLINIC CROWN LENGTHEN - HARD TISSUE
OSSEOUS SURGERY 4 OR + PER QUADRANT
BONE REPLACE GRAFT - 1ST SITE/QU
BONE REPLACE GRAFT - EACH ADD/QU
GUIDED TISS REGEN-RESORB-PER
SOFT TISSUE ALLOGRAFT RB-PER
BONE REPL GRAFT RIDGE PRSV/SITE
FRENULECTOMY - SEPARATE PROCEDURE
ORAL SURGERY
EXTRACTION - SURGICAL/ERUPT TOOTH
EXTRACTION - IMPACTEDL/SOFT TISSUE
EXTRACTION - IMPACTEDL/PART BONY
EXTRACTION - IMPACTED/COMPLBONY (Cordales)
REMOV IMPACT - COMP BONY W/COMP
SURGIC REMOVL RESID TOOTH ROOT
BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH)
BIOPSY OF ORAL TISSUE - SOFT (ALL OTHER)
BIOPSY LAB
ORTHODONTICS
COMPREHENSIVE ORTHO, ADOLESCENT
COMPREHENSIVE ORTHO, ADULT
IMPLANTS
SURG PLACE IMPLANT, ENDOSTEAL
COMPLETED CROWN IMPLANT
OVERDENTURE UPPER WITH 4 IMPLANTS
OVERDENTURE LOWER WITH 3 IMPLANTS
51
FEE
$695.00
$775.00
$925.00
$750.00
$825.00
$1,125.00
$450.00
$800.00
$900.00
$650.00
$500.00
$900.00
$1,200.00
$400.00
$500.00
$240.00
$300.00
$395.00
$450.00
$500.00
$250.00
$120.00
$95.00
$50.00
$3,490.00
$3,490.00
$1,200.00
$1,950.00
$4,650.00
$3,650.00
OPTICAL SERVICES
In the following vision centers, Med Plan members will
receive a comprehensive eye exam(s) at $35 per visit which includes:
• Vision Evaluation.
• Intraocular Pressure Evaluation to check for Glaucoma.
• Dilated Eye Exam to determine eye health and to look for disease such as high blood pressure and diabetes.
• External eye health evaluation
----------------------------------------------------------------------------------------------------------------------------------------------------------En los siguientes centros de visión, los miembros de Med Plan recibirán un (1) examen ocular completo con un costo de $35.00 por visita que incluye:
• Evaluacion de la vista - (Optometría)
• Evaluación de la Presión Intraocular para verificar evidencia de glaucoma.
• Dilatación de la pupila para determinar la salud y para identificar enfermedades tales como presión alta o diabetes.
• Evaluación externa para determinar la salud de los ojos.
MIAMI-DADE
(SOUTH FLORIDA VISION). **
Harrold Forrest, O.D
James Hagen, O.D
Martha Alfonso, O.D.
(Navarro Pharmacy # 32)
366 East 4th Avenue.
Hialeah, Fl. 33010
Phone: (305) 888-9910
Martha Alfonso, OD.
Harrold Forrest, OD.
James Hagen OD.
(Navarro Pharmacy # 25)
11865-A SW 26th Street.
Miami, Fl. 33175
Phone: (305) 552-9100
(305) 225-4004
VISION WORLD OPTICAL CORP.
(Vision Center/ Optica)
7367 SW 8th Street
Miami , Fl. 33144
Phone: (305) 265-7778
Call for Appointment
(AVENTVISION) **
767 NW 37th Ave
Miami Fl. 33125
Phone: (786) 452-8544
Call for appointment
(VISION CENTER OPTICA). **
Gerald D. Furnari O.D. F.A.A.O.
Robert L. Lofton O.D. F.A.A.O.
Patrick F. Vecchio O.D. F.A.A.O.
948 N. Krome Ave
Homestead Fl. 33030
Phone: (305) 247-2331
(TRIANGLE VISION CENTER.) ***
1750 West 39 Place
Hialeah, Fl. 33012
Phone: (305) 490-3816
LISET OPTICAL, INC
4306 SW 8th Street
Miami , Fl. 33144
Phone: (305) 444-0535
Call for Appointment
Note: ( ** ) Evaluation includes Intraocular Exam to Detect Glaucoma, Diabetes and High Blood Pressure.
Nota: ( ** ) La evaluación incluye Examen Intraocular para verificar si hay Glaucoma, Diabetes y Presión Alta.
Note: ( *** ) Evaluation does NOT include Intraocular Exam to Detect Glaucoma, Diabetes and High Blood Pressure.
Nota: ( *** ) La evaluación NO incluye Examen Intraocular para verificar si hay Glaucoma, Diabetes y Presión Alta.
52
(OPTICA ARIAS). **
9160 NW 122th Street, Suite 28
Hialeah Gardens , Fl. 33018
Phone: (305) 512-4408
Optical & Vision Centers / Centros Opticos
(SOUTH FLORIDA VISION). ** Eric Dupuis, OD.
Christopher Boalding, OD. Laurie Lesser, OD.
2551 South University Drive Davie, Fl. 33324
Phone: (954) 370-5883
(SOUTH FLORIDA VISION). ** Christopher Boaldin,
OD. Harold Forrest, OD. Laurie Lesser, OD.
12538 Pines Blvd. Pembroke Pines, Fl. 33027
Phone: (954) 430-4030
Broward
(SOUTH FLORIDA VISION). ** Eric Dupuis, OD.
Christopher Boaldin, OD. Robert Coppola, OD.
2900 W. Cypress Creek Rd. # 1 Ft. Lauderdale Fl. 33309
Phone: (954) 979-2191
(SOUTH FLORIDA VISION). ** Robert Coppola, OD.
Christopher Boaldin, OD.
1205 S. Powerline Rd.Pompano Beach, Fl. 33069
Phone: (954) 977-6636
Palm Beach
Ashley Nochomson, OD. Karen Puchalski, OD.
Miriam Farag, OD.
9851- B South Military Trail. Boynton Beach, Fl. 33436
Phone: (561) 742-8701
Christopher Boaldin, OD.
143 N. Powerline Road Deerfield Beach, Fl. 33442
Phone: (954) 429-9600
Mitchell Biderman, OD.
Karen Puchalski, OD. Lori Raynor, OD.
6618 West. Atlantic Ave. Delray Beach, Fl. 33446
Phone: (561) 498-5007
Mitchell Biderman, OD.
Christopher Boaldin, OD. Lori Raynor, OD.
Ashley Nochomson, OD.
6266 S. Congress Ave. # 9 Lantana, Fl. 33462
Phone: (561) 966-9000
St. Lucie
(ST. LUCIE VISION CENTER). ** Mitchell Biderman, OD. **
10077 South Federal Hwy. Port St. Lucie, Fl. 34952
Phone: (772) 398-3244
53
(SOUTH FLORIDA VISION). ** Mirian Faraq, OD.
Christopher Boaldin, OD. Jerrold Mills, OD.
3181 North State Rd. # 7 Margate Fl. 33063
Phone: (954) 974-7695
(SOUTH FLORIDA VISION). **Laura DeMarco, OD.
1666 East Oakland Park Blvd.. Ft. Luderdale Fl. 33334
Phone: (954) 566--1404
Ronie Zaruches, OD.
143 N. Powerline Road Deerfield Beach, Fl. 33442
Phone: (954) 429-9600
Karen Puchalski, OD. Jason Aronson, OD.
2905-G N. Military Trail
Phone: (561) 684-5548
VISION AND OPTICAL FEE SCHEDULE
TARIFAS DE SERVICIOS OPTICOS
EYE EXAM
SOUTH FLORIDA VISION**
BIFOCAL LENSE FITTING
SINGLE VISION
$35.00
Single Vision Contact Lense Fitting: $60.00
$35.00
Frames and Standard Lenses
Standard Stock
CR-39
Standard Stock
CR-39
Standard Stock
CR-39
Standard Select Progressive
39 (Single Vision) $35.00
(Bi-Focal FT-28) $35.00
(Tri focal 7x28) $45.00
(Bi-Focal)
$60.00
Bifocal Transition Lens
Transition Progressive
Lens
$80.00
$90.00
VISION CENTER**
EYE EXAM
SINGLE VISION
$30.00
$35.00
Standard Stock
CR-39
Standard Stock
CR-39
Standard Stock
CR-39
(Bi-Focal FT-28) $30.00
(Tri focal 7x28) $40.00
(Bi-Focal)
$55.00
Lens
$80.00
$90.00
OPTICA ARIAS**
EYE EXAM
SINGLE VISION
$30.00
$35.00
Standard Stock
CR-39
Standard Stock
CR-39
Standard Stock
CR-39
(Bi-Focal FT-28) $30.00
(Tri focal 7x28) $40.00
(Bi-Focal)
$55.00
54
Lens
$80.00
$90.00
VISION AND OPTICAL FEE SCHEDULE
TARIFAS DE SERVICIOS OPTICOS
TRIANGLE VISION CENTER ***
EYE EXAM
SINGLE VISION
$30.00
$30.00
Standard Stock
CR-39
Standard Stock
CR-39
Standard Stock
CR-39
(Bi-Focal FT-28) $30.00
(Tri focal 7x28) $40.00
(Bi-Focal)
$55.00
(**) Evaluation includes an intraocular exam to detect Glaucoma, Diabetes and High Blood Pressure.
La evaluación incluye un examen intraocular para verificar si hay Glaucoma, Diabetes y Presión alta.
(***) Evaluation does NOT include an intraocular exam to detect Glaucoma, Diabetes and High Blood Pressure.
La evaluación NO incluye un examen intraocular para verificar si hay Glaucoma, Diabetes y Presión alta.
55
Lens
$80.00
$90.00
CLINICAL LABS / LABORATORIOS CLNICOS
Over One thousand “1000” Lab tests available 80% of the tests are priced below $20.00. Five Complementary Lab tests free for all Med Plan members and their family once
a year. Included tests are:
• CBC. • Comprehensive Metabolic Panel. • Lipid Profile. • TSH • Urinalysis.
All Laboratories require that the tests being requested are ordered by a licensed healthcare professional that is authorized to practice medicine in the State of Florida. The order
must be written in a Physicians prescription or on the Laboratories requisition form that is signed by the ordering physician.
All Laboratory results will be sent to the office of the Physician or Specialist that has ordered the test. This procedure is to protect the confidential information regarding the
outcome or the test results.
De las pruebas de laboratorio disponibles, el 80% de su totalidad están bajo precios fijos.
MedPlan ha coordinado con sus laboratorios asociados que ofrecen precios preferenciales a nuestros miembros en varios exámenes y además cinco (5) exámenes
complementarios cada año sin costo alguno para usted.
• CBC.• Panel metabólico completo. • Perfil de lípitdos. • TSH (Tiroides) • Análisis de orina.
Todos los laboratorios requieren que los exámenes que se solicitan hayan sido previamente indicados por un profesional de la salud con licencia que le autoriza a ejercer la
práctica de la medicina en el Estado de la Florida. La indicación del examen debe estar escrita en una receta médica o en su lugar en el formulario de solicitud establecida para
los Laboratorios y firmada por el médico que la indica.Todos los laboratorios cumplirán el procedimiento legal establecido de confidencialidad del paciente y para proteger este
derecho enviaran los resultados de su/s examen a la oficina de su doctor.
CLINICAL LABS / LABORATORIOS CLINICOS
Complete Bio Solutions
2546 West 6th ave
Hialeah, Fl. 33010
Phone: (305) 477-6520
Veni puncture Fee: $5.00
41 Tamiami Canal Rd
Miami Fl 33166
Phone: (305) 269.0833
Veni puncture Fee:$10.00
Clinical Labs / Laboratorio Clínico
Broward
First Quality Laboratory
11460 Interchange Circle North Miramar, Fl. 33025
Phone: (954) 430-4424
Home Blood Collection $15.00 (Call For Appointment)
Lab and Doctor’s Office Collection $10.00
(Only Venipuncture/Sólo extracción de sangre)
(Tuesdays 8:30 am to 1:00 pm) (Martes 8:30 am
- 1:00 pm) 4947 Tamiami Trail N Suite # 206
Naples, Fl. 34103 / Phone: 239-304-9290
Complete Bio Solutions Clinica Los Angeles
5038 Coronado Pkwy Naples, Fl. 34116
Phone: (239) 234-6835/6948
Venipuncture: $10.00
Collier
Miami-Dade
3626 NW 7 St
Miami FL 33125
Phone: (305) 643.4343
3720 SW 107 Ave
Miami FL 33165
Phone: (305) 554.4270
70 NW 8 St
Homestead FL 33030
Phone: (305) 242.5225
Extraccion a domicilio.
305.477.6520.
11460 Interchange Circle North Miramar, Fl. 33025
Phone: (954) 430-4424 Home Blood Collection
$15.00 (Call For Appointment)
Lab and Doctor’s Office Collection $10.00
Palm Beach
First Quality Laboratory First Quality Laboratory
6300 S.Dixie Hwy #101
220 S.Dixie Hwy #4
Phone: (561) 429-5086 Phone: (561) 296-1116
Venipuncture Fee $10
Venipuncture Fee $10
11460 Interchange Circle North
Miramar, Fl. 33025 Phone: (954) 430-4424
Home Blood Collection $15.00
(Call For Appointment) Lab and Doctor’s
Office Collection $10.00
Lee / Cape Coral
Venipuncture Center for Med Plan Members at a cost of $10.00 only on Mondays.
Centro habilitado para la extraccion de sangre a los miembros de
Med Plan con un costo de $10.00. Este servicio se ofrece sólo los Lunes.
56
3144 North Side Drive
Key West FL 33040
2500 Del Prado Blvd South Cape Coral
Fl. 33954 /Phone: (239) 772-1194 / 1195
6650 NW 57 St
Tamarac FL 33319
201 SW 16 St
Okeechobee FL 34974
2007 S 25 St
Fort Pierce FL 34947
Phone: 772.577.4200
1500 Lakeland Hills Blvd # 5
Lakeland Fl 33805
5609 N Armenia Ave
Tampa FL 33603
LABORATORY SERVICES FEE SCHEDULE
ONE ANNUAL HEALTH SCREENING LABORATORY PER MEMBER PER CONTRACT YEAR AT NO CHARGE
CBC
COMP. METABOLIC PANEL
TSH
LIPID PANEL
URINE
URIC ACID
PATHOLOGY TEST / EXAMENES DE PATOLOGIA
TEST NAME
PAP SMEAR (slide)
PAP LIQUID SUREPATH
HUMAN PAPILOMA VIRUS hc2
CHLAMYDIA & GC DNA
CHLAMYDIA & GC DNA hc2
PAP PANEL (liquid pap+HPVhc2+chlamydia&GC hc2
TEST CODE
9161
9142
1845
5344
9193
9190
FEE
$12.00
$25.00
$38.00
$25.00
$35.00
$99.00
All the Gynecology collections will cost $20.
Todas las colecciones ginecologicas tendran un costo de $20.
*The fees for the biopsies level (I-II-III-IV-V-VI) will be determined by the specimen site, number of the specimens and any special stains required for the final diagnosis.
BIOPSY Level I - Gross only
BIOPSY Level II
BIOPSY Level III
BIOPSY Level IV
57
TEST CODE
FEE
9181
9182
9183
9184
$30.00
$40.00
$65.00
$85.00
TEST NAME
MP.LAB.FS 01/13
TEST CODE
1106
7200
1274
8170
3525
1102
8160
7302
7304
AMYLASE
ACTH (ADRENOCORTICOTROPIC HORMONE)
AFP TUMOR MARKER
ALBUMIN
ALCOHOL IN URINE
ALDOLASE
ALKALINE PHOSPHATASE
ALLERGEN FOOD PANEL (ADULT) each allergen ($9)
ALLERGEN RESPIRATORY PANEL(SUB-TROPICAL) each allergen ($9)
ALLERGY PANEL PER ALLERGEN each allergen ($9)
ALPHA PHETO PROTEIN QUAD SCREEN
ALPHA PHETO PROTEIN TRIPLE SCREEN
ALT (SGPT)
AMIKACIN SERUM
AMMONIA
ANA
ANTIBODY SCREENING
ASO
AST (SGOT)
B-12 & FOLID ACID
B-12
BASIC METAB PANEL
BETA 2 MICROGLOBULIN
BILIRUBIN DIRECT
BILIRUBIN TOTAL
BIOPSY (see comments at the end)
BLEEDING TIME
BLOOD TYPE & RH
BNP
BUN
CBC
C3 COMPLEMENT
1673
8260
8154
1695
1104
5200
4259
4201
8152
8794
7272
8118
1404
8149
8166
9181
4108
4200
1430
8142
4110
6115
58
FEE
$6.00
$37.00
$15.50
$2.50
$12.00
$9.50
$2.50
$9.00
$9.00
$9.00
$82.00
$56.00
$8.00
$15.50
$12.50
$12.00
$11.50
$15.00
$8.00
$30.00
$12.50
$8.00
$16.50
$4.50
$4.50
$4.50
$18.00
$40.00
$5.00
$7.00
$20.00
C4 COMPLEMENT
CA 125
CA 15-3
CA 19-9
CA 27-29
CALCIUM
CALCIUM IONIZED
CALCULUS (stone) ANALYSIS
CARBAMAZEPIN
CEA
CERULOPLASMIN
CHLAMYDIA & GC IN URINE
CHLAMYDIA & GC DNA
CHOLESTEROL
CK (CPK TOTAL)
CMV IgG
CMV IgM
COMPRENH. METABOLIC PANEL
COOMBS DIRECT
COOMBS INDIRECT
CORTISOL
C-PEPTIDE
CPK - MB (CREATINE KINASE MB FRACTION)
C-REACTIVE PROTEIN - QUANT
C-REACTIVE PROTEIN (CRP)
C-REACTIVE PROTEIN (CRP) ULTRASENSITIVE
CREATININE 24 HRS
CREATININE CLEARANCE
CREATININE SERUM
CULTURE & SENSIT
CYSTIC FIBROSIS
DEPAKENE (VALPROIC ACID)
DHEA (DEHYDROEPIANDROSTERONE
DHEA-S
TEST NAME
MP.LAB.FS 01/13
TEST CODE
6126
1462
1462
1463
1664
8172
2130
1318
3119
7214
6119
5346
5344
8146
8156
1353
5210
8112
4214
4215
7206
1431
6127
3595
4216
6657
2115
2127
8150
5145
6442
1938
7171
1655
59
FEE
$20.00
$19.50
$19.50
$19.50
$19.50
$4.50
$11.00
$27.00
$15.00
$19.50
$36.00
$60.00
$25.00
$4.50
$7.00
$14.50
$12.50
$9.00
$10.00
$10.00
$17.50
$15.00
$12.50
$12.50
$5.00
$12.50
$10.00
$9.50
$4.00
$14.00
$250.00
$14.00
$26.00
$26.00
TEST NAME
TEST CODE
DIHYDROTESTOSTERONE DHT
D-DIMER
DILANTIN LEVEL
DRUG SCREEN IN URINE
ELECTROLYTE PANEL
EPSTEIN BARR VIRAL CAPSIDE ANTIGEN (VCA) IgG & IgM
EPSTEIN BARR VIRUS EARLY
EPSTEIN BARR VIRUS NUCLEAR ANTIGEN IgG ANTIBODY
EPSTEIN BARR VIRUS NUCLEAR ANTIGEN IgM ANTIBODY
ERYTHROPOIETIN
ESTRADIOL
ESTRIOL
ESTROGEN TOTAL
ESR (SED RATE)
EYE CULTURE & SENSITIVITY
FERRITIN
FIBRINOGEN
FOLIC ACID
FREE T3
FREE T4
FSH
FSH&LH
FINE NEEDLE ASPIRATION
FTA AG
FUNGUS CULTURE
GAMMA GT (GGTP)
GC CULTURE
GENTAMYCIN
GLIADIN IgA, IgG
GLUCOSE 2 HRS P.P
GLUCOSE 2 HRS TOLERANCE TEST
GLUCOSE 3 HRS
GLUCOSE GRAY TUBE
GLUCOSE SERUM
3126
3223
8200
1920
1632
1861
1902
5215
7226
7224
7227
4160
5145
7275
4223
7229
1603
7120
7228
7261
5220
5114
1116
5118
7232
1432
8180
8188
8189
8141
8140
60
FEE
$26.50
$22.50
$15.00
$23.00
$6.50
$14.00
$14.00
$17.50
$17.50
$18.50
$22.00
$28.00
$22.00
$8.00
$12.00
$14.00
$22.00
$13.00
$7.00
$7.00
$17.00
$34.00
$69.00
$35.00
$35.00
$5.00
$35.00
$28.00
$80.00
$7.00
$13.00
$17.00
$3.50
$3.50
TEST NAME
TEST CODE
6145
1295
1297
1294
6147
7282
7240
6145
6151
4132
8698
1376
1621
1799
1614
7237
7236
1711
2298
1716
1439
1440
1437
1398
1227
7238
1846
6140
7248
6142
GLYCOHEMOGLOBIN
H. PYLORI AB IgG
H.PYLORI AB IgM
H.PYLORI IN STOOL (ANTIGEN)
HAPTOGLOBULIN
HCG QUAL
HCG QUANT
HEMOGLOBIN A1C
HEMOGLOBIN ELECTROPHORESIS
HEMOGLOBIN/HEMATOCRIT
HEPATIC FUNCTION PANEL
HEPATITIS A IgM
HEPATITIS A TOTAL
HEPATITIS B CORE IgM ANTIBODIES
HEPATITIS B CORE TOTAL ANTIBODY
HEPATITIS Bs ANTIBODY
HEPATITIS Bs ANTIGEN
HEPATITIS C ANTIBODY
HEPATITIS PANEL ABC
HERPES CULTURE
HERPES I SELECT
HERPES SELT II IgG
HIV 1 & 2 SCREEN
HLA-B-27
HOMOCYSTEINE
HUMAN GROWTH HORMONE
HUMAN PAPILOMA VIRUS hc2
IgA (Immunoglobulin)
IgE (Immunoglobulin E)
IgG (Immunoglobulin)
61
FEE
$9.00
$15.00
15.00
$43.00
$25.00
$7.00
$15.50
$9.50
$12.00
$12.00
$7.50
$11.50
$10.50
$11.50
$11.50
$11.00
$10.00
$13.50
$44.00
$35.00
$12.50
$18.50
$9.50
$70.00
$28.00
$16.00
$39.00
$9.00
$16.00
$9.00
TEST NAME
IgM (Immunoglobulin M)
IMMUNOELECTROPHORESIS
IMMUNOGLOBULIN IgG-A-M
INSULINE LEVEL
INSULINE LIKE GROWTH FACTOR I SOMATOMEDIN-C IgF1
IRON
IRON & IBC
LEAD BLOOD
L.E. SCREEN
LDH
LH
LIPASE
LIPID PANEL
LIPOPROTEIN A
LITHIUM
LIVER PROFILE I
MAGNESIUM SERUM
MEASLES ANTIBODY IgG
MEASLES ANTIBODY IgM
METANEPHRINE 24 HRS URINE
MICROALBUMIN 24 HRS URINE
MICROALBUMIN RANDOM
MITOCHONDRIAL TOTAL AUTOANTIBODIES
MONO TEST
MUMPS ANTIBODY IgG
MUMPS ANTIBODY IgM
MYCOPLASMA IgM TITER PNEUMONIAE ANTIBODY
MYCOPLASMA PNEUMONIAE ANTIBODY IgG, IgM
MYELIN BASIC PROTEIN (MBP) AUTOANTIBODIES
MYSOLINE (PRIMIDONE)
TEST CODE
6143
6160
6156
7250
1666
8162
8161
2160
3662
8158
7244
1126
6188
6165
2163
8158
2166
2362
2361
2169
1208
1209
5226
4213
1362
1317
1985
1363
1404
3162
MP.LAB.FS 01/13
62
FEE
$9.00
$21.50
$27.00
$11.50
$30.00
$5.00
$8.50
$10.50
$10.00
$4.00
$19.50
$6.50
$9.00
$33.20
$7.00
$10.00
$6.50
$12.50
$12.50
$80.00
$35.00
$4.00
$55.00
$12.00
$12.50
$12.50
$60.00
$65.00
$90.00
$55.00
MP.LAB.FS 01/13
TEST NAME
TEST CODE
1609
3198
8136
4320
4321
2173
2172
9161
9142
3155
8174
4149
8210
8223
2011
4330
3162
3163
7256
7252
6129
2305
8168
2216
1937
4254
1373
4253
2183
4257
8108
7258
4154
NEURONTIN (GABAPENTIN)
NICOTINE METABOLITE URINE
OBSTETRIC PANEL
OCCULT BLOOD PER SPECIMEN
OVA AND PARASITES
OXALATES - 24HRS
OXALATES - URINE RANDOM
PAP SMEAR
PAP LIQUID SUREPATH
PHENOBARBITAL
PHOSPHORUS
PLATELET COUNT
POTASIUM
POTASIUM IN URINE
PRE - ALBUMIN
PREGNANCY TEST IN URINE
PRIMIDONE
PROCAINAMIDE (PRONESTYL + NAPA)
PROGESTERONE
PROLACTIN
PROTEIN ELECTROPHORESIS
PROTEIN TOTAL 24HRS
PROTEIN TOTAL SERUM
PSA FREE & TOTAL
PSA SCREEN
PT
PTH INTACT
PTT
QUINIDINE
R A LATEX
RENAL FUNCTION PANEL
RENIN
RETIC COUNT
63
FEE
$50.00
$24.50
$45.23
$5.00
$9.00
$13.00
$13.00
$15.00
$25.00
$11.00
$4.00
$6.00
$4.00
$4.00
$7.00
$6.50
$15.00
$16.50
$26.00
$19.50
$10.00
$3.50
$5.00
$29.00
$15.00
$3.50
$35.00
$3.50
$14.50
$7.00
$8.00
$18.50
$4.00
TEST NAME
TEST CODE
4202
4257
5230
1752
4272
1752
4160
4331
2186
4161
1601
2334
2335
8221
8205
1318
5113
1603
7260
7105
7110
1282
7268
7269
3174
7175
5155
5202
1201
7121
5205
1389
1391
RH FACTOR (ONLY)
RHEUMATOID FACTOR
RUBELLA ANTIBODY IgG
RUBELLA ANTIBODY IgM
RPR
RUBELLA ANTIBODY IgM
SED RATE
SEMEN ANALYSIS
SEROTONIN (5-HIAA)
SICKLE CELL SCREEN
SMOOTH MUSCLE ANTIBODY
SODIUM (U) 12 HRS
SODIUM (U) 24 HRS
SODIUM IN URINE
SODIUM SERUM
STONE ANALYSIS (KIDNEY)
STOOL CULTURE
T-3 FREE
T3 TOTAL
T3-UPTAKE
T4
TACROLIMUS (PROGRAF)
TESTOSTERONE
TESTOSTERONE FREE & TOTAL
THEOPHYLLINE
THIAMINE LEVEL (VITAMIN B1)
THROAT CULTURE
THYROGLOBULIN Abs SCREEN
THYROGLOBULIN QUANT.
THYROID II PANEL (TSH)
THYROID PEROXIDE AB (TPO)
THYROID STIMULATING IMMUNOGLOBULINS (TSI)
THYROXIDE BINDING GLOBULIN
64
FEE
$5.50
$6.00
$15.00
$15.00
$4.50
$15.00
$3.50
$50.00
$11.00
$6.00
$30.00
$4.50
$4.50
$4.50
$4.00
$27.00
$13.50
$7.00
$7.00
$6.00
$6.00
$16.00
$25.00
$27.50
$14.50
$6.00
$13.50
$16.00
$14.00
$29.00
$15.00
$12.50
$11.00
TEST NAME
TOBRAMYCIN
TORCH PANEL
TOXOPLASMA IgG
TRANSFERRIN
TRAZODONE
TREPONEMA PALLIDUM TOTAL ANTIBODIES (FTA)
TRIGLYCERIDES
TROPONIN I
TSH
URINALYSIS
URIC ACID
URINE CULTURE
URINE CYTOLOGY
VARICELLA ANTIBODY IgG
VITAMIN D25
VITAMIN D
VITAMIN B-6
VAGINAL CULTURE
VARICELLA ZOSTER ANTIBODY IgM
VITAMIN B-1 (THIAMINE)
VMA (VANILLYLMANDELIC ACID 24 HRS URINE)
VALPROIC ACID
VITAMIN B-12
WESTERN BLOT ANALYSIS
WET MOUNT
WBC IN STOOL
ZINC
TEST CODE
3185
8420
5236
6175
1798
5220
8148
8157
7264
4340
8144
5113
2772
1300
1301
1346
5156
2772
7175
2196
1938
7272
1833
4319
2199
65
FEE
$16.00
$60.00
$15.00
$15.00
$70.00
$22.00
$6.00
$15.50
$14.00
$2.00
$3.00
$13.50
$25.00
$15.00
$33.50
$33.50
$14.00
$13.50
$15.00
$6.00
$12.50
$14.00
$15.00
$35.00
$4.00
$8.00
$11.50
DIAGNOSTICS / CENTROS DE DIAGNOSTICO
Over 300 Diagnostic Tests available which include:
•
Digital Mammography
•
MRI
•
CT Scans
•
PET CT Scans
•
Ultra Sound
•
X-Rays
•
Sleep Studies
All Diagnostic Centers requires that the tests being requested are ordered by a
licensed healthcare professional that is authorized to practice medicine in the
State of Florida. The order must be written in a Physicians prescription or on the
Diagnostic Centers requisition form that is signed by a physician.
All test results will be sent to the office of the Physician or Specialist that ordered
the test. This procedure is to protect the confidential information regarding your
health.
Diagnostic Radiology / Centro de Diagnóstico
Digital Medical Diagnostic
41 Tamiami Canal Rd
Miami Fl. 33166
Phone: (305) 269-0833
Fax: (305) 269-0851
Mamografía digital
por sólo $50.00
Universal Imaging of Florida.
14462 Commerce Way.
Phone: (305) 821-8585
Refer to Fee Schedule
Mamografía digital
por sólo $50.00
CT Imaging Inc.
395 West 10 Street, Suite 2
Hialeah Fl. 33010
Phone: (305) 887-7562
CMS Open MRI
9200 SW 72 Ave Bldg 4
Miami, Fl. 33165
Phone: (305) 227-2500
Rivero Radiology.
285 West 49th Street.
Hialeah, Fl. 33012
Phone: (305) 826-6040
Systems Associate Inc.
(Neurological Diagnostic)
Home and Office Service
Miami, Fl. 33173
Phone: (305) 270-7771
Más de trescientos (300) procedimientos de diagnóstico están disponible e incluyen:
•
Mamografia Digital
•
Tomografia computaizada
•
CT Scans
•
PCT Scans
•
Ultrasonido
•
Rayos X
•
Estudios del sueno
Todos los Centros de Diagnóstico requieren que los exámenes que se solicitan hayan sido
previamente indicados por un profesional de la salud con licencia que le autoriza a ejercer la
práctica de la medicina en el estado de la Florida. La indicación del procedimiento debe estar escrita
en una receta médica o en su lugar en el formulario de solicitud establecida para los procedimientos
de Diagnósticos y firmada por el médico que la indica. Todos los laboratorios cumplirán el
procedimiento legal establecido de confidencialidad del paciente y para proteger este derecho
enviaran los resultados de sus exámenes a la oficina del doctor que lo indicó.
Miami - Dade
Pinnacle Imaging
2390 NW 7 St, Suite 103
Miami, Fl. 33125
Phone: (305) 642-7388
Mamografía digital
por sólo $50.00
Larkin Community Hospital Imaging Center.
3320 Palm Avenue. Hialeah, Fl. 33012
Phone: (305) 596-9992
Refer to Fee Schedule / Transportation Available
Miami Diagnostic &
Interventional Center
2975 Coral Way Miami, Fl. 33145
Phone: (305) 448-4950
Millennium Open MRI
7360 Coral Way, # 27 A
Miami, Fl. 33155
Phone: (305) 261-6744
66
Larkin Community Hospital
Imaging Center.
692 N. Homestead Blvd, Ste 106
Homestead, Fl. 33030 / Phone:
(305) 596-9992
Larkin Community Hospital
Imaging Center.
7101 SW 99 Avenue, Suite 106
Miami, Fl. 33173
Phone: (305) 596-9992
Transportation Available
B & G Diagnostic Services
444 West 51 Place Hialeah, Fl. 33012
Phone:(305) 818 - 2006
Free Transportation in Miami-Dade
and Broward County
Diagnostic Professional, Inc.
7301 NW 4th Street #107
Phone: (954) 449-7023
Broward
1799 West Oakland Park Blvd 105
Ft Lauderdale Fl. 33311
Phone: (954) 777-3466
Broward Pet Imaging Center
4850 W. Oakland Park Blvd Suite 1A
Lauderdale Lakes, Fl. 33313
Phone: (954) 735-6330
10950 Pines Boulevard
Phone: (954) 430-2044
PAN AM DIAGNOSTICS
1820 N. University Drive
Phone: (954) 704-1966
6808 N. State Road 7 Coconut Creek, Fl. 33073
Phone: (954) 570-5560
West Palm Beach
Diagnostic Radiology
Orange County
PAN AM DIAGNOSTICS
6421 Milner Boulevard, # 1
Orlando, Fl. 32809
Phone: (407) 857-1700
A1 Imaging Centers, LLC -- Florida Locations (MRI Only) (MRI solamente)
A1 Imaging of Aventura
20880 W. Dixie Hwy, Suite 111/106
North Miami Beach, Fl. 33180
Phone: (305) 933-9565 / Services:
Closed and Open MRI
A1 Imaging of Boynton Beach
3795 Boynton Beach Blvd Ste. C
Boynton Beach, Fl. 33436
Phone: (561) 740-9305
Services: Open MRI
A1 Imaging of Pembroke Pines
8384 Pines Blvd
Phone: (954) 450-4020
Services: Open MRI
A1 Imaging of Plantation
150 N. University Dr. Ste 110
Phone: (954) 423-3674
Services: Closed and Open MRI
A1 Imaging of Orange Park
1566 Kingsley ave
Orange Park, Fl. 32073
Phone: (904) 278-2128
Services: Closed and Open MRI
A1 Imaging of Orlando
500 N Semoran Blvd., Ste 103
Orlando, Fl. 32807
Phone: (407) 275-6072
Services: Open MRI
A1 Imaging of Mandarin
3753 Cardinal Point Dr.
Jacksonville, Fl. 32223
Phone: (904) 636-5674
Services: Open MRI
A1 Imaging of St. Augustine
200 S. Park Blvd.,Ste 210
St. Augustine, Fl. 32086
Phone: (904) 819-0920
Services: Open MRI
A1 Imaging of Kissimmee
810 North John Young Pkwy
Kissimmee, Fl. 34741
Phone: (407) 847-6745
Services: Open MRI
A1 Imaging of Deerfield
1890 W. Hillsboro Blvd.
Deerfield Beach, Fl. 33442
Phone: (954) 429-8381
Services: Open MRI
A1 Imaging of West Palm Beach
1117 N. Olive Ave #101
Phone: (561) 651-7410
Services: Open MRI
A1 Imaging of Ocala
301 SE 17th St., Unit 102
Ocala, Fl. 34471
Phone: (352) 622-7459
Services: Open MRI
67
A1 Imaging of Ft. Lauderdale
5100 N federal Hwy, Ste 102
Ft. Lauderdale, Fl. 33308
Phone: (954) 202-3400
Services: Open MRI
A1 Imaging of Ocoee
9450 W. Colonial Dr. Ste 12
Ocoee, Fl. 34761
Phone: (407) 822-0999
Services: Open MRI
A1 Imaging of Cape Coral
1003 Del Prado Blvd., Unit 102
cape Coral, Fl. 33990
Phone: (239) 573-6333
Services: Open MRI
DIAGNOSTIC AND RADIOLOGY SERVICES FEE SCHEDULE
ABDOMEN & RETROPERITINIUM
PROCEDURE
CPT
Abdomen Complete
76700
RUQ (Liver, Gallbladder & Pancreas)
76705
Liver
76705
Gallbladder
76705
Pancreas
76705
Spleen
76705
Renal
76775
Bladder
76857
Renal & Bladder
76770
PELVISLVIS
Pelvic Complete
76856
Pelvic Transvaginal
76830
Prostate Transabdominal
76857
Prostate Transrectal
76872
Scrotum & Contents
76870
PROCEDURE
Ankle (2 views)
Ankle Complete (3 views)
Bone Age
Bone Length
Calcaneus (2 views)
Cervical Spine (2 or 3 views)
Cervical Spine (4 or more views)
Cervical Spine Complete
Chest (Single View)
Chest (2 views)
Chest Complete (4 views)
Chest (Special Views)
Chest (Oblique Projections)
Chest (Stereo Frontal)
Chest (Apical Lordoctic Proc)
Clavicle Complete
Elbow (2 views)
Elbow Complete (3 views)
Eye
Femur (2 views)
Fingers (2 views)
Foot (2 views)
Foot Complete (3 views)
Forearm (2 views)
CPT
73600
73610
77072
77073
73650
72040
72050
72052
71010
71020
71030
71035
71022
71015
71021
73000
73070
73080
70030
73550
73140
73620
73630
73090
FEE
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
ULTRASOUNDS
PROCEDURE
FEE
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
ECHOGRAPHY
Echo Complete W/Color & Flow Ultrasound
Echo Stress Test W/Color & Flow
SMALL PARTS
Abdominal Aorta
Carotid Doppler
Arterial Lower Extremity Bilateral
Arterial Lower Extremity Unilateral
Thyroid or Parotid Glands
Head or Neck
Arterial Upper Extremity Bilateral
VENOUS STUDIES
Arterial Upper Extremity Unilateral
Venous Duplex Bilateral
$70.00
$70.00
$70.00
$70.00
$70.00
DIGITAL X-RAYS
PROCEDURE
Hand (2 views)
Hand (3 views)
Hip Unilateral (1 view)
Hip Bilateral (2 views)
Hip Complete (2 views)
Knee (1 or 2 views)
Knee (3 views)
Knee Complete (4 or more Views)
Knee Billateral Standing
Lumbosacral (4 or more)
Lumbosacral Comp (Band V)
Mastoids
Mastoids Complete (3 views)
Nasal Bones
Neck
Osseus Survey (Single View)
Osseus Survey Limited
Osseus Survey C Axial P
Pelvis (1 or 2 views)
Pelvis Complete (3 views)
Ribs Unilateral (2 views)
Ribs Bilateral (3 views)
Ribs Posteroanter Chest (3V)
Ribs Posteroanter Chest (4V)
each view
each view
each view
each view
each view
each view
each view
each view
each view
each view
each view
each view
each view
68
CPT
73120
73130
73500
73520
73510
73560
73562
73564
73565
72110
72114
70120
70130
70160
70360
77077
77074
77075
72170
72190
71100
71110
71101
71111
CPT
93306
93306
FEE
$150.00
$350.00
93979
93880
93925/93923
93926/93923
76536
76880
93930/93923
$90.00
$90.00
$100.00
$100.00
$60.00
$60.00
$90.00
93931/93923
93970
$90.00
$90.00
FEE
$25.00 each view
$25.00 each view
$25.00 each view
$25.00 each view
$25.00 each view
$25.00 each view
$25.00 each view
$25.00 each view
$25.00
$25.00
$25.00
$25.00
$25.00 each view
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00
$25.00 each view
$25.00 each view
$25.00 each view
$25.00
$25.00
NUCLEAR MEDICINE
PROCEDURE
Bone Scan Whole Body
Bone Scan Limited
Bone Sacn 3 Phase
Bone Scan Multiple Areas
Thyroid Scan Only
Parathyroid Scan
Thyroid 24 hours (Uptake)
Scan (Single)
Thyroid 24 hours (Uptake)
Scan (Multiple)
Muga Scan
78494/A9502/78465/78478/78480
CPT
78306
78320
A9503
78320
A9503
78315
78320
A9503
78305
78320
A9503
78010
A9516
78070
A9500
78001
78006
A9528
78001
98007
A9528
93015
MEDPLAN
$ 250.00
PROCEDURE
Stress Test Cardiolite
$ 250.00
Stress Test Thallium
$ 300.00
Multiple Renal Function
W/Vascular Flow W/Med
Lasix/Capt
Renal Function W/O Pharmalogica
Renal Scan (morphology)
W/ Vascular Flow
Renal Sacan W/O Vascular
Flow
Renal Function W/ Vascular
Flow W/O Med
Single Renal Function
W/ Vascular Flow W/Med
Lasix/Capt
Gastric Emtying Study
Hepabiliary Ductal System
Gallbladder HIDA
Hepatobiliary (HIDA)
Liver and Spleen Study
Static
Liver Spect W/O Vascular
Flow
Liver Hemangomia W Flow and Spect
Liver Hemangomia W Flow / Flow
Lung Perfusion Scan
Quantitative
$ 250.00
$ 300.00
$ 250.00
$ 250.00
$ 250.00
$ 300.00
BONE DENSITOMETRY
PROCEDURE
DEXA Bone Density
CPT
77080
MEDPLAN
$ 65.00
69
CPT
93015 / 78465
78478 / 78480 / A9500
MEDPLAN
$ 450.00
93015 / 78465
78478 / 78480 / A9505
$ 450.00
78709
A9562
$ 400.00
78707
78700
78701 / A9540
78700
A9540
78707
A9562
78708
A9562
$ 400.00
$ 400.00
$ 425.00
$ 400.00
78264 / A9541
78223
A9537
78220
78215
A9541
78205
A9560
78206 / A9560
78202 / A9537
78580
A9540
$ 300.00
$ 400.00
$ 450.00
$ 300.00
$ 300.00
$ 300.00
$ 300.00
$ 300.00
$ 300.00
DIAGNOSTIC AND RADIOLOGY SERVICES FEE SCHEDULE
PROCEDURE
Abdomen W
Abdomen W & W/O
Abdomen W/O
Ankle W
Ankle W & W/O
Ankle W/O
Arm W
Arm W & W/O
Arm W/O
Brain W
Brain W & W/O
Brain W/O
Breast Unilat W & W/O
Breast Bilat W & W/O
Breast Implant W & W/O
Cervical Spine W
Cervical Spine W & W/O
Cervical Spine W/O
Chest W
Chest W & W/O
Chest W/O
Elbow W
Elbow W & W/O
Elbow W/O
Facial W
Facial W & W/O
Facial W/O
Foot W
Foot W & W/O
Foot W/O
Hand W
Hand W $ W/O
Hand W/O
Hip W
Hip W & W/O
Hip W/O
ILIAC W
ILIAC W & W/O
MP.D/R.FS 01/13
CPT
74182
74183
74181
73722
73723
73721
73219
73220
73218
70552
70553
70551
77058
77059
77059
72142
72156
72141
71551
71552
71550
73222
73223
73221
70542
70543
70540
73719
73720
73718
73219
73220
73218
73722
73723
73721
70552
70553
“MRI” MAGNETIC RESONANCE IMAGING
FEE
PROCEDURE
$325.00
ILIAC W/O
$375.00
Knee W
$275.00
Knee W & W/O
$325.00
Knee W/O
$375.00
Leg-Femur-TIB-FIB W
$275.00
Leg-Femur-TIB-FIB W&W/O
$325.00
Leg-Femur-TIB-FIB W/O
$375.00
Lumbar Spine W
$275.00
Lumbar Spine W & W/O
$325.00
Lumbar Spine W/O
$375.00
Neck W
$275.00
Neck W & W/O
$475.00
Neck W/O
$475.00
Orbit W
$475.00
Orbit W & W/O
$325.00
Orbit W/O
$375.00
Pelvis W
$375.00
Pelvis W & W/O
$325.00
Pelvis W/O
$375.00
Pituitary W
$275.00
Pituitary W & W/O
$325.00
Pituitary W/O
$375.00
Prostate W
$275.00
Prostate W & W/O
$325.00
Prostate W/O
$375.00
Scrotum W
$275.00
Scrotum W & W/O
$325.00
Scrotum W/O
$375.00
Shoulder W
$275.00
Shoulder W & W/O
$325.00
Shoulder W/O
$375.00
Thoracic Spine W
$275.00
Thoracic Spine W & W/O
$325.00
Thoracic Spine W/O
$375.00
TMJ Joints W/O
$275.00
Wrist W
$325.00
Wrst W & W/O
$375.00
Wrist W/O
70
CPT
70551
73722
73723
73721
73719
73720
73718
72149
72158
72148
70542
70543
70540
70542
70543
70540
72196
72197
72195
70552
70553
70551
72196
72197
72195
72196
72197
72195
73222
73223
73221
72147
72157
72146
70336
73222
73223
73221
FEE
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$275.00
$325.00
$375.00
$275.00
PROCEDURE
Abdomen W
Abdomen W & W/O
Abdomen W/O
Cervical Spine W
Cervical Spine W & W/O
Cervical Spine W/O
Chest W
Chest W & W/O
Chest W/O
Head/Brain W
Head/Brain W & W/O
Head/Brain W/O
IACS W
IACS W & W/O
IACS W/O
Leg/Femur/TIB/FIB W
Leg/Femur/TIB/FIB W & W/O
Leg/Femur/TIB/FIB W/O
CPT
74160
74170
74150
72126
72127
72125
71260
71270
71250
70460
70470
70450
70481
70482
70480
73701
73702
73700
“CT SCAN” COMPUTED TOMOGRAPHY
FEE
PROCEDURE
$200.00
Lumbar Spine W
$275.00
Lumbar Spine W & W/O
$150.00
Lumbar Spine W/O
$200.00
Maxilofacial W
$275.00
Maxilofacial W & W/O
$150.00
Maxilofacial W/O
$200.00
Pelvis W
$275.00
Pelvis W & W/O
$150.00
Pelvis W/O
$200.00
Sinuses W
$275.00
Sinuses W & W/O
$150.00
Sinuses W/O
$200.00
Soft Tissue Neck W
$275.00
Soft Tissue W & W/O
$150.00
Soft Tissue Neck W/O
$200.00
Thoracic Spine W
$275.00
Thoracic Spine W & W/O
$150.00
Thoracic Spine W/O
CPT
72132
72133
72131
70487
70488
70486
72193
72194
72192
70487
70488
70486
70491
70492
70490
72129
72130
72128
BREAST DIAGNOSTIC RADIOLOGY PROCEDURES
FEE
$200.00
$275.00
$150.00
$200.00
$275.00
$150.00
$200.00
$275.00
$150.00
$200.00
$275.00
$150.00
$200.00
$275.00
$150.00
$200.00
$275.00
$150.00
FEE SCHEDULE
PROCEDURE
Diagnostic Digital Mammo
CPT
G0204
Screening Digital Mammo
G0202
$70.00
US Breast Unilateral or Bilateral
76645
$70.00
19103
19295*
76942**
G0206***
77051****
Breast Biopsy Unilateral or Bilateral
FEE
$70.00
$600.00
*19295
At times the surgeon may choose to do a biopsy and, at the same opearative session, leave a metallic localization clip so that the site may be found later if it is necessary to remove
more tissue. The placement of a clip is reported using add-on code 19295, Image guided placement, metallic localization clip, percutaneous, during breast biopsy.
**76942
Ultrasonic guidance for needle placement (e.g.,biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
***G0206
Diagnostic mammography, producing direct digital image, unilateral, all views
****77051
Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film
radiographic images; diagnostic mammography (list separately in addition to code for primary procedure)
71
Ultrasound
76801
76802
76805
76810
76811
76812
76813
76814
76815
76816
76817
76818
76819
76820
76821
76830
76856
76945
76946
59000
59015
99211
99241
99242
99243
99244
99251
99252
99254
59025
Ultrasound
AMNIO
CVS
1ST TRIMESTER
SCREENING
INTEGRATED
SCREENING
SEQUENTIAL
SCREENING
PERINATAL DIAGNOSTIC SERVICES FEE SCHEDULE
SFPM Rates
1st Tri<14 wks New
1st Tri each Add Gest w/76801
Complete Routine
Comp Routine each Add Gestw/76805
>1 Tri HighRisk Detailed Targ - New
>1 Tri HgRk Detailed Tgt eachAdd Gest w/76811
OB/US Nuchal Measurement I Gest
Nuchal Measurement each additional Gestation
Limited-quick look @1or more elements
Follow Up (re-eva org susp abnormal)
OB Transvag (use in addition to transadom code)
BPP w/NST
BPP w/out NST
Doppler UA
Doppler CA
Vag. Ultra (non-obstetrical purposes)
Pelvic TR
CVS Guidance
Amnio Guidance
Amnio
CVS
Minor 5 minute established
Minor 15 minute
Low 30 Min
Moderate 40 Min
Mod High 60 Min
Inpatient Consult 20 Min
NST
Fees
$240.00
$140.00
$245.00
$230.00
$415.00
$265.00
$230.00
$155.00
$175.00
$160.00
$230.00
$245.00
$230.00
$180.00
$225.00
$265.00
$225.00
$245.00
$230.00
$300.00
$370.00
$70.00
$125.00
$160.00
$210.00
$265.00
$115.00
$175.00
$280.00
$125.00
SFPM Rates
Includes Counseling, U/S, Guidance, Amnio
Includes Counseling, U/S, Guidance, Amnio (Twins)
Includes Counseling,U/S, Guidance, CVS
Includes Counseling,U/S, Guidance, CVS (Twins)
Includes Counseling, 1st Trimester U/S, Labs & Nuchal Translucency
Includes Counseling, 1st Trimester U/S, Labs & Nuchal Translucency (Twins)
Includes Counseling, 1st Trimester U/S, NT 1st & 2nd Labs Included
Includes Counseling, 1st Trimester U/S, NT 1st & 2nd Labs Included (Twins)
Includes Counseling, 1st Trimester U/S, NT and first part Labs
Includes Counseling, 1st Trimester72
U/S, NT and first part Labs (Twins)
Fees
$1,645.00
$2,700.00
$1,665.00
$2,775.00
$805.00
$1,100.00
$900.00
$1,195.00
$825.00
$1,120.00
HIGH RISK PREGNANCY TESTS
South Miami
6200 Sunset Drive - Suite 301
Ph: 305-669-9521
Baptist Medical Arts Building
8940 N. Kendall Drive - Suite 901E
Ph: 786-621-7770
LOCATIONS PERINATAL DIAGNOSTIC SERVICES FEE SCHEDULE
Mercy Hospital
3663 S. Miami Ave - 5th floor, Room 5335
Ph: 305-403-7600
Hialeah Hospital Office
777 East 25th St - Suite 402
Ph: 305-835-7909 Fax: 305-835-9353
Kendall Regional Medical Office
11760 Bird Road - Suite 714
Ph: 786-621-5300
North Shore Medical Center
1100 NW 95th St, South Lobby-1st Floor
Ph: 305-691-2180
ANCILLARY SERVICES/ SERVICIOS AUXILIARES
TRANSPORTATION SERVICES
DURABLE MEDICAL SUPPLIES
When ordering medical equipment you must have a valid prescription signed by a licensed
and authorized healthcare professional in the State of Florida indicating the supplies or
equipment needed. You must present your Med Plan membership card with a picture ID so
that your eligibility can be verified before your supplies are delivered. In order to receive the
exclusive pricing offered to Med Plan members at contracted provider locations your monthly
membership fee needs to be current.
The durable medical supply offered to Med/Plan members are:
•
•
•
•
Mt. Sinai Medical Center
4308 Alton Road - Suite 730
Ph: 305-403-1234
Wheel Chairs
Walkers
Hospital Beds
Oxygen Concentrators
MIAMI-DADE
Medical Care Trasportation.
(Patient Transportation Services)
2766 NW 62nd Avenue Miami, Fl 33147
Phone: 305.633.0553
Offered 80% savings off of Providers Usual and Customary Fees.
Unlimited Access to all Durable Medical Services.
EQUIPOS MEDICOS
Al pedir suministro de algún equipo médico debe tener una receta de prescripción válida
firmada por su Doctor donde se indique los suministros y equipos que necesita. Usted tendrá
que presentar su tarjeta de miembro conjuntamente con una identificación (ID) con foto para
que su elegibilidad pueda ser verificada en el momento y pueda beneficiarse de las tarifas
preferenciales exclusivas que aplican únicamente a los miembros de MedPlan.
Entre los equipos medicos duraderos ofrecidos por Med/Plan estan:
•
•
•
•
Sillas de ruedas
Andadores
Camas de hospital
Concentradores de oxígeno
Estos servicios ofrecen un ahorro del 80% de descuento de los proveedores habituales y
tarifas habituales. Acceso ilimitado a todos los servicios de equipos medicos duraderos.
73
Reservation 24 hours in advance.
Reservaciones con 24 horas de antelación
Price $26.00 round trip within Miami-Dade.
Precio $26.00 Ida y regreso dentro de Miami-Dade
74
Orthotics Center INC (Durable Medical Equipment (DME) 14331 SW 120 St Suite # 212 Miami, Fl. 33186 Phone: (305) 640-5966
ORTHOPEDIC SUPPLIES / SUPLEMENTOS ORTOPEDICOS
CPT CODE
SERVICES DESCRIPTION
A5500 x2
A5512 X2
A5513 x2
L3002 x2
L3350 x2
L5000 x1
A6530 X2
A6531 x2
A6532 x2
A6534 x2
A6539 x2
A6540 x2
A6541 x2
L4360 x1
L4360 x1
L4386 x1
L4396 x1
L3000 x2
L3010 x2
L3020 x2
L1902 x2
L1906 x1
L1930 x1
L1940 x1
L 1960 x1
L8000 x1
L8020 x1
L8030 x1
L1810 x1
L1832 x1
L1845 x1
L1847 x1
L0120 x1
L0190 x1
OFF SHELF DIAB SHOE/ZAPATOS
DIAB MULTIDENSITY INSERTS/ SOPORTE DE DIAB PREFAB
DIAB MULTIDENSITY CUSTOM INSERT / SOPORTE DE DIAB
DIAB PLASTAZOTE CUSTOM INSERT/ SOPORTE ACODATIVOS DE DIABETICOS
HEELWEDGE/ SOPORTE DE TALON
INSERT FOR MISSING TOES/SOPORTE PARA DEDOS AMPUTADOS
BELOW KNEE 13-30 COMPRESSION STOCKING /MEDIAS PARA LA CIRCULACION A LA RODILLA 18-30
BELOW KNEE 30-40 COMPRESSION STOCKING / MEDIAS PARA LA CIRCULACION A LA RODILLA 30-40
THIGH LENGTH 18-30 COMPRESSION STOCKING/ MEDIAS PARA LA CIRCULACION AL MUSLO 18-30
THIGH LENGTH 30-40 COMPRESSION STOCKING/ MEDIAS PARA LA CIRCULACION AL MUSLO 30-40
WAIST LENGTH 18-30 COMPRESSION STOCKING / MEDIAS PARA LA CIRCULACION PANTY 18-30 MMHG
WAIST LENGTH 30-40 COMPRESSION STOCKING / MEDIAS PARA LA CIRCULACION PANTY 30-40 MMHG
WAIST LENGHT 40-50 COMPRESSION STOCKING / MEDIAS PARA LA CIRCULACION PANTY 40-50 MMHG
AIR CAST PREFAB
PNEUMATIC CAM WALKER PREFAB / BOTA DE MARCHA INMOVILIZADORA NEUMATICA
REGULAR CAM WALKER PREFAB / BOTA DE MARCHA INMOVILIZADORA CORTA O LARGA
NIGHT SPLINT PREFAB
UCBL CUSTOM FOOT ORTHOTIC / SOPORTE A LA MEDIDA TIPO UCB
CUSTOM LONGITUDINAL ARCH SUPPORT / SOPORTE ARCO LONGITUDINAL
CUSTOM METATARSAL ARCH SUPPORT/ SOPORTE LONGITUDINAL METATARSIANO
AFO GAULET PREFAB / AFO AOARATO PARA EL PIE TIPO GUANTE PREFABRICADO
AFO FOR PPTD PREFAB / AFO PARA ESTABILIZAR EL PIE PREFABRICADO
AFO PLASTIC PREFAB / AFO PLASTICO PREFABRICADO
AFO CUSTOM FAB/ AFO A LA MEDIDA
AFO POSTERIOR SOLID ANKLE CUSTOM / AFO A LA MEDIDA CON REFUERZO EN EL TOBILLO
MASTECTOMIE BRAS/ AJUSTADOR DE MASTECTOMIA
BREAST PROSTHESIS MASTECTOMIE FORM FOAM / PROTESIS DE SENO DE ESPUMA
BREAST PROSTHESIS SILICONE OR EQUAL / PROTESIS DE SENO EN SILICONA
KO, ELASTIC WITH JOINTS PREFAB / RODILLERA SENCILLA PREFABRICADA
KO, ADJUSTABLE KNEE JOINT, RIGID SUPPORT PREFAB / RODILLERA CON ARTICULACION PREFABRICADA
KO DOUBLE UPRIGHT, THIGH AND CALF PREFAB
KO DOUBLE UPRIGHT AIR PREFAB / RODILLERA CON ARTICULACION PREFAB
CERVICAL COLLAR TAYLOR TYPES/ COLLAR CERVICAL TIPO TAYLOR
75
NEW
85.00
30.00
50.00
131.00
35.00
100.00
45.00
55.00
60.00
62.00
170.00
170.00
179.00
48.00
141.00
90.00
79.00
286.00
131.00
131.00
35.00
70.00
67.00
185.00
213.00
22.00
109.00
118.00
67.00
450.00
450.00
300.00
10.00
220.00
CPT CODE
L0700 X1
L0710 x1
L1300 x1
LO462 X1
L0464 x1
L0482 x1
L0486 x1
L0488 x1
L0627 x1
L0631 x1
L1686 x1
L2112 x1
L2114 x1
L2116 x1
L2128 x1
L2134 x1
L3670 x1
L3760 x1
L3908 x1
L3931 x1
L3982 x1
L3982 x1
L3984 x1
L39995 x1
L8300 x1
L8310 x1
CTLSO MINERVA TYPE CUSTOM / CTLSO TIPO MINERVA A LA MEDIDA
CTLSO ANTERIOR/POSTERIOR CONTROL MINERVA TYPE CUSTOM
SCOLIOSIS JACKET CUSTOM/ SCOLIOSIS JACKET A LA MEDIDA
TLSO TRIPLANAR 3 PLASTIC SHELLS/TLSO TRIPLANAR 3 MODULOS PLASTICOS
TLSO MODULAR SEGMENTED 4 PLASTIC SHEELS /TLSO MODULAR SEGMENTADO 4 PLASTICOS
TLSO TRIPLANAR CONTROL ONE PIECE RIGID PLASTIC SHEEL/ TLSO CONTROL TRIPLANAR UNA PIEZA RIGIDA EN PLASTICO
TLSO TRIPLANAR CONTROL TWO PIECE RIGID PLASTIC SHELL/ TLSO CONTROL TRIPLANAR DOS PIEZAS RIGIDAS EN PLASTICO
TLSO TRIPLANAR CONTROL ONE PIECE RIGID PLASTIC SHELL
LSO SAGITAL CONTROL RIGID PANELS/ LSO CONTROL SAGITAL PANELES RIGIDOS
LSO SAGITAL CONTROL POSTERIOR EXTENDS, REDUCE LOAD
HIP ORTHOSIS ABDUCTION CONTROL PREFAB/ APARATO DE CADERA CONTROLA ABDUCCION
AFO TIBIAL FRACTURE ORTHOSIS, SOFT PREFAB / AFO APARATO PARA FRACTURA TIBAL SUAVE
AFO TIBIAL FRACTURE ORTHOSIS SEMI RIGID PREFAB
AFO TIBIAL FRACTURE ORTHOSIS RIGID PREFAB / APARATO PARA FRACTURA FEMORAL A LA MEDIDA
KAFO FEMORAL FRACTURE CAST ORTHOSIS CUSTOM/ KAFO APARATO PARA FRACTURA FEMORAL A LA MEDIDA
KAFO FEMORAL FRACTURE CAST ORTHOSIS SEMIRIGID PREFAB/ APARATO PARA FRACTURA FEMORAL SEMIRIGIDO PREFABRICADO
SO ( CANVAS AND WEBBING TYPE ) PREFAB/CABLESTRILLO DE BRAZO PREFABRICADO
ELBOW ORTHOSIS WITH ADJUSTBLE POSITION PREFAB/ APARATO DE CODO AJUSTABLE PREFABRICADO
WRIST HAND ORTHOSIS PREFAB/ MUÑEQUERA PREFABRICADA
WRIST HAND FINGER ORTHOSIS PREFAB/ MUÑEQUERA CON DEDO GORDO
HUMERAL RACTURE ORTHOSIS PREFAB/ APARATO DE FRACTURA DE HUMERUS PREFABRICADO
RADIUS ULNAR FRACTURE ORTHOSIS PREFAB
WRIST FRACTURE ORTHOSIS PREFAB / APARATO DE FRACTURA DE NUÑECA PREFABRICADA
ADDIT FRACTURE SOCK OR EQUAL
SINGLE ABDOMINAL BINDER / FAJA ABDOMINAL SENCILLA
BILATERAL ABDOMINAL BINDER/ FAL ABDOMINAL BILATERAL
76
NEW
1195.00
1319.00
440.00
440.00
795.00
867.00
192.00
250.00
600.00
458.00
281.00
395.00
395.00
829.00
373.00
46.00
227.00
14.50
109.00
102.00
185.00
207.00
9.85
76.00
136.00
CPT CODE
L1843
L1830
L3807
L3660
L1971
L1951
L4350
L3350
L3170
L0621
L0174
PERFECT FOR PATIENT WITH MILD TO MODERATE OSTEOARTHRITIS OF THE KNEE
DESIGNED FOR ACL MCL PCL AND SOFT TISSUE INJURIES
IDEAL IN TREATING THE QUERVAIN SYDROME GAME KEEPERS THUMB CARPOMETACARPAL INSTABILITY
DESIGNED TO TREAT ROTATOR CUFF INJURIES, SHOULDER INSTABILITIES AND ANTERIOR DISLOCATION OF THE G-H JOINT
DESIGNED FOR ACUTE AND CHRONIC ANKLE SPRAINS
INDICATED FOR PERONEAL PARALYSIS, ANKLE JOINT ARTHRITIS AND POST OPERATIVE ACHILLES TREATMENT
INDICATED FOR ACUTE ANKLE SPRAINS , ANKLE STABILITY AND PROPHYLACTIC USE
DESIGNED TO CORRECT HEEL POSTURE AND UNEVEN SHOE WEAR , HEEL WEDGES HELP CONTROL PRONATION
MOLDED FROM MEDICAL GRADE SOFT SILICONE WITH SOFT AREAS AT TH EHEEL REGION TO HELP REDUCE PAIN
SACROILIAC ORTHOSIS ,FLEXIBLE PROVIDES SACRAL SUPPORT
Designed for post operative support and control of unwanted fexion and extension
77
NEW
450.00
91.00
150.00
70.00
220.00
490.00
50.00
16.00
38.00
67.00
0.00
Home Health Service
Miami - Dade
C&O Home Healthcare Corp (Home Health Services) (Physical Therapy)
ALC Home Health. Home Health Services (Physical Therapy) 1100 West 29th street Suite H Hialeah Fl. 33012 Tel: (305) 360-4104
13275 SW 124 St. Miami Fl. 33186 / Phone: (305) 828-5310
Home Health Aid: $30.00 per Visit / Skilled Nursing: $45.00 per Visit / Physical Therapy: $80.00 per Visit
Home Health Aid: $15.00 per Visit / RN:$ 29.00 per Visit Physical Occupational Therapy: $80.00 per Visit / Speech Therapy: $80.00 per Visit
Therapy: $80.00 per Visit / Occupational Therapy: $80.00 per
Q Home Health Care Corp. (Home Health Services)
Visit / Speech Therapy: $95.00 per Visit / HHA or CAN Visit:
10300 SW 72 St #230 Miami, Fl. 33173 / Tel: (305) 273-4435
$15.00 per visit
Home Health Care. Preferred Home Health Agency, Inc. 13903 NW 67 Avenue, Suite 420 Miami Lakes, Fl. 33014
Holistic Nursing Care Agency Home Health Services
Phone: (305) 231-4250 / Language: English / Spanish / Home Health Aid: $30.00 per Visit / Skilled Nursing: $45.00 per
7400 NW 7 St. Miami Fl. 33126
Visit / Physical Therapy: $80.00 per Visit / Occupational Therapy: $ 80.00 per Visit / Speech Therapy: $80.00 per Visit
Phone: 305-265-9618 / Skilled Nursing: $30.00 /Home health
Aid: $15.00 / Physical Therapy: $80.00 / Occupational Therapy: Capital Health Services Inc. (Home Health Services) 85 Gran Canal Dr. Suite 201 Miami, Fl.33144
$80.00 / Speech Therapy: $80.00 / HHA or CAN: $15.00
Tel: (305) 261-3831 / Home Health Aid: $ 34.00 per Visit License Practice Nurse per Visit $27.00 Home Health AIDE per
Visit $18.00
HEARING AIDS / SUPLEMENTOS AUDITIVOS
Belgica Mock (Hearing Specialist) (Crystal Clear Hearing) / 11342 Quail Roost Drive Miami, Fl. 33157 / Phone: (305) 235-4035 / Price 1st Visit: $ 60.00 / Price Follow Up: $ 40.00
Physical Therapy
Miami - Dade
Associates Rehabilitation, Inc.
(Physical Therapy)
13238 SW 8 St Miami, Fl. 33184
Phone: (305) 552-9505
RT Professional, Inc. (Physical Therapy)
7374 NW 35 Terr #102
Miami, Fl. 33122
Phone: (305) 418-8990
Selecta Physical Therapy
2140 West Flagler St, Ste 112 Miami Fl. 33135
Phone: (786) 953-6735
Language: English/Spanish
United Medical of South Florida
14750 SW 26 St #213
Miami, Fl. 33185
Phone: (786) 476-7314
First Choice Rehabilitation INC(Massage - Therapist )
6850 Sw 24 St # 505 Miami Fl. 33155
Phone: (305) 667-1080
Horario: 11:00 am - 7:00 pm
The New City Medical Center (Physical Therapy)
4118 W 12 Ave Hialeah Fl. 33012
Phone: (305) 824-8787
United Wellcare Center
12150 SW 128 Cort # 129 Miami Fl. 33186
Phone: (786) 732-2593
THERAPY SERVICES FEE SCHEDULE
CODES
97010
97010
97012
97014
97018
97026
97032
97034
97035
97039
SERVICES
Hot / Cold Pack
Ice / Cryo therapy
Mechanical Traction
E.M.S
Paraffin Bath
Infrared
E.M.S Attended
Contrast Bath
Ultrasound
Vibratory Massage
Fees
$12.00
$12.00
$33.34
$26.50
$18.40
$13.20
$34.16
$32.00
$27.50
$17.50
CODES
97110
97112
97124
97139
97140
97140
E0217
E0218
97535
78
SERVICES
Therapeutic Exercise
Neuromuscular Re-Education
Massage
Hydro massage
Manual Therapy
Manual Traction
Water Circulating Cold
Water Circulating Hot
Self / Home Care
Fees
$57.00
$63.00
$47.00
$17.00
$65.00
$65.00
$91.00
$91.00
$41.00
Alternative Medicine / Medicina Alternativa
Luis Guzman PH,D Acuworks
Sleep Study of South Florida Acuworks
4160 West 16 ave #201 HIaleah, Fl. 33012 14750 SW 26 St #213 Miami, Fl. 33185
Phone: (786) 274-9837
Phone: (786) 476-7314 Price: $500.00
Florida Sleep and Neuro Diagnostic Services
14394 Commerce Way Miami Lakes, Fl. 33016
Phone: (305) 370-3100 / Services:Sleep study: $485
Free Transportation for Miami-Dade & Broward
Miami - Dade
Oscar Morell A.P. Health Promotions LLC
4410 West 16 ave #59 HIaleah, Fl. 33012
Phone: (305) 512-3085
Larkin Community Hospital Imagings Center.
(Sleep Studies / Estudio del Sueño)
9835 SW 72th Street, Suite 107 Miami, Fl. 33173
Phone: (305) 596-9992 / Precio: $500.00
Orlando Santana A.P. Health Promotions LLC
2555 NW 102 ave # 200 Doral, Fl. 33172
Phone: (786) 336-0805
Oscar Morell A.P. Health Promotions LLC
912 SW 67th ave Miami, Fl. 33144
Phone: (305) 261-4677
DIABETES SUPPLY FEE SCHEDULE
Entrega gratis a domicilio.
Acceso ilimitado de todos los suministros para diabéticos.
Free Home Delivery.
Unlimited Access to all Diabetic Supplies.
When ordering diabetic supplies you must have a valid prescription signed by a
Med Plan participating physician indicating the supplies needed.
Note: Free Delivery service is provided as a courtesy to Med Plan members but
is subject to the Diabetes Medical Supply provider’s ability and the distance to
the Member’s Delivery Address. Please call the provider for more details.
Al pedir suministros para Diabetes o algún equipo médico debe tener una receta de
prescripción válida firmada por su Doctor donde se indique los suministros y equipos que
necesita.
Nota: El servicio a domicilio es gratuito y se ofrece como una cortesía para los miembros de
Med Plan, pero está sujeto a la capacidad del proveedor de los suministros y la distancia
donde se encuentre el miembro como punto de entrega. Por favor, llame al proveedor para
obtener más detalles.
PRODUCT
Glucose Meter (Glucometro)
Lancets
Test Strips
DIABETES SUPPLY STARTER KIT
QUANTITY
1
100
50
PRODUCT
Glucose Meter Replacement (Glucometro)
Lancets
Test Strips
MONTHLY RENEWABLE SUPPLIES
QUANTITY
1
100
50
Provided by:
DIRECT MEDS OF FLORIDA
TOTAL FEE
$19.95
FEE
$2.50
$9.99
$19.99
Telf: 954-454-8118 Free Shipping anywhere in the United States
79
•
•
•
•
•
•
PHARMACY SERVICES
Exclusive Pharmacy Services in Miami Dade County with.
Rx Savings Plus program available for out of State Pharmacy services.
400 Medication Formulary of the most frequently used medications for $9.99 for 100
pills or tablets.
Over 65,000 medications offered at Florida MAC plus $3.73 for Dispensing.
Prescription Assistance Program available for most brand medications.
Home Delivery Program available to all Med Plan members.
When visiting your Pharmacy to fill a prescription you must have a valid prescription signed
by a licensed and authorized healthcare professional in the State of Florida.
Med Plans “Prescription Assistance Program” are services provided directly by the
pharmaceutical medi cation manufacturer. These programs are designed to help pay for
the high cost of Brand medications that our members may not be able to afford. These
“PAP” programs can greatly reduce the cost of the medications or in some case the
member can get their medication completely free. Med Plan will help its members identify
which programs are available and assist them in filling the necessary documents as part of
our commitment to our members.
Rx SavingsPlus Program is offered as an added value service which provides Med Plan
members access to pharmacy services outside of Med Plans Florida coverage area. Your
membership kit contains a brochure with your “Rx SavingsPlus” card inside. You can use
this card outside of Florida at any Pharmacy as listed on the back of the brochure. Please
note that pricing for medications under this program differs from the Florida Pharmacy
providers. For medication pricing under this program you can go to www.medplan.
rxsavingsplus.com to get specific cost. This service is only to be used if the member is
outside the Med Plans Florida coverage area.
Pharmacy / Farmacia
SERVICIOS DE FARMACIA
Servicios exclusivos en el condado Miami Dade y Broward.
Programa Rx Savings Plus disponible para los servicios de Farmacia fuera de la Florida.
400 medicamentos genéricos usados con más frecuencia a un costo de $ 9.99 por 100 pastillas.
Más de 65.000 medicamentos se ofrecen en Florida MAC además de $3.73 para la distribución.
Programa de asistencia de receta médica para todos los medicamentos (no genéricos).
Programa de entrega de medicamentos a domicilio para todos los miembros de Med Plan.
Para obtener algún medicamento pre-escrito por su Doctor, deberá presentar en la farmacia
participante una receta válida firmada por un medico licenciado y autorizado en el Estado de la
Florida.
El Programa de Asistencia de receta médica es un servicio prestado directamente por el fabricante
de medicamentos farmacéuticos. Este programa está diseñado para ayudar a pagar el alto costo de
los medicamentos no genéricos que nuestros miembros no pueden pagar. Este programa puede
reducir considerablemente el costo de los medicamentos o en algunos casos el miembro puede
obtener sus medicamentos completamente gratis. Med Plan ayudará a sus miembros a identificar
los programas que están disponibles y los ayudará a completar los documentos necesarios como
parte del compromiso con sus miembros.
Rx Savings Plus se ofrece como un servicio de valor añadido que provee a los miembros el acceso
a los servicios de farmacia fuera de área de la Florida. Su paquete de membrecía contiene un
folleto en su interior “Rx SavingsPlus”. Usted puede utilizar esta tarjeta fuera de la Florida en
cualquier farmacia como aparece en el reverso del folleto. Tenga en cuenta que los precios de los
medicamentos dentro de este programa se diferencian de los proveedores de farmacia locales de
la Florida.
Broward
Pharmacy / Farmacia
Cape Coral Express Pharmacy 4419 Del
Prado Blvd North Cape Coral Fl. 33904 /
Tel: (239) 574-8846 Refer to Drug Pricing
Fee Schedule Home Delivery Service
Free Mail Order Delivery Service
Direct Meds of Florida 800 E. Hallandale Beach Blvd Hallandale Beach Fl. 33009
Tel: (954) 454-8118 Refer to Drug Pricing Fee Schedule Home Delivery Service Free
Mail Order Delivery Service
Pharmacy / Farmacia
Lee / Cape Coral
St. Jude Pharmacy 1202 N.E Pine Island
Road Ste 1V Cape Coral Fl. 33909
Tel: (239) 673-7777 Refer to Drug Pricing Fee
Schedule Home Delivery Service Free Mail
Order Delivery Service
Palm Beach
Garcia Pharmacy 2525 N. Dixie Hwy Lake Worth Fl. 33460 Phone: (561) 588-2252
80
PHARMACY / FARMACIA
3155 NW 77 Ave Miami FL 33122
Phone: 305.857.4425 / 305.857.4407
Horarios: 8:00 am - 4:30 pm
Farmacias en las Clínicas de MedPlan - MedCare
LOCATED/LOCALIZADO
MEDCARE
LOCATED/LOCALIZADO
MEDCARE
LOCATED/LOCALIZADO
MEDCARE / MEDPLAN
LOCATED/LOCALIZADO
MEDCARE
Little Havana
1149 SW 27th Avenue 3er Floor
Miami, FL 33175
Phone: (305) 857.4371
Coral Way
11825 SW 26 Street
Miami, FL 33135
Phone: (305) 857.4372
Miami
7200 NW 7th Street 1st Floor
Miami, FL 33126
Phone: (305) 857.4373
West Hialeah
900 West 49th Ave 1st Floor
Hialeah, FL 33012
Phone: (305) 857.4375
81
LISTADO DE MEDICAMENTOS.
82
83
84
85
86
87
88
JUVENTUS COSMETIC CENTER FEE SCHEDULE / COSMETIC PROCEDURES / TRATAMIENTOS ESTETICOS
920 SW 82 Ave Miami, Fl. 33144
Phone: 305-262-3999
COSMETIC SURGERY AND TREATMENT FEE SCHEDULE
PROCEDURES / PROCEDIMIENTOS
Breast Augmentation (saline breast implants)
Breast Augmentation (silicone breast implants)
Breast Lift Surgery (saline breast implants)
Breast Lift Surgery (silicone breast implants)
Breast Augmentation (Saline Aeroplastics)
Breast Augmentation (Silicone Aeroplastics)
Breast Lift Surgery without implats
Hypertrophic Breast Reduction
Breast Aug w/Exchange Implants Saline
Breast Augmentation With Exchange (saline breast implants)
Breast Augmentation With Exchange (silicone breast implants)
Breast Augmentation with Exchange (capsule implants)
MiniTummy Tuck (Mini-Abdominoplastia)
Tummy Tuck I (Abdominoplasty)
Tummy Tuck II (Abdominoplasty)
Tummy Tuck III (Abdominoplasty)
Liposculpture
Liposculpture + Fat Transfer
Lipo x Areas (each area) 4 areas minimum
Arms lipo (each arm)
Arm Surgery (both arms)
Inner Thighs Lipo
Outter Thighs Lipo
Lipo (double chin) combo
89
ORIGINAL
PRICE
$3,500
$4,900
$6,000
$7000
$4,800
$5,800
$5,500
$7,500
$4,200
$5,400
$4,900
$5,900
$3,300
$4,900
$5,500
$7,000
$3,700
$5,000
$600
$1,200
$3,900
$1,200
$1,200
$1,200
FEE
$2,800
$3,900
$4,500
$5,500
$3,800
$4,600
$4,000
$6,000
$3,400
$4,300
$3,900
$4,700
$2,500
$3,900
$4,500
$5,500
$3,000
$4,000
$300
$900
$3,000
$900
$900
$900
PROCEDURES / PROCEDIMIENTOS
Lipo (double chin) only
“Z” Neck Surgery
“Z” Neck Surgery (combo)
Face Lift
Eyebrow Lift
Eyelids (Up and Down)
Eyelids (Up)
Eyelids (Down)
Nose (cartilage only)
Nose (bone + cartilage)
Laser Skin Rejuvenation (Face)
Microdermabrasion Treatment
Chin Implant
Otoplasty (Ear Surgery)
Vagina Rejuvenation
Gastric Banding
Therapies
Torso Lift through Thighs
Cavitation (10 sections)
Cavitation (1 section)
Reductive Massage (10 sections)
Reductive Massage (1 section)
Passive Gymnastics (10 sections)
Passive Gymnastics (1 section)
Butt Lift (10 sections)
Butt Lift (1 section)
Vacum Therapy (10 sections)
Mesotherapy (10 sections)
Mesotherapy (1 section)
Carboderm facial (1 section)
SPA TREATMENTS / TRATAMIENTOS DE SPA
90
ORIGINAL
PRICE
$3,000
$3,700
$1,700
$6,500
$4,000
$4,000
$2,000
$2,000
$4,000
$6,500
$3,500
$800
$2,500
$4,000
$4,500
$14,000
$750
$4,700
$2,400
$3,000
$1,400
$4,500
$3,000
$3,000
$1,500
$1,500
$3,000
$4,000
$2,500
$600
$2,000
$2,800
$2,500
$9,900
$550
$3,000
$1,200.00
$120.00
$700.00
$120.00
$400.00
$45.00
$400.00
$45.00
$450.00
$800.00
$90.00
$70.00
$750.00
$85.00
$500.00
$85.00
$300.00
$35.00
$300.00
$35.00
$350.00 $650.00
$75.00
$55.00
FEE
Carboderm facial (10 sections)
Carboderm body ( 5 sections)
Carboderm body (10 sections)
Endermology (10 sections)
Yeso Therapies (1 section)
Parafango (10 sections)
Parafango (5 sections)
Plasma
Basic Facial
Facial Acne
Facial Oxígeno
Facial con radio frecuencia
Peeling
Collagen Hydra Gel Mask
Micro Dermabrasion (1 section)
Micro Dermabrasion (3 sections)
Micro Dermabrasion (5 sections)
Parafina treatment (10 sections)
Body Wrap (1 section)
Body Wrap (10 sections)
Radiofrequency (10 sections)
Radiofrecuency (5 sections)
Radiofrecuency (1 section)
Varicose Vains Treatment (1 section)
Varicose Vains Treatment (10 sections)
Package 10 Relax Massages (Full Body) Include Free Trigger Point or Neuromuscular
1 Relax Massage (Full Body) Include Free Trigger Point or Neuromuscular
Package 10 Swedish Massage Include Free Trigger Point or Neuromuscular
91
ORIGINAL
PRICE
$650.00
$750.00
$1,350.00
$550.00
$150.00
$950.00
$525.00
$300.00
$75.00
$75.00
$90.00
$120.00
$90.00
$25.00
$85.00
$225.00
$350.00
$650.00
$85.00
$750.00
$1,200.00
$550.00
$90.00
$40.00
$350.00
$750.00
$100.00
$750.00
FEE
$500.00
$500.00
$1,100.00
$500.00
$100.00
$700.00
$400.00
$200.00
$50.00
$60.00
$70.00
$60.00
$70.00
$16.00
$65.00
$185.00
$260.00
$500.00
$60.00
$500.00
$900.00
$450.00
$60.00
$30.00
$250.00
$650.00
$70.00
$650.00
1 Swedish Massage Include Free Trigger Point or Neuromuscular
Post-Surgery Therapy (1 section)
Permanent Makeup
Eyebrows
3 lines
Bottom Line
Upper Line
Lighting
Lips Alignment
Wax
Eyebrows (Con pinza)
Eyebrows (between)
Upper Lip
Armpits
Full face (Brows Included)
Bikini Line
Full Bikini
Brazilian Bikini
Full Arms (w/hands)
Chest
Chest with Stomach
Stomach
Back with Shoulders
Full Legs (w/Toes)
Upper Legs
Lower Legs (w/Toes)
Toes
92
ORIGINAL
PRICE
$85.00
$100.00
$425.00
$750.00
$70.00
$60.00
$375.00
$500.00
$200.00
$300.00
$130.00
$130.00
$130.00
$200.00
$150.00
$250.00
$90.00
$90.00
$90.00
$150.00
$15.99
$7.99
$9.99
$20.00
$52.99
$21.99
$29.99
$50.00
$36.99
$20.99
$36.99
$21.99
$35.00
$70.00
$35.00
$29.99
$15.00
$10.00
$5.00
$6.00
$15.00
$45.00
$18.00
$22.00
$40.00
$30.00
$15.00
$29.00
$16.00
$29.00
$55.00
$29.00
$25.00
$10.00
FEE
Laser Treatments / Tratamientos de Láser
Laser Hair Removal (1 section)
Laser Hair Removal (10 sections)
Chin (1 section)
Chin (10 sections)
Double Chin (1 section)
Double Chin (10 sections)
Sideburn ( 1 section)
Sideburn (10 sections)
Full Face (1 section)
Full face (10 sections)
Armpits (1 section)
Armpits (10 sections)
Linea Alba (1 section)
Linea Alba (10 sections)
Thighs ( 1 section)
Thighs (10 sections)
Legs ( 1 section)
Legs (10 sections)
Full Legs ( 1 section)
Full Legs ( 10 sections)
Buttocks (1 section)
Buttocks (10 sections)
Bikini Line (1 section)
Bikini Line (10 sections)
Back of male (10 sections)
Full Chest (1 section)
Full Chest (10 sections)
Full Bikini (1 section)
Full Bikini (10 sections)
ORIGINAL PRICE
$30.00
$250.00
$55.00
$450.00
$75.00
$600.00
$40.00
$350.00
$150.00
$1,300.00
$50.00
$400.00
$40.00
$350.0
$200.00
$1,800.00
$150.00
$1,200.00
$350.00
$2,800.00
$70.00
$600.00
$80.00
$650.00
$2,200.00
$140.00
$1,200.00
$150.00
$1,300.00
93
FEE
$20.00
$170.00
$45.00
$400.00
$65.00
$500.00
$30.00
$250.00
$110.00
$1,000.00
$35.00
$300.00
$30.00
$250.00
$150.00
$1,300.00
$100.00
$900.00
$250.00
$2,300.00
$50.00
$400.00
$50.00
$450.00
$1,700.00
$85.00
$700.00
$110.00
$900.00
Laser Treatments / Tratamientos de Láser
Laser Spots / Láser para manchas
Hands (1 section)
Hands (10 sections)
Cheeks (1 section)
Cheeks (10 sections)
Full Face (1 section)
Full Face (10 sections)
Forearm (1 section)
Forearm (10 sections)
Arm (1 section)
Arm (10 sections)
Laser Acne (1 section)
Laser Acne (10 sections)
Botox (Regular) 40 unidades
Juvederm (1 jeringuilla)
Arnica
Lipocell
Kelocote
Latisse
Scarguard (para proteger heridas)
Procolagen
Cocoa Butter
VEIN TREATMENTS
1 Section (one at a time)
Package (6) Treatment
GENERIC PRODUCTS / PRODUCTOS GENERICOS
94
ORIGINAL PRICE
FEE
$45.00
$350.00
$40.00
$300.00
$100.00
$900.00
$75.00
$600.00
$90.00
$750.00
$75.00
$650.00
$35.00
$300.00
$30.00
$200.00
$80.00
$700.00
$65.00
$500.00
$70.00
$600.00
$60.00
$500.00
$350.00
$550.00
$30.00
$35.00
$70.00
$125.00
$70.00
$60.00
$25.00
$325.00
$500.00
$25.00
$28.00
$60.00
$100.00
$60.00
$50.00
$18.00
$75.00
$450.00
$600.00
$750.00
$1020.00
$55.00
$330.00
$440.00
$550.00
$600.00

premier plan

Transcription

Similar documents

Presentamos Nuevos los Implantes OSSEOTITE ® 2

Feria Internacional del Libro de Miami

medical center / centro medico

pharmacy services servicios de farmacia

Opalesque Round Table

pharmacy services servicios de farmacia

Quick Start Guide

clase de graduados de pre-kindergarten 2006

dental services / servicios dentales

Formulario Tramitaci.n de Visados.indd

7 días/24 horas... www.libreonline.com...con noticias y fotos al

7 días/24 horas... www.libreonline.com...con noticias, TV y fotos al

7 días/24 horas... www.libreonline.com...con noticias, TV y fotos al