medical center / centro medico

Transcription

305-262-1610
TABLE OF CONTENTS / TABLA DE CONTENIDO
Membership Agreement / Acuerdo de Membrecia..........................................................7
Welcome Letter / Carta de Bienvenida...............................................................................8
Terms and Conditions / Términos y Condiciones.............................................................9
How to Use Your Card? / ¿Cómo usar su tarjeta?..........................................................10
Primary and Specialist Physicians / Medicos Primarios y Especialistas ....................11
Gynecology & Obstetrics / Ginecologia y Obstetricia....................................................18
Pediatrics / Pediatria..........................................................................................................19
Primary and Specialist Provider Fee Schedule / Precios de los servicios medicos
primarios y especialistas...................................................................................................21
Medical Centers / Centros Medicos..................................................................................22
Specialist Physicians Locations / Direcciones de los Medicos Especialistas.............26
Neurological Studies Fee Schedule / Estudios neurológicos.......................................30
Urgent Care Centers / Centros de Cuidados de Urgencia.............................................34
Dental Services / Servicios Dentales................................................................................36
General Dentistry Fee Schedule / Servicios de Odontologia General..........................37
Dental Specialties Fee Schedule / Servicios Dentales por Especialidad.....................41
Optical Services / Servicios Opticos................................................................................42
Corrective Surgery Laser / Cirugía correctiva por Laser...............................................42
Clinical Laboratories / Laboratorios Clinicos..................................................................46
Laboratory Services Fee Schedule / Servicios de Laboratorio.....................................49
Diagnostic and Radiology Centers / Centros de Diagnostico y Radiologia.................54
Diagnostic Services Fee Schedule / Servicios de Diagnostico.....................................56
Perinatal Medicine / Medicina Perinatal...........................................................................59
Ancillary Services / Servicios Auxiliares........................................................................60
Durable Medical Supplies / Equipos Medicos Duraderos..............................................60
Transportation/ Transportacion........................................................................................61
Orthopedic Supplies/ Suplementos Ortopedicos...........................................................62
Hearing Aids/ Suplementos Auditivos.............................................................................63
Home Health / Servicios a domicilio................................................................................63
Physical Therapy / Terapia Fisica.....................................................................................64
Alternative Medicine / Medicina Alternativa....................................................................65
Diabetes Supply Services / Suplementos para la Diabetes...........................................66
Pharmacy Services / Servicios Farmaceuticos...............................................................67
Pharmacy Services Fee Schedule/ Precios de los Servicios de Farmacia......................70
Cosmetic Services Fee Schedule / Precios de los Servicios de Cosmetologia...........74
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 305-262-1610, 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.
Providers are independent.
Providers are listed in this directory by the type of provider: Primary Care Physicians (PCP), Family Medicine,
Specialists, Urgent Care Centers, Diagnostic Centers, Laboratory, Pharmacy, Optical, Dental, and Durable Medical
Equipment providers.
Within each provider type, providers are lsited by COUNTY. You can also visit www.floridamedplan.com or call
Customer Care Department at 305-262-1610.
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. MedPlan does however recommend that the member choose
a primary care physician from our directory to be the gate keeper or central coordinator for all referrals to specialist
and services.
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This insures that the member’s service ordered or more importantly that the member is not
prescribed medication that can be contraindicated to another medication ordered by an unknown provider.
Also please note due to the nature of health care delivery systems it is sometimes necessary to have a written
prescription or medical treatment plan in order to have services rendered by certain MedPlan providers. These
services are Pharmacy, Durable Medical Equipment, Laboratory Services, Physical Therapy and Diagnostic
Radiology services. Please visit your Primary Care Provider or Specialist to get the proper treatment orders
before visiting any MedPlan support service providers listed above. Services such as Dental and Optical can
be accessed directly by the member at anytime without providing notification to your PCP. Please note that any
medical emergency should be directed to the nearest Urgent Care Center or local Hospital Emergency Room.
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
Excepción 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 305262-1610, 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 algunos de estos servicios,
como son los exámenes de laboratorio, radiología o diagnóstico sí requieren de una referencia por parte del
doctor que le ordena el examen o procedimiento. 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.
Los proveedores son independientes.
Los proveedores en este directorio han sido clasificados según tipo de proveedor: Doctores primarios(PCP),
Medicina familiar, Especialistas, Centros de cuidados de urgencia, Centros de terapia física, Centros de diagnóstico,
Laboratorios, Cuidado médico en el hogar, Farmacias y Equipos médicos. Cada especialidad ha sido clasificada
en sus respectivos condados. Visítenos en www.floridamedplan.com o llámenos al Departamento de atención al
cliente al 305-262-1610.
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.
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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. MedPlan recomienda,
sin embargo, que el miembro elija un médico de atención primaria de nuestro directorio para ser el coordinador
central para todas las derivaciones al especialista y servicios.
Esto asegura que los servicios de los miembros se coordinen y el miembro reciba la atención
médica adecuada con el pleno conocimiento de su PCP. 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. Estos servicios son Farmacia, Equipo médico duradero, Laboratorio, Radiología
diagnóstica, Terapia física, etc. Visite a su proveedor de atención primaria o especialista para obtener las órdenes
de un tratamiento adecuado antes de visitar cualquier proveedor de los antes mencionados.
El siguiente directorio está sujeto a modificaciones constantes y puede cambiar sin previo aviso. Para más
información actualizada visítenos en www.floridamedplan.com
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MEMBERSHIP AGREEMENT
MED PLAN LLC
Attn: Compliance Department
5300 NW 77th Ct
Doral, Fl. 33166
For assistance and plan information call: 305-262-1610. 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 nonpayment. 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 one-time application fee.
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 asistencia e información sobre el plan por favor llame al 877-334-1634. 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: 305-262-1610.
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.
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.
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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.
We help in caring for your health and your family.
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.
BIENVENIDOS
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.
Le ayudamos en el cuidado de su salud y la de su familia
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 de la compra o 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 sin costo alguno, simplemente llamando al Departamento de Servicios al cliente. 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!
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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.
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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 Physician and or 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 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 5300 NW 77 Ct, Doral FL 33166
(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 a un proveedor (Ejemplo: Médico general o Especialista) usted deberá presentar su tarjeta de miembro
con una identificación con fotografía (ID) para que su elegibilidad pueda ser verificada en el momento de solicitar sus
servicios y pueda beneficiarse de las tarifas preferenciales exclusivas que aplican únicamente a los miembros de MedPlan.
Cuando usted visite a proveedor participante 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 el consultorio de un médico de atención primaria o especialista usted lo 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 al (877) 334-1634 y solicite que se le coordine la cita con el
doctor que usted haya elegido. En ese caso tenga a mano el nombre del doctor para que la asistencia sea efectiva
y rápida en función de sus necesidades.
Nos encontramos en 5300 NW 77 Ct, Doral FL 33166
(305) 262-1610.
Nuestras oficinas estan abieras de Lunes a Viernes de 9:00 a.m. to 5:00 p.m.
10
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 305-262-1610.
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 305262-1610.
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. Si usted
necesita ayuda para coordinar estos servicios por favor contacte a nuestro departamento de servicio al cliente (877) 3341634.
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.
11
Primary Care Physicians / Médicos Primarios
12
Miami - Dade
Julian N. Guerrero, M.D.
(General Practice)
(Med Plan Clinic)
7200 N.W. 7th St #202
Miami, Fl. 33126
Phone: (305) 267-7784
Fax: (305) 266-9939
1st Visit :$25 - Follow Up: $20
Esperanza A. Nuñez, M.D.
(General Practice)
(Glez and Gonzalez Medical Center)
3804 NW 167th Street
Opalocka, Fl. 33054
Phone: (305) 624-2700
Fax: (305) 624-3154
John Padron, M.D.
(General Practice)
(Opa Medical Center)
1865 NE 163th Street
North Miami, Fl. 33162
Phone: (305) 948-9958
Fax: (305) 948-9518
Juan C. Romero, M.D.
(General Practice)
(C&I Medical Center)
13903 NW 67th Ave #440
Miami Lakes, Fl. 33014
Phone: (305) 824-0880
Fax: (305) 824-2321
Mara De Garcia, M.D.
(General Practice)
(C&I Medical Center)
13903 NW 67th Ave #440
Phone: (305) 824-0880
Fax: (305) 824-3321
Armando Segui, M.D.
(General Practice)
(Ambert Medical Center)
15495 Eagle Nest Ln, Suite 100
Phone: (305) 556-0021
Fax: (305) 556-0071
Felix A. Rodriguez, M.D.
(General Practice)
(American Family Health Center)
1840 W. 49 St, Suite 425
Hialeah, Fl. 33012
Phone: (305) 231-8996
Fax: 305-231-8433
Miguel A. Chamah, M.D.
(General Practice)
1800 West 68th St, Suite 127
Hialeah, Fl. 33014
Phone: (305) 820-0903
Fax: (305) 826-3827
Humberto Hernandez, M.D.
(General Practice)
1435 West 49th Place, Ste 604
Hialeah, Fl. 33012
Phone: (305) 231-3151
Fax: (305) 885-5884
Gilda de la Calle, M.D.
(General Practice)
1435 West 49th Place Suite 400-B
Hialeah, Fl. 33012
Phone: (305) 823-5730
Fax: (305) 823-5732
Odalys Frontela, M.D. F.A.C.P
(General Practice)
801 West 48th St, Suite A
Hialeah, Fl. 33012
Phone: (305) 698-7172
Fax: (305) 698-7649
Johspercer Anchinihm, M.D.
(Family Practice)
(Felicidad Medical Center)
4410 West. 16th Ave. # 55
Hialeah, Fl. 33013
Phone (305) 824-8559
Fax: (305) 824-8561
Lucky Flores, M.D.
(General Practice)
(Elite Health & Rehabilitation)
6450 West. 21 Ct, Suite 200
Hialeah, Fl. 33016
Phone: (305) 698-0806
Fax: (305) 698-2325
Conchita Jackson, M.D.
(General Practice)
(Vida Health Centers)
881 E 2nd Ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
Fax: (305) 887-3273
Maray Rocher, M.D.
(General Practice)
87 E 49 ST
Hialeah, Fl. 33013
Phone: (786) 536-5001
Fax: (786) 536-5535
Juan C. Sarol, M.D.
(General Practice)
87 E 49 ST
Hialeah, Fl. 33013
Phone: (786) 536-5001
Fax: (786) 536-5535
Juan J. Salinas, M.D.
(General Practice)
4212 W 16 Ave
Hialeah, Fl. 33012
Phone: (305) 821-5525
Fax: (786) 342-6017
Viviana Pérez, M.D.
(General Practice)
4410 West. 16 ave Suite 26
Hialeah, Fl. 33012
Phone: (305) 822-8883
Fax: (305) 825-2873
Amado Viera, M.D.
(General Practice)
777 East 25th St. Suite 118
Hialeah, Fl. 33013
Phone: (305) 835-0438
Fax: (305) 693-0768
Ausberto Hidalgo, M.D.
(Family Practice)
5590 W 20 Ave # 101
Hialeah, Fl. 33016
Phone: (305) 827-3303
Fax: (305) 819-6634
Edgar N Escobar, M.D.
(General Practice)
(Florida Care Health Center)
11300 NW 87th Court, Suite 141
Hialeah Gardens, Fl. 33018
Phone: (305) 364-8600
Fax: (305) 364-8604
Miami - Dade
Sandra R. Alvarez, M.D.
(General Practice)
Gonzalez Medical Center, Inc
Hialeah, Fl. 33012
Phone: (305) 818-1099
Fax: (305) 820-3272
Jorge Paoli-Bruno, M.D.
(General Practice)
Gonzalez Medical Center, Inc
Hialeah, Fl. 33012
Phone: (305) 818-1099
Fax: (305) 820-3272
Mayre Urdaneta, M.D.
(General Practice)
8060 NW 155th Street Ste 201
Phone: (305) 826-0606
Fax: (305) 826-0630
Thomas F. Sevilla, M.D.
(General Practice)
NW Community
Medical Center, Inc
6401 NW 27 ave
Miami, Fl. 33147
Phone: (786) 391-1475
Fax: (786) 391-1481
Ramon M. Hernandez, M.D.
(General Practice)
NW Community
Medical Center, Inc
6401 NW 27 ave
Miami, Fl. 33147
Phone: (786) 391-1475
Fax: (786) 391-1481
Gretell Trullenque, M.D.
(General Practice)
(Acevedo Medical Group)
2525 NW 54th St.
Miami, Fl. 33142
Phone: (305) 633-9090
Fax: (305) 633-9383
Lucky Flores, M.D.
(General Practice)
5881 NW 151 St, Suite 127
Phone: (305) 827-0208
Fax: (305) 827-0280
Johanne Zephir, M.D.
(General Practice)
(7th Ave. Medical Plaza)
10071 NW 7 ave
Miami, Fl. 33150
Phone: (305) 403-7777
Fax: (305) 403-7700
Jon Hemstreet, M.D.
(General Practice)
10071 NW 7 ave
Miami, Fl. 33150
Phone: (305) 403-7777
Fax: (305) 403-7700
Abraham A. Benchabatt, M.D.
(General Practice)
MD Health Care and Rehabilitation
7975 NW 154 St, Suite 200
Phone: (305) 822-2824
Fax: (305) 822-2355
Hector Rodriguez, M.D.
(General Practice)
2525 NW 54th St.
Miami, Fl. 33142
Phone: (305) 633-9090
Fax: (305) 633-9383
Gamaliel Mattos, M.D.
(General Practice)
4001 NW 97 ave #101
Doral, Fl. 33178
Phone: (305) 418-2233
Fax: (305) 418-2295
Raul A. Tamayo, M.D.
(General Practice)
(RT Professional Inc)
7374 NW 35 Terr # 102
Miami, Fl. 33122
Phone: (305) 418-8990
Fax: (305) 418-8997
Jorge Martinez, M.D.
(General Practice)
(St. John Medical Center)
161 NW 29th St
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: (305) 573-1100
Juan Delgado, M.D.
(Family Practice)
161 NW 29th St
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: 1-877-346-4133
José Gil, M.D.
(General Practice)
(Davila Medical Center)
782 NW 42th Ave # 348
Miami, Fl. 33126
Phone: (305) 441-2760
Fax: (305) 441-2762
Valdemir Santos, M.D.
(General Practice)
(All Future Medical Center)
3237 NW 7 St # 101
Miami, Fl. 33125
Phone: (305) 805-6903
Fax: (305) 805-6918
Andres Ocampo, ARNP
(General Practice)
(J.A Norwhite Rehab Med Center)
888 NW 27 ave #12
Miami, Fl. 33125
Phone: (305) 644-2907
Fax: (305) 644-2908
Jesús J. Cid, M.D.
(General Practice)
(Medical Consulting Center)
759 NW 22 ave
Miami, Fl. 33125
Phone: (305) 649-0492
Fax: (305) 649-0496
Jesús J. Cid, M.D.
(General Practice)
711 NW 23 ave # 301
Miami, Fl. 33125
Phone: (305) 643-4797
Fax: (305) 643-4880
Baudilio Cuzco Prieto, M.D.
(General Practice)
(Complete Medical Care)
630 NW 33th Ave
Miami, Fl. 33125
Phone: (305) 649-6378
Fax: (305) 541-6077
13
Miami - Dade
Yamile Porro, M.D.
(General Practice)
(Private Medical Center)
10 NW 42th Avenue, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Jose Pena, M.D.
(General Practice)
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Lazaro Miguel Garcia, M.D.P.A
(General Practice)
3626 NW 7 St
Miami, Fl. 33125
Phone: (305) 643-4343
Fax: (305) 643-3488
Conchita Jackson, M.D.
(General Practice)
10 N.W. 42th Ave, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Mauricio Vargas, M.D.
(General Practice)
10 N.W. 42th Ave, Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Luis E. De Armas, M.D.
(General Practice)
11373 W Flagler St. # 212
Miami, Fl. 33174
Phone: (305) 220-7730
Fax (305) 220-7703
Pedro R. Caro, M.D.
(General Practice)
Varadero Medical Center
5850 West Flagler ST
Miami, Fl. 33144
Phone: (305) 263-9590
Fax: (305) 263-9657
Julian N. Guerrero, M.D.
(General Practice)
8370 W. Flagler St, Suite 120
Miami, Fl. 33144
Phone: (305) 222-8365
Fax: (305) 222-8366
Leonardo Marquez, M.D.
(General Practice)
J.O. Medical Center, Inc.
2260 SW 8th St, Suite 200
Miami, Fl. 33135
Phone: (305) 642-7704
Fax: (305) 642-5171
Mario R. Villoch, M.D.
(General Practice)
(AV Medical Center)
2075 SW 27 ave Suite 101
Miami, Fl. 33145
Phone: (305) 856-6081
Fax: (305) 854-5968
John A. Padron, M.D.
(General Practice)
8370 W. Flagler St, Suite 120
Miami, Fl. 33144
Phone: (305) 222-8365
Fax: (305) 222-8366
Maria L. Margolles, M.D.
(General Practice)
(Varadero Medical Center)
5850 W. Flagler St
Miami, Fl. 33144
Phone: (305) 263-9590
Fax: (305) 263-9657
Ariel Duran Mondragon, M.D.
(General Practice)
(Selecta Physical Therapy)
2140 West Flagger St, Ste 112
Miami Fl. 33135
Phone: (786) 953-6735
Fax: (786) 953-6943
Ramon A. Pichardo, M.D.
(General Practice)
(Medical Health and Research Inc)
6854 W Flagler St
Miami Fl. 33144
Phone: (786) -310-7697
Fax: (786) 334-6078
Ramon Pichardo, M.D.
(General Practice)
Miami Fl. 33135
Phone: (786) 953-6735
Fax: (786) 953-6943
Aurelio A. Ortiz, M.D.
(General Practice)
1313 SW 1th Street.
Miami, Fl. 33135
Phone: (305) 541-8448
Fax: (305) 541-8565
Maria Valdivia, M.D.
(General Practice)
(International Medical Center)
1393 SW 1th ST Suite 320
Miami, Fl. 33135
Phone: (305) 644-0977
Remy H. Kindelan, M.D.
(General Practice)
Miami Fl. 33135
Phone: (786) 953-6735
Fax: (786) 953-6943
Gilda de la Calle, M.D.
(General Practice)
421 SW 107th Avenue
Miami, Fl. 33174
Phone: (786) 360-4219
Fax: (786) 360-4217
Shirley P. Jimenez, P.A.
(General Practice)
(Leda Medical Center, Inc)
6621 SW 8th ST
Miami, Fl. 33144
Phone (305) 262-4801/03
Fax: (305) 262-4840
14
Miami - Dade
Abdón S. Borges, M.D.
(General Practice)
8300 SW 8th St. Suite 105
Miami, Fl. 33144
Phone: (305) 446-8236
Fax: (305) 448-7830
Maria Lourdes Zeno, M.D.
(General Practice)
Best Medical Care, Inc
920 SW 82th ave
Miami, Fl. 33144
Phone: (305) 262-3999
Fax: (305) 262-3995
Alberto Gonzalez-Gomez, M.D.
(General Practice)
7968 SW 8th ST
Miami, Fl. 33144
Phone: (786) 332-2093
Fax: (786) 332-3295
Josefina Hernández, M.D.
(General Practice)
8480 SW 8th Street.
Miami, Fl. 33144
Phone: (305) 264-1131
Fax:(305) 264-1134
Rogelio O. Bardiñas, M.D.
(General Practice)
747 Ponce de Leon Blv # 700
Coral Gables, Fl. 33134
Phone: (305) 441-9700
Fax: (305) 441-9702
Adolfo R. Martínez, M.D.
(General Practice)
8480 SW 8th Street.
Miami, Fl. 33144
Phone: (305) 264-1131
Fax:(305) 264 -1134
Hilda M Brito M.D.
(General Practice)
12260 SW 8th Street, Suite 224
Miami, Fl. 33184
Phone: (305) 220-6917
Fax: (305) 220-6977
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
Fax: (305) 267-6033
Eduardo Almaguer, M.D.
(General Practice)
330 S.W 27th Ave # 404
Miami, Fl. 33135
Phone: (305) 644-9798
Fax: (305) 644-9794
Lazaro Martinez. M.D.
(General Practice)
9600 SW 8 St, Suite 30
Miami, Fl. 33174
Phone: (786) 312-0333
Fax: (305) 503-6934
Francisco Macias, M.D.
(General Practice)
(Miami Community Health Center)
2324 SW 8 St
Miami, Fl. 33135
Phone: (305) 643-0535
Fax: (305) 642-9360
Valdemir Santos, M.D.
(General Practice)
(ACN Physician Group)
7490 SW 23 ST #201
Miami, Fl. 33155
Phone: (786) 953-8221
Fax: (786) 953-7514
Lucky Flores, M.D.
(General Practice)
(Micnady Medical Office)
8820 SW 24 St
Miami, Fl. 33165
Phone: (786) -391-0264
Fax: (786) 391-0276
Rodolfo Vega, M.D.
(General Practice)
(Vega Medical Center)
3720 SW 107 ave
Miami, Fl. 33165
Phone: (305) 554-4270
Fax: (305) 553-5271
Jorge L. Santander, M.D.
(General Practice)
4080 SW 84 ave Suite D
Miami, Fl. 33155
Phone (305) 223-1140
Fax: (305) 223-1174
Julio C. Rosales, M.D.
(General Practice)
Kendall Medical Plaza
11880 SW 40 St # 120
Miami, Fl. 33175
Phone: (305) 225-7330
Fax: (305) 225-7314
Juan Blemil Fdez. M.D, P.A.
(General Practice)
13303 SW 42th Street
Miami, Fl. 33175
Phone: (305) 227-6497
Fax: (305) 551-2370
Julio C. Rosales, M.D.
(General Practice)
(Hammocks Medical Center)
15122 SW 72th Street
Miami, Fl. 33193
Phone: (305) 383-3848
Fax: (305) 383-7601
Florence Faucauld, M.D.
(Family Practice)
11010 SW 88th Street, Ste 104
Miami, Fl. 33176
Phone: (305) 595-1122
Fax: (305) 595-1127
Jose L. Avila, M.D.
(General Practice)
(MMG-Clinics)
12001 SW 128 CT Suite 209
Miami Fl. 33186
Phone: (305)-964-7648
Fax: (305) 888-1199
Oscar Ordenana, M.D.
(General Practice)
(MMG-Clinics)
12001 SW 128 CT Suite 209
Miami Fl. 33186
Phone: (305)-964-7648
Fax: (305) 888-1199
15
Sophia Khawly, ARNP
(General Practice)
First Quality Medical Center, Corp
8900 SW 107 ave #311
Miami, Fl. 33176
Phone: (305) 270-7608
Fax: (305) 270-7609
Anselmo H. Humaran, M.D.
(General Practice)
(0-99 years)
11474 Quail Roost Dr.
Miami, Fl. 33157
Phone: (305) 232-2066
Fax: (305) 232-2089
Jorge L. Garcia, M.D.
(General Practice)
(Caribe Medical Center of
Homestead)
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
Fax: (305) 258-6071
Maria C. Cubillas, M.D.
(General Practice)
27543 S. Dixie Hwy
Homestead, Fl. 33032
Phone: (305) 246-0047
Fax: (305) 247-8540
Maria V. Garcia, M.D.
(General Medicine)
(Caribe Medical Center of Homestead)
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
Josefa L. Binker, M.D.
(Family Practice)
70 NW 8 St
Phone: (305) 242-5225
Fax: (305) 242-6525
Rafael A. Ubeda, M.D.
(Family Practice)
(Leal Medical Center LLC)
632 Washington Ave
Phone: (305) 246-1265
Fax: (305) 246-1240
Arles Perdomo, M.D.
(General Practice)
311 NE 8 St #110
Phone: (786) 339-0466
Fax: (786) 339-8516
John G. Gutleber, M.D.
(General Practice)
139 N.E 15th Street
Phone: (305) 247-1213
Fax: (305) 247-5701
Maria Delgado, M.D.
(General Practice)
(Homestead Medical Clinic, M.D)
125 N.E 8th St, Suite 6
Phone: (786) 243-1909
Fax: (786) 243-4292
Eduardo Medrano, M.D.
(General Practice)
(All Family Care Inc.)
38 Northwest 8th Street
Phone: (305) 246-0460
Fax: (305) 246-0516
16
Miami - Dade
Broward
Silvia Soto, M.D.
(General Practice)
(Miramar Medical Center)
11904 Miramar Parkway
Miramar, Fl. 33025
Phone: (954) 639-7560
Fax: (954) 639-7563
Price 1st Visit: $ 40.00
Price Follow Up: $ 20.00
Oli Mendez, M.D.
(General Practice)
Miramar, Fl. 33025
Phone: (954) 639-7560
Fax: (954) 639-7563
Elsa Pichardo Matos, M.D.
(General Practice)
(Sunset Strip Medical Center)
4269 N.W 88 ave
Sunrise, Fl. 33351
Phone: (954) 578-0200
Fax: (954) 578-0050
Eugene Gregorie, M.D.
(General Practice)
4141 NW 5th Street, Ste 100
Plantation, Fl. 33317
Phone: (954) 486-6866
Fax: (954) 581-0543
Yaneth Trujillo, M.D.
(General Practice)
2300 North Commerce Park Way
Suite 301
Weston, Fl. 33326
Phone: (954) 436-8036
Fax: (954) 949-9180
Jaynier Moya, M.D.
Pines Care Medical Center
(General Practice)
301 NW 103 Ave, # 235
Pembroke Pines, Fl. 33026
Phone: (954) 251-1497
Fax: (954) 404-9537
Johnjairo Catano, M.D.
(General Practice)
7300 W. Menab Rd Suite 112
Tamarac, Fl. 33321
Phone: (954) 718-3752
Fax: (954) 718-3753
Controlled Substance
Call for a Schedule
Broward
Karen Prida, M.D.
Pines Care Medical Center
(General Practice)
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Fax: (954) 404-9537
Mark Leeds, D.O. PA.
(General Practice)
3500 Hollywood Blvd
Hollywood, Fl. 33021
Phone: (954) 239-6060
Fax: (954) 239-6100
Mon-Fri 9am to 5pm
Controlled Substance
Call for a Schedule
Emmauel Eloi, M.D.
(General Practice)
(Sunshine Medical &
Chiropractic Care Inc)
3500 N. State Rd Suite # 211
Lauderdale Lakes, Fl. 33319
Phone: (954) 766-4233
Fax: (954) 306-2056
Karen Gaynair, M.D.
(General Practice)
4900 West Oakland Park Blv #202
Phone: (954) 730-7993
Fax: (954) 730-7994
Jeanne - Elyse Cedeño, M.D.
(General Practice)
(Children and Adults)
1601 N. Palm ave, Suite 102 B
Phone: (754) 273-6278
Fax: (954) 374-6954
Herbert Pardell, DO.
Emeril Health Medical Center
(General Practice)
4330 Sheridan Street, Suite 102
Phone: (954) 987-4455
Fax: (954) 964-7342
Charles Merson, M.D.
SFL Medical & Wellness Clinic)
(General Practice)
5931 S. University Dr.
Davie, Fl. 33328
Phone: (954) 252-3339
Palm Beach
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
Fax: (561) 391-6285
Paul Murry, M.D.
(General Practice)
(Boca Family Practice)
7280 West Palmetto Park Rd Suite # 104
Phone: (561) 391-6552
Fax: (561) 391-6285
Rafael Ubeda, M.D.
(General Practice)
(Basic Gynecology)
(Johnson Medical Services)
2531 N Dixie Hwy
Lake Worth, Fl. 33460
Phone: (561) 582-0330
Fax: (561) 582-0339
Marco Fabregas, M.D.
(General Practice)
(Basic Gynecology)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Jose E. Blandon, M.D.
(General Practice)
(Basic Gynecology)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Alfonso Ramirez, M.D.
(General Practice)
(Basic Gynecology)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Martha R. Fernandez, M.D.
(General Practice & Gynecology)
Naples Health Care Inc
4947 Tamiami Trail North Suite 206
Naples Fl. 34103
Phone: (239) 304-9290
Fax: (239) 304-9295
Alfonso Garcia, M.D.
Naples Health Care Inc
Naples Fl. 34103
Phone: (239) 304-9290
Fax: (239) 304-9295
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
17
Varghese E. Mathai, M.D.
(General Practice)
(Region Medical Center)
3900 Broadway Unit 1 Bldg A
Fort Myers, Fl. 33976
Phone: (239) 288-5413
Fax: (239) 288-5418
Martha R. Fernandez, M.D.
Del Prado Medical Center.
2500 Del Prado Blvd South
Cape Coral Fl. 33954
Phone: (239) 772-1194 / 1195
Fax: (239) 772-1196
Kuanne Coombo, M.D.
(General Practice)
Medical Center of Lehigh Acres.
1303 Homestead Rd. North, Suite 102
Lehigh Acres, Fl. 33936
Phone: (239) 303-2700
Fax: (239) 303-2756
Ralph Rayback, M.D.
(General Practice)
Phone: (239) 303-2700
Gynecology & Obstetrics / Ginecología y Obstetricia
Lee
Emilio Mufdi, M.D.
(General Practice)
1303 Homestead Rd. North,
Suite 102
Phone: (239) 303-2700
Fax: (239) 303-2756
Miami - Dade
Esperanza A. Nuñez M.D. (OB)-(GYN)
(Glez. and Glez. Medical Center)
3804 NW 167th Street.
Opa-Locka, Fl. 33054
Phone: (305) 624-2700
Fax: (305) 624-3154
Conchita Jackson, M.D.(GYN))
10 NW 42 Ave Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Ramon Hechavarria, M.D.(GYN)
Miami, Fl. 33126
Phone: (305) 774-0742
Matias Guerra M.D. (OB-GYN).
(ST. John Medical Center)
161 NW 29th Street
Miami, Fl. 33121
Phone: (305) 576-0231
Fax: (305) 573-1100
Tomas Seville, M.D. (OB-GYN).
(Holistic Medical Center)
5040 NW 7th street Suite 300
Miami Fl. 33126
Phone: (305) 448-8557 / 397-7230
Fax: (305) 448-8570
Emilio Blanco, M.D. (OB) - (GYN)
881 East 2nd ave
Hialeah Fl. 33010
Phone: (305) 882-1100
Fax: (305) 887-3273
Eduardo Lavado, M.D. (OB-GYN)
4160 W. 16 Avenue, Ste 406
Hialeah, Fl. 33012
Phone: (305) 822-4561
Fax: (305) 826-9366
Esperanza A. Nuñez M.D. (OB)-(GYN)
1840 W 49th ST Ste # 420
Hialeah, Fl. 33012
Phone: (305) 823-3000
Fax: (305) 822-9807
Julio A. Diaz-Jane, M.D. (OB) - (GYN)
4201 Palm Ave Suite 2A
Hialeah, Fl. 33012
Phone: (305) 822-8123
Fax: (305) 822-0628
Fernando Lora, M.D. (OB) - (GYN)
(Vital Medical Center)
8300 W Flagler, Suite 175
Miami, Fl. 33144
Phone: (305) 220-0300
Fax: (305) 220-1472
Rolando Padro, M.D. (GYN)
15439 SW 137 Avenue
Miami, Fl. 33177
Phone: (305) 259-5570
Fax: (305) 259-5533
Carlos M. Verdeza, M.D. (GYN)
7000 SW 62 Ave Suite PH5
Miami, Fl. 33143
Phone: (305) 553-8033
Fax: (786) 453-2787
Josefa L. Binker, M.D. (GYN)
70 NW 8 St
Phone: (305) 242-5225
Fax: (305) 242-6525
Gynecology / Ginecología
Edward Buonopane, M.D.
(Womens Awareness)
4540 N. Federal Hwy
Fort Lauderdale, Fl. 33308
Phone: (954) 791-4475
Fax: (954) 791-5652
18
Broward
Carolyn Zaumeyer MSN, ARPN
(Womens Awareness)
4540 N. Federal Hwy
Phone: (954) 791-4475
Fax: (954) 791-5652
Lee / Cape Coral
Luis Martinez, M.D.
(Ginecology)
Phone: (239) 772-1194 / 1195
Pediatrics / Pediatría
Miami - Dade
Yamile Porro, M.D.
(7 and Up)
Miami, Fl. 33126
Phone: (305) 774-0742
Fax: (305) 774-0836
Olabisi Oyadiran, M.D.
99 NW 183 St, Suite 114
Miami Gardens, Fl. 33169
Phone: (305) 625-4100
Fax: (305) 625-4004
Miriam Estévez, M.D.
St. John medical Center
161 NW 29th ST
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: (786) 230-6127
Armando Segui, M.D.
(Ambert Medical Center)
15495 Eagle Nest Ln, Suite 100
Phone: (305) 305-556-0021
Fax: (305) 556-0071
Jorge L. Alsina, M.D.
4980 W. 10 Ave. Suite, 204
Hialeah, Fl. 33012
Phone: (305) 556-4447
Fax: (305) 556-6290
5590 W 20 Ave # 101
Hialeah, Fl. 33016
Phone: (305) 827-3303
Fax: (305) 819-6634
Armando Acevedo, M.D.
Miami, Fl. 33142
Phone: (305) 633-9090
Fax: (305) 633-9383
Juan Del Sol, M.D.
161 NW 29th Street
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: (305) 573-1100
Ivette Valle, M.D.
161 NW 29th Street
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: (305) 573-1100
Eduardo Díaz, M.D.
5703 NW 7 ST
Miami, Fl. 33126
Phone: (305) 267-3462
Fax: (305) 267-3463
Hilda M. Brito, M.D.
Miami, Fl. 33184
Phone: (305) 220-6917
Fax: (305) 220-6977
Gloria López, M.D.
747 Ponce de Leon Blv, Ste 607
Phone: (305) 443-2324
Fax: (305) 443-6301
Rodolfo Sidron, M.D.
7285 W Flagler St
Miami, Fl. 33144
Phone: (786) 388-9877
Fax: (786) 388-9627
Luis E. De Armas, M.D.
11373 W Flagler St. # 212
Miami, Fl. 33174
Phone: (305) 228-1919
Fax (305) 220-7730
Johanne Zephir, M.D.
(0 and Up)
10071 NW 7 ave
Miami, Fl. 33150
Phone: (305) 403-7777
Fax: (305) 403-7700
John Hemstreet, M.D.
(0 and Up)
10071 NW 7 ave, Miami, Fl. 33150
Phone: (305) 403-7777
Fax: (305) 403-7700
Otneil Hernandez, DNP, ARNP.
4410 West. 16th Ave. # 55
Hialeah, Fl. 33013
Phone (305) 824-8559
Fax: (305) 824-8561
Pedro C. Reimon, M.D.
(Child Obesity Specialist)
13155 SW 42nd Street Ste 106
Miami Fl. 33175
Phone: (305) 220-1310
Fax: (305) 220-1323
Maria I. Delgado, M.D.
7815 SW 24th street, Suite 106
Miami, Fl. 33155
Phone: (305) 262-2467
Fax: (305) 262-2469
Rodolfo B. Ferretti M.D.
7765 SW 87 Avenue Suite 209
Miami, Fl. 33173
Phone: (305) 595-0429
Fax: (305) 595-0431
Lazaro de la C. Nunez, M.D.
6854 W Flagler St
Miami Fl. 33144
Phone: (786) -310-7697
Fax: (786) 334-6078
Myriam Lacayo, M.D.
The Children Medical Center Group, Inc
8300 SW 8 St, Suite # 302
Miami, Fl. 33144
Phone: (305) 225-4434
Fax: (305) 267-6033
Juan Ruiz, M.D.
8900 SW 24 ST #204
Miami, Fl. 33165
Phone: (305) 554-6666
Fax: (305) 554-0176
Francisco Martinez, M.D.
15122 SW 72th ST
Miami, Fl. 33193
Phone: (305) 383-3848
Fax: (305) 383-7601
19
Dorses Goosby, M.D.
(Pediatric Ass. of Florida)
151 N.W 11th St. Ste E-202
Phone: (305) 245-3220
Fax: (305) 247-5849
Alfredo Machado, M.D.
(Pediatric Ass. of Florida)
151 N.W 11th St. Ste E-202
Phone: (305) 245-3220
Fax: (305) 267-6033
Roberto B. Carpio, M.D.
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
Fax: 305-258-6071
Marta Delgado, M.D.
(Homestead Medical Clinic PA)
125 NE 8th St # 6
Phone: (786) 243-1909
Fax: 786-243-4292
Yoelice A. Villamar, M.D.
(Sacred Hearth Medical)
17901 N.W. 5 St. # 205
Phone: (954) 392-0333
Fax: 954-398-0393
(Pines Professional Campus)
302 NW 179 St # 103
Phone: (954) 442-8888
Fax: 954-442-8661
Neelan Seth, M.D.
2929 University Dr.
Coral Spring, Fl. 33065
Phone: (954) 510-7900
Fax: 954-510-7999
Emmauel Eloi, M.D.
(0 through 18 years old)
(Sunshine Medical & Chiropractic care Inc)
3500 N. State Rd Suite # 211
Phone: (954) 766-4233
Fax: (954) 306-2056
Miami - Dade
Milady Fernandez, M.D.
(All Family Care Inc.)
38 Northwest 8 Street
Phone: (305) 246-0460
Fax: 305-246-0516
Bradley J. Bradford, M.D.
(Pediatrics by the Sea)
285 SE 5th Ave
Delray Beach, Fl. 33483
Phone: (561) 272-8991
Fax: (561) 272-8985
Jose E. Blandon, M.D.
(6 and Up)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Alfonso Ramirez, M.D.
(6 and Up)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Marco Fabregas, M.D.
(6 and Up)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Héctor Cordero, M.D.
1090 6th Ave N
Naples, Fl. 34102
Phone: (239) 213-9200
Fax: 239-213-9205
20
Broward
Collier
Dibanni Vazquez, M.D.
(Pines Professional Campus)
302 NW 179 St # 103
Phone: (954) 442-8888
Fax: 954-442-8661
Palm Beach
Rafael Ubeda, M.D.
(6 and Up)
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Varghese E. Mathai, M.D.
Phone: (239) 288-5413
Fax: (239) 288-5418
Lee
Physician and Specialist Provider Fee Schedule
Family and General Practice Consultation Fees
Initial Office Visit
$40.00
Follow-Up OfficeVisit
$20.00
Specialist Physician Practice Consultation Fees
$60.00
Follow-Up Office Visit
$40.00
Pediatric / Pediatrician
$40.00
Follow-Up Office Visit
$30.00
Codes
93000
93307
93320
93325
93324
Codes
76705
76700
76645
76856
76873
76770
76536
93923
93925
93965
93970
76705
Codes
J0780
J1100
J1030
J1040
J2480
J3120
J3410
J3420
J1670
J3180
J0500
J3450
J1885
J1200
Cardiovascular
ECG
Echo
Echo Doppler
Color Flow Doppler
Holter Monitor 24 hr
Diagnostics US
Abdomen / Single
Abdomen / Complete
Breast
Pelvic
Prostate
Kidney / Renal
Thyroid
US Arterial Upper-lower
Duplex Scan Arterial
US venous extremity
Duplex scan venous
Abdomen / Single
Injections
Compazine 10 mg Cost
Decadron up to 5mg Cost
Depo-Medrol 40 mg
Depo-Medrol 80 mg
Terramycin up 50 mg
Testosterone to 100 mg
Vistaril to 25 mg
Vitamin B12 to1000 mg
Tetanun (Globulin)
Tetanun Toxoid Cost
Bentyl
Tigan
Tiradol
Benadryl
Med Plan
$10.00
$90.00
$90.00
$25.00
$55.00
Med Plan
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
Med Plan
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
Cost +$10.00
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 its members $10.00 for the
administration of each vaccine only.
Codes
73600
71010
71020
73070
73620
73090
73120
73500
73510
73520
73060
74020
72110
71100
73020
73030
73590
73100
73560
73550
73140
72040
72070
73562
70220
70260
70160
70110
70200
Codes
97010
97010
97012
97014
97018
97028
97022
Codes
94060
94664
94665
94010
94060
94070
94200
94240
94250
Codes
69210
X Ray Procedures
Ankle 2 views
Chest PA Only
Chest PA & LA
Elbow 2 Views
Foot 2 Views
Forearm 2 Views
Hand 2 Views
Hip 1 Views
Hip 2 views
Hip Bilateral
Humerus 2 views
KUB 2 Views
Lumbo Sacral Spine
Ribs 2 views
Shoulder 1 views
Shoulder 2 views
Tibia 2 views
Wrist 2 views
Calcaneus
Femur
Finger(s)
Cervical Spine
Thoracic Spine
Knee
Sinus
Skull Series
Nasal Bones
Mandible
Orbits
Therapies
Hot Pack Therapy
Cold Pack Therapy
Tractional Mechanical
EMS (High Frequence)
Paraffin Bath
Ultra Sound
Whirpool
Pulmonary
Bronchospasm Eval
Nebulizer Treatment
Nebulizer Subsequent
Spirometry
Spirometry W bronco sp.
Prolonged Broncho sp.
Maximum Breathing cap.
Func. Resd. Cap.
Exp. Gas Collecion
Pulmonary
Ear Lavage
PAP Smear Papanicolau Liquid
PAP Papanicolau Slide
Med Plan
$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
$25.00
$25.00
$25.00
$25.00
$25.00
Med Plan
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
Med Plan
$12.50
$12.50
$12.50
$12.50
$12.50
$12.50
$12.50
$12.50
$12.50
Med Plan
$5.00
$35.00
$20.00
21
MP . P/S . FS 01/13
MEDICAL CENTER / CENTRO MEDICO
7200 N.W 7TH ST, SUITE 202
Miami, Fl. 33126
Phone: 305-267-7784
Fax: 305-266-9939
CONVENIENT HOURS
Nuestro Centro cuenta con un
horario de atención que
se ajusta a su conveniencia
Hours / Horario
Mon-Fri 8:00AM-7:00PM
A CLINIC FOR
OUR MEMBERS
UNA CLINICA PARA NUESTROS MIEMBROS
• Primary Physician / Médico Primario
• Laboratory / Laboratorio
• Ultrasound / Ultrasonido
• X-Rays / Rayos X
• Electrocardiogram / Electrocardiograma
• Pharmacy / Farmacia
Med Plan members will receive
excellent health services
aimed at detecting and preventing
diseases by means of
PREVENTIVE MEDICINE
Nuestros miembros cuentan
con excelentes servicios de
salud especialmente pensados
para detectar y prevenir a tiempo
enfermedades mediante la
MEDICINA PREVENTIVA
CALL NOW FOR AN APPOINTMENT
LLAME HOY PARA UNA CITA
305-267-7784
Medical Centers / Centros médicos
Miami - Dade
Gonzalez and Gonzalez.
(Medical Center Family)
Opa-Locka Fl. 33054
Phone: (305) 624-2700
Fax: (305) 624-3154
Services / Servicios:
General Medicine, Psychiatrist
Psiquiatry, Gynecology
Opa Medical Center.
1865 NE 163th Street.
Miami, Fl. 33162
Phone: (305) 948-9958
Fax: (305) 948-9518
General Medicine
Gynecology and Minor Surgery
Ambert Medical Center.
15495 Eagle Nest Ln Suite 100
Phone: (305) 556-0021
Fax: (305) 556-0071
General Medicine
Pediactrics
Florida Care Health Center.
11300 NW 87th Court, Ste 141
Hialeah Gardens, Fl. 33018
Phone: (305) 364-8600
Fax: (305) 364-8604
General Medicine
C&I Medical Center.
13903 NW 67th Ave #440
Phone: (305) 824-0880
Fax: (305) 824-3321
General Medicine
Vida Health Medical Center.
881 East 2 ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
Fax: (305) 887-3273
General Medicine, Surgery, Angiology, Gastroenterology, Gynecology and Psychiatry
Felicidad Medical Center
4410 West. 16th Ave. # 55
Hialeah, Fl. 33013
Phone (305) 824-8559
Fax: (305) 824-8561
General Medicine, Internal Medicine,
Loss Weight, Ultrasound
Laboratory, Physical Therapy.
Acevedo Medical Group.
2525 NW 54th Street
Miami, Fl. 33142
Phone: (305) 633-9090
Fax: (305) 633-9383
General Medicine
St. John Clinic Medical Center.
161 NW 29th Street.
Miami, Fl. 33127
Phone: (305) 576-0231
Fax: (305) 573-1100
General Medicine, Pediatric
Podiatric, Cardiovascular
Gynecology, Orthopedic
Medical Consulting Center.
759 NW 22 ave
Miami , Fl. 33125
Phone: (305) 649-0492
Fax: (305) 649-0496
General Medicine, .Ginecology
Physicial Therapy
Complete Medical Care.
630 NW 33 Avenue
Miami, Fl. 33125
Phone: (305) 649-6378
Fax: (305) 541-6077
General Medicine
Holistic Medical Center
(Family Medicine)
5040 NW 7th Street, Suite 300
Miami, Fl. 33126
Phone: (305) 448-8557
General Medicine, Gynecology
Ophthalmology
Private Medical Center.
10 NW 42th Ave. Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
General Medicine, Ginecology
Pediatric, Cardiology, Dermathology,
Internal Medicine.
J.O. Medical Center.
42 NW 27 ave Ste 303
Miami, Fl. 33125
Phone: (305) 642-7704
General Medicine
International Medical Center
1393 SW 1st Street, Suite 320
Miami Fl. 33135
Phone: (305) 644-0977
General Medicine
Miami Community Health Center
2324 SW 8 ST
Miami, Fl. 33135
Phone: (305) 643-0535
(305) 767-5635
Fax: (305) 642-9360
General Medicine, Basic Ginecology
Podiatry.
Universal Community Mental Care.
928 SW 82 Ave.
Miami, Fl. 33144
Phone: (305) 265-5744
Fax: (305) 265-5745
General Medicine, Internal Medicine
Psyquiatry, Neurology, Pain Management,
Podiatry
ACN Physician Group
7490 SW 23 St, Ste 201
Miami, Fl. 33155
Phone: (786) 953-8221
General Medicine
23
Miami - Dade
Delgado Pediatrics After Hours PA.
Miami, Fl. 33155
Phone: (305) 262-2467
Pediactric
Anchor Medical Center.
12781 SW 40th St # H
Miami, Fl. 33175
Phone: (305) 229-3990
Fax: (305) 229-3880
General Medicine
Hammocks Medical Center.
15122 SW 72 Street.
Miami Fl. 33193
Phone: (305) 383-3848
General Medicine
Pediactrics
All Family Care Inc.
38 NW 8th Street.
Phone: (305) 246-0460
General Medicine
Pediactrics
Pediatrics Ass. of South Florida.
151 N.W 11th Street, Suite E-202
Phone: (305) 245-3220
Fax: (305) 247-5849
Pediactrics
Homestead Medical Clinic PA.
125 NE 8th Street, Suite 6
Phone: (786) 243-1909
General Medicine
Pediactrics
Leal Medical Center
632 Washington Ave
Phone: (305) 246-1265
Fax: 305-938-5088
General Medicine
Pediactrics
Broward
Emeril Health Medical Center.
Phone: (954) 987-4455
Fax: (954) 964-7342
Internal Medicine
Pines Care Medical Center, LLC.
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Fax: (954) 404-9537
General Medicine
Internal Medicine
Miramar Medical Center.
Miramar, Fl. 33025
Phone: (954) 639-7560
Fax: (954) 639-7563
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
Broward Medical Center of Davie.
255 SE 14 St Suite C-1
Ft. Lauderdale, Fl. 33316
Phone: (954) 321-9826
Fax: (954) 321-9660
Cardiology
Urgent Care Center.
(UrgentMed)
2337 S. University Drive
Davie, Fl. 33324
Phone: 954-423-9234
Fax: (954) 423-9231
French, Italian & Creole
General Medicine
Pines Professional Campus
302 NW 179th St, Suite 103
Pembroke Pines Fl. 33029
Phone: (954) 442-8888
Pediatrics
Pediatrics by the Sea
285 SE 5th ave
Delray Beach Fl. 33483
Phone: (561) 272-8991
Pediatrics
24
Johnson Medical Service
2531 N. Dixie Hwy
Lakeworth Fl. 33460
Phone: (561) 582-0330
General Medicine, Pediatrics,
Ophthalmology
Palm Beach
Collier
Naples Health Care Inc.
Naples Fl. 34103
Phone: (239) 304-9290
SERVICES / SERVICIOS:
Multi Specialist Practice,
Podiatry, Physical Therapy
Phone: (239) 772-1194 / 1195
Multi Specialist Practice
General Medicine,
Gynecology, Podiatry
Podiatría, Physical Therapy
Lee / Cape Coral
The Medical Center of Lehigh Acres.
Phone: (239) 303-2700
General Medicine, Internal Medicine
Psychiatry, OB-GYN, Chiropractor
Laser Therapy, Therapeutic massage
Acupuncture and Radiology.
25
SPECIALIST PHYSICIANS / ESPECIALISTAS
Angiology / Angiólogo
8300 SW 8th St. Suite 105
Miami, Fl. 33144
Phone: (305) 446-8236
Miami-Dade
3850 SW 87 ave # 305
Miami, Fl. 331165
Phone: (786) 558-5485
Fax: (786) 558-5486
Alergist /Alergista
Vicente A. Chavarria, M.D
1840 W. 49th Street, Suite 515
Hialeah, Fl. 33012
Phone: (305) 670-7006
Miami-Dade
Vicente A. Chavarria, M.D
7400 N. Kendall Dr., Suite 204
Miami, Fl. 33156
Phone: (305) 670-7006
Anesthesiology / Anestesiólogo Miami-Dade
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
Palm Beach
Ali A. Danesh, P.h.D.FAAA
Labyrinth Audiology
1500 NW 10th ave #104
Phone: (561) 807-7873
Cardiology / Cardiólogo
Miami-Dade
(AV Medical Center)
2075 SW 27 ave #101
Miami, Fl. 33145
Phone: (305) 856-6081
Francisco Dieguez, M.D.
1435 West 49 Place, Suite 500
Hialeah, Fl. 33012
Phone: (305) 575-1776
Fax: (305) 575-1780
Michelle Malow, M.D.
161 NW 29 Street.
Miami, Fl. 33127
Phone: (305) 576-0231
(7 years and Up)
Miami, Fl. 33126
Phone: (305) 774-0742
Guido A. Perez, MD
(Cardiovascular Disease)
8756 SW 8 St,
Miami, Fl. 33174
(Phone: (305) 554-1819
Melvin Martinez-Castrillon, M.D.
3661 South Miami Ave # 902
Miami, Fl. 33133
Phone: (305) 856-7636
Cardiology / Cardiología
Broward
Mian Hasan, MD
603 N Flamingo Road #150
Pembroke Pine, Fl. 33028
(Phone: (954) 436-6660
Maximo Fernandez, MD
603 N Flamingo Road #150
Pembroke Pine, Fl. 33028
Phone: (954) 436-6660
Mian Hasan, MD
100 NW 82nd ave #401
(Phone: (954) 370-9402
100 NW 82nd ave #401
(Phone: (954) 370-9402
255 SE 14th St C1
(Phone: (954) 321-9826
26
Audiology / Audiologia
Luis Tami, M.D.
Miramar, Fl. 33025
Phone: (954) 639-7560
Mian Hasan, MD
255 SE 14th St C1
(Phone: (954) 321-9826
Chiropractor / Quiropráctico
Aixa Goodrich, D.C.
7990 SW 117 Ave Suite 205
Miami, Fl. 33183
Phone: (305) 271-7447
Fax: (305) 271-7448
Miami - Dade
Maria Del Campillo, DC.
3625 NW 82nd Ave. Suite 320
Doral, Fl. 33166
Phone: (305) 593-1555
Fax: (305) 593-1556
Dennis Kogut, DC.
9999 NE 2nd ave Ste # 303
Miami Shores, Fl. 33138
Phone: (305) 978-7680
Fax: (305) 757-6220
Yolaris Garcia, DC.
11730 Biscayne Blv. #104
North Miami, Fl. 33181
Phone: (305) 981-0899
Jan Scott Buchholz, D.C.
(Hands On Healthcare)
2901 West Oakland Park Blvd, Suite A-23
Phone: (954) 731-8097
Broward
David Shwartz, D.C.
SFL Medical & Wellness Clinic)
5931 S. University Dr.
Davie, Fl. 33328
Phone: (954) 252-3339
Lee
Charles Wolter, D.C.
Phone: (239) 288-5413
Fax: (239) 288-5418
Cosmetic Surgery / Cirugía Cosmética
Constantine N. Kitsos, M.D.
(Board certified plastic surgeon)
(Seduction Cosmetic Center)
2500 NW 107 Ave #102
Doral, Fl. 33172
Phone: (305) 406-9055
Camille Chavez, M.D.
2500 NW 107 Ave #102
Doral, Fl. 33172
Phone: (305) 406-9055
Patrick Abuzeni, M.D.
2500 NW 107 Ave #102
Doral, Fl. 33172
Phone: (305) 406-9055
Manuel Lopez Prieto, M.D.
2500 NW 107 Ave #102
Doral, Fl. 33172
Phone: (305) 406-9055
Dermatology / Dermatología
Miami - Dade
Horacio Leyva, M.D.
(Board Certified Plastic Surgeon)
2500 NW 107 Ave #102
Doral, Fl. 33172
Phone: (305) 406-9055
(See price list, Page 94)
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
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)
7400 N. Kendall Drive Suite 411
Miami Fl. 33156
Phone: (305) 670-0178
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
Josefa L. Binker, M.D.
70 NW 8 St
Phone: (305) 242-5225
27
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.
7400 North Kendall Dr., Suite 617
Miami, Fl. 33156
Phone: (305) 670-0576
Carlos Barrera, M.D.
151 NW 11th Street, Ste 102-B
Phone: (305) 670-0576
Endocrinology / Endocrinología
Miami - Dade
Alexander A. Miranda, M.D.
Juventus Medical Center, Inc.
1165 W 49th St # 208
Hialeah, Fl. 33012
Phone: (305) 512-5480
Broward
Emilio Castañeda
Miramar, Fl. 33025
Phone: (954) 639-7560
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
Juan Sarol, M.D.
881 E 2nd ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
Internal Medicine / Medicina Interna
28
Miami - Dade
Juan C. Sarol, M.D.
87 E 49 St
Hialeah, Fl. 33013
Phone: (786) 536-5001
Miami - Dade
Mayre Urdaneta, M.D.
8060 NW 155th Street Ste 201
Phone: (305) 826-0606
Fax: (305) 826-0630
Miami, Fl. 33126
Phone: (305) 774-0742
Margarita del Val, M.D.
(MD Health Care and Rehabilitation)
7975 NW 154th St # 200
Phone: (305) 855-2824
Felix A. Rodriguez, M.D.
(American Family Health Center)
2150 W. 68th Street, Suite 102
Hialeah, Fl. 33018
Phone: (305) 231-8996
Fax: (305) 231-8433
Noel E. Lezama, M.D.
(Universal Comunity Mental Care)
928 SW 82 Ave.
Miami, Fl. 33144
Phone: (305) 265-5744
Fax: (305) 265-5745
(General Medicine)
1435 West 49th Place, Ste 604
Hialeah, Fl. 33012
Phone: (305) 231-3151
Alejandro de la Cruz, M.D.
4118 W 12 Ave
Hialeah, Fl. 33012
Phone: (305) 824-8787
Odalys Frontela, M.D. F.F.C.P
(General Medicine)
801 West 48th Street, Suite A
Hialeah, Fl. 33012
Phone: (305) 698-7172
Otneil Hernandez, DNP, ARNP.
4410 West. 16th Ave. # 55
Hialeah, Fl. 33013
Phone (305) 824-8559
Miami - Dade
Gonzalo Gonzalez, M.D.
6854 W Flagler St
Miami Fl. 33144
Phone: (786) -310-7697
Joseph Thevenin, M.D.
9635 SW 181 Terrace.
Miami, Fl. 33157
Phone: (305) 238-8561
José Padrón, M.D.
2601 SW 37 Ave, Suite 707
Miami, Fl. 33133
Phone: (305) 569-0010
(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
Roberto Sotolongo, M.D.
632 Washington Ave
Phone: (305) 246-1265
Alfonso Garcia_Bello, M.D.
9632 Washington Ave
Phone: (305) 246-1265
Juan Miguel Fernandez, M.D.
2322 NW 28 St
Miami, Fl. 33142
Phone: (305) 633-3667
Fax: (305) 633-3664
Juan Miguel Fernandez, M.D.
9600 SW 8 St #30
Miami, Fl. 33174
Phone: (305) 633-3667
Fax: (305) 633-3664
Herbert Pardell, DO.
Emeril Health Medical Center
Phone: (954) 987-4455
Santiago Cardenas ,M.D.
(General & Internal Medicine)
Pines Care Medical Center, LLC
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Carlos Vallin, M.D.
Miramar Medical Center
Miramar, Fl. 33025
Phone: (954) 639-7560
Emilio Castañeda, M.D.
Miramar, Fl. 33025
Phone: (954) 639-7560
Karen Prida, M.D.
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Jayner Moya, M.D.
301 NW 103 Ave, # 235
Phone: (954) 251-1497
Internal Medicine / Medicina Interna Palm Beach
Jean-Luc Michel, M.D.
(Internal Medicine)
1800 Forest Hill Blvd Suite B-9
West Palm Beach, Fl. 33406
Phone: (561) 968-7288
Fax: (561) 968-7488
Immacula Michel, M.D.
(Internal Medicine)
1800 Forest Hill Blvd Suite B-9
Phone: (561) 968-7288
Fax: (561) 968-7488
Nephrology / Nefrología
Guibel Perera, M.D.
10710 SW 38 St
Miami, Fl. 33165
Phone: (305) 392-1000
Broward
Internal Medicine
Collier
Alfonso Garcia, M.D.
Naples Health Care, Inc.
Naples, Fl. 34103
Phone: (239) 304-9290
Miami - Dade
Jorge L. Posada, M.D.
747 Ponce de Leon Blvd # 605
Phone: (305) 445-4535
Luis Garcia-Mayol, M.D.
Phone: (305) 445-4535
29
Neurology / Neurología
Enrique A. Wulff, M.D. P.A
(Neurology)
351 NW 42 Ave #103
Miami, Fl. 33126
Phone: (305) 642-4616
Fax: (305) 631-1419
Miami - Dade
Martha Bustamante, M.D
(Pediatric Neurology)
4160 W. 16 Ave. Suite 100
Hialeah, Fl. 33012
Phone: (305) 826-5655
Diagnostic Center of Neurological Studies
Neurology Mobile System Associates, Inc
7374 SW 93 ave, Suite 201
Miami, Fl. 33173
Phone: 305-270-7771
Fax: 305-270-7775
See procedures and fee schedule of this center only in the chart below
PROCEDURE
Soft-Tissue
Ultrasound
Neurological
Studies
DESCRIPTION
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
Ophthalmology / Oftalmología
30
CPT ODES
76536
76800
76880
95900
95903
95904
95900
95903
95904
95819
92585
92280
95930
95860
95861
95863
95864
95933
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
Miami - Dade
Manuel Airala, M.D.
Marta Airala M.D.
(Laser & Cataract Institute)
202 East 49 Street.
Hialeah, Fl. 33013
Phone: (305) 558-7895
Salomon Esquenazi, M.D.
202 East 49 Street.
Hialeah, Fl. 33013
Phone: (305) 558-7895
Jorge J. Bacallao, M.D.
202 East 49 Street.
Hialeah, Fl. 33013
Phone: (305) 558-7895
Tomas Ugarte M.D.
(Ophthalmology)
900 West 49th Street, Ste 300
Hialeah, Fl. 33012
Phone: (305) 823-6525
Fax: (305) 823-6527
Marta Airala, M.D.
2441 SW 37 Avenue.
Miami, Fl. 33145
Phone: (305) 442-0066
Jonathan Leon-Rosen MD
2441 SW 37 Avenue.
Miami, Fl. 33145
Phone: (305) 442-0066
Salomon Esquenazi, MD
2441 SW 37 Avenue.
Miami, Fl. 33145
Phone: (305) 442-0066
2441 SW 37 Avenue.
Miami, Fl. 33145
Phone: (305) 442-0066
Osvaldo Caffa, M.D.
(Vision Specialty Care)
9000 SW 87 Ct Suite 206
Miami, Fl. 33176
Phone: (305) 596-1717
Osvaldo Caffa, M.D.
7949 NW 2 St
Miami, Fl. 33126
Phone: (305) 263-9050
Rodrigo Belalcazar, M.D.
7949 NW 2 St
Miami, Fl. 33126
Phone: (305) 263-9050
7949 NW 2 St
Miami, Fl. 33126
Phone: (305) 263-9050
MP. NS .FS 01/13
Ophthalmology / Oftalmología
Palm Beach
Marco Fabrega, PAC
2531 N Dixie Hwy
Phone: (561) 582-0330
Fax: (561) 582-0339
Call for Appointment
Orthopedics / Ortopedia
Miami - Dade
Alejandro de la Cruz, M.D.
(Orthopedic / Ortopédico)
4118 W 12 Ave
Hialeah, Fl. 33012
Phone: (305) 824-8787
Carlos Roig, M.D.
(Orthopedic Medicine & Surgery)
161 NW 29 Street,
Miami, Fl. 33127
Phone: (305) 576-0231
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
Arnaldo V. Lopez, M.D.
1545 S.W 1St Street, Suite 200
Miami, Fl. 33135
Phone: (305) 541-3230
Fax: (305) 541-1650
Jose L Ponce de Leon, M.D.
(Orthopedic / Ortopédico)
3501 SW 107 ave
Miami, Fl. 33165
Phone: (305) 229-1227
Ignacio Calvo, M.D.
1800 SW 27 Ave, Ste 400
Miami, Fl. 33145
Phone: (305) 856-7411
Podiatry / Podiatría
Miami - Dade
Dominique Rameau, D.P.M.
888 NW 126 St Suite #200
Miami, Fl. 33161
Phone: (305) 892-7959
Fax: (305) 892-7960
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
Yanssel Delgado, D.P.M.
5590 W 20 Ave Suite # 404
Hialeah, Fl. 33016
Phone: (305) 819-9240 / 9239
Richard Mallia, D.P.M.
161 NW 29 Street.
Miami, Fl. 33127
Phone: (305) 576-0231
Joaquin Fernandez, D.P.M.
605 SW 57 Avenue.
Miami, Fl. 33144
Phone: (305) 269-8223
Fax: (305) 262-0554
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
Flavia Inesta, D.P.M.
1797 SW 3 ave
Miami, Fl. 33129
Phone: (305) 856-4454
Howard Umansky, D.P.M.
(Miami Community Health Center)
2324 SW 8 St
Miami, Fl. 33135
Phone: (305) 643-0535
Francisco Perez Clavijo, D.P.M
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
1st Visit: $60 - Follow Up: $40
Riquel Gonzalez, D.P.M
Private Medical Center.
10 NW 42th Ave. Suite 300
Miami, Fl. 33126
Phone: (305) 774-0742
1st Visit: $60 - Follow Up: $40
31
Collier
Angel Garcia, D.P.M.
Naples Fl. 34103
Phone: (239) 304-9290
Lee / Cape Coral
Nelson Gonzalez, M.D.
(Podiatry)
Phone: (239) 772-1194 / 1195
Psychiatry / Psiquiatría
Evelyn Lopez Brignom, M.D.
(Adults and Children )
Miami Community Health Center
2324 SW 8 ST
Miami, Fl. 33135
Phone: (305) 643-0535 / (305) 767-5635
Fax: (305) 642-9360
Miami - Dade
Carlos Pérez, M.D.
881 E 2nd ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
Silvia R. Silva-Duluc, M.D.
(Healthy Connections CMHC, Inc)
2780 SW 37th ave, Suite 206
Miami, Fl. 33133
Phone: (305) 646-0112
Fax: 305-646-0113
Jose C. Lopez-Escobar, M.D.
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
Psychology / Psicología
Mercedes Llenin, M.D.
5600 SW 135 Ave, Suite 116
Miami, Fl. 33183
Phone: (305) 387-7850
Maria Moncayo, M.D.
10406 Taft St
Phone: (954) 436-3880
Calixto Garcia, M.D.
(Psychologist)
Phone: (239) 772-1194 / 1195
32
Miami - Dade
Amelie Bethart-Tejera PH,D
5600 SW 135 Ave, Suite 116
Miami, Fl. 33183
Phone: (305) 387-7850
Broward
Prince R. Drago, M.D.
(Healthy Connections CMHC, Inc)
2780 SW 37th ave, Suite 206, Miami, Fl. 33133
Phone: (305) 646-0112
Fax: 305-646-0113
Collier
Calixto Garcia, M.D.
(Psychologist)
Naples Fl. 34103
Phone: (239) 304-9290
Lee / Cape Coral
Pulmonology / Neumología
Miami - Dade
(Pulmonary Medicine)
1435 West 49n Place #604
Hialeah, Fl. 33012
Phone: (305) 231-3151
Fax: (305) 885-5884
Surgery / Cirugía
(Surgeon / Cirujano)
(Private Medical Center Inc).
10 NW 42nd Ave Ste 300
Miami Fl. 33126
Phone:(305) 774-0742
Fee: Florida Medicaid Rate
Miami - Dade
John Padron, M.D.
(OPA Medical Center)
1865 NE 163 Street
Miami, Fl. 33162
Phone: (305) 948-9958
Jorge Alvarez Moreno, M.D.
881 E 2nd ave
Hialeah, Fl. 33010
Phone: (305) 882-1100
Fernando Lora, M.D.
(Surgeon / Cirujano General y Vascular)
(Vital Medical Center)
8300 W Flagler, Suite 175
Miami, Fl. 33144
Phone: (305) 220-0300
Urology / Urología
Luis Sabogal, M.D.
(Urology / Urología)
1800 SW 27 Avenue, Suite 402
Miami, Fl. 33145
Phone: (305) 445-2404
Luis F. Maggiolo, M.D.
(Urlogy / Urología)
Phone: (305) 444-2858
Fax: 305-448-3346
Miami - Dade
Eduardo Guzman, M.D.
1800 SW 27 Avenue, Ste 402
Miami, Fl. 33145
Phone: (305) 445-2404
Juan B Suarez, M.D.
5450 SW 8th St #204
Miami, Fl. 33134
Phone: (305) 443-8041
Fax: (305) 444-2054
33
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
Urgent Care Centers / Centros de Urgencia
34
Miami - Dade
Med Clinic Inc.
9588 NW 41th St.
Miami Fl. 33178
Phone: (305) 477-4475
Fax: (305) 477-4487
Language: English / Spanish
HOURS OF OPERATION:
MON – FRI 10AM – 10:00PM
SAT – SUN 10:00AM – 10:00PM
MDD Medical Center.
(Urgent Care)
6905 NW 77 ave
Miami, Fl. 33166
Phone: (305) 884-1919
Fax: (305) 884-1969
HOURS OF OPERATION:
MON – FRI 10:00AM – 6:00PM
Elite Health & Rehabilitation.
6450 W. 21 Ct. Suite 200
Hialeah, Fl. 33016
Phone: (305) 698-0806
Fax: (305) 698-2325
HOURS OF OPERATION:
MON – FRI 8:AM – 6:00PM
SAT – 8:00AM – 2:00PM
South Florida Urgent Care
(Urgent Care)
5590 W 20 Ave # 100
Hialeah Fl. 33016
Phone: (305) -827-3303
HOURS OF OPERATION:
MON – FRI 8:00AM – 8:00PM
Campbell Urgent Care.
1855 NE 8th Street.
Phone: (305) 242-8025
Fax: (305) 245-1839
Gonzalez Medical Center, Inc.
Hialeah, Fl. 33012
Phone: (305) 818-1099
Fax: (305) 820-3272
HOURS OF OPERATION:
MON – FRI 9:00AM – 12:00AM
SAT 9:00AM-6:00PM
For assistance after hours please call us.
HOURS OF OPERATION:
SAT – SUN 10:00AM – 4:00PM
Urgent Care Centers / Centros de Urgencia
Urgent Care Center.
(UrgentMed)
2337 S. University Drive
Davie, Fl. 33324
Phone: 954-423-9234
Fax: (954) 423-9231
Medicaid Rates after 5:00 PM.
HOURS OF OPERATION:
SAT – 9:00AM – 5:00PM
Pines Professional Campus
(Urgent Care)
302 NW 179 St # 103
Phone: (954) 442-8380
HOURS OF OPERATION:
SAT-SUN 9:00AM – 6:00PM
Broward
Caribe Medical Center of Homestead
(Urgent Care)
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
HOURS OF OPERATION:
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
$145.00
35
DENTAL SERVICES / SERVICIOS DENTALES
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 $75 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 $75.00 el cuadrante (Código 4341). Si la dentadura está
incompleta el precio a pagar será de $60.00 (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
Miami - Dade
Med Dental Associated Inc.
7200 NW 7St Suite 333
Miami, Fl. 33126
Phone: 305-264-0063
Fax: 305-264-0065
America Dental Clinic
3631 SW 87 Ave
Miami, Fl. 33165
Phone: (305) 485-8427
Fax: (305) 9485-8429
Maria J. Alvarez, DDS.
Dental Group of South Florida II
11336 SW 184 St
Miami, Fl. 33157
Phone: (305) 251-4262
Ernesto Quezada, DDS.
Dental Group of South Florida II
11336 SW 184 St
Miami, Fl. 33157
Phone: (305) 251-4262
Life Dental Care Corp.
123 N Powerline Rd.
Derfield Beach, Fl. 33442
Phone: (954) 429-8840
Fax: 954-429-8842
Hialeah Dental Care
4240 W 16 ave
Hialeah, Fl. 33012
Phone: (305) 823-1882
Broward
Pines Dental Care Inc.
17868 NW 2 ST
Phone: (954) 538-0047
Fax: 954-538-0924
Palm Beach
Mario Hernandez, DDS.
6815 South Dixie Hwy
Phone: (561) 585-5891
Fax: 561-586-6014
36
MP. D. FS 01/13
SPECIAL FEES FOR DENTAL SERVICES PROVIDED EXCLUSIVELY AT:
MED DENTAL ASSOCIATES, INC
7200 NW 7 ST, SUITE 333
MIAMI, FL 33126
PHONE: (305) 264-0063
FAX: (305) 264-0065
DENTAL SERVICES ONLY FOR NEW MED PLAN MEMBERS
SERVICIOS DENTALES SOLO PARA NUEVOS PACIENTES DE MED PLAN
FEE
Comprehensive Oral Evaluation / Examen Dental Completo
$0.00
D 0210
Full Mouth X-Rays / Radiografia completa de la boca
$0.00
D 1110
Simple Prophylaxis / Limpieza Dental Simple
$0.00
D 0150
D 2330 Single Restoration Per Surface / Empaste de una superficie anterior (Cubre un empaste)
$0.00
D 1203 Topical Application of Fluoride - Child / Aplicacion de fluoruro - Niño menor de 16 años
$0.00
D 1204 Topical Application of Fluoride - Adult / Aplicacion de fluoruro para adultos
$0.00
D 7110 Single Tooth Extraction / Extracción simple (Cubre una extracción)
$0.00
DENTAL SERVICES OFFERED ONLY BY THIS CLINIC TO MED PLAN MEMBERS
SERVICIOS DENTALES OFRECIDOS SOLO EN ESTA CLINICA PARA PACIENTES DE MED PLAN
D 2330 Single Restoration Per Surface / Empaste de una superficie anterior.
$45.00
D 2331 Resin Based Composite Filling Two Surface Anterior / Empaste de dos superficies anterior
$55.00
D 2332 Resin Based Composite Filling - Three Surfaces Anterior / Empaste de tres superficies anterior
$65.00
D 2335 Resin Based Composite Filling - Four or more surfaces anterior / Empaste de 4 superficies anterior
$75.00
D 7110 Simple Extraction / Extraccion Simple
$60.00
D 3310 Root Canal Anterior (DENTISTA GENERAL)
$350.00
D 3320 Root Canal – Bicuspid (DENTISTA GENERAL)
$450.00
D 3330 Root Canal - Molar (DENTISTA GENERAL)
$550.00
D 2952 Cast post/core in addition to crown
$120.00
D 2750 Crown porcelain fused to high noble metal / Porcelana fundida al metal (PFM)
$395.00
D 2740 Crown porcelain ceramic / Porcelana completa
$450.00
D 4341* Periodontal scaling and root planing/quad - Limpieza profunda por cuadrante (de 4 o más dientes)
$60.00
D 4342 Periodontal scaling and root planing - 1 to 3 teeth per quadrant / Limpieza profunda por cuadrante (de 1 a 3 dientes)
$45.00
D 5110 Complete denture - Maxillary / Dentadura completa superior
$375.00
D 5120 Complete Denture - Mandibular / Dentadura Completa Inferior
$375.00
D 5213 Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases / Dentadura parcial de metal superior.
$395.00
D 5214 Mandibular Partial Denture - Cast Metal Framework with Resin Denture Bases / Dentadura parcial de metal inferior
$395.00
The fees of the procedures not listed in the above chart can be found in the following pages.
El costo de los procedimientos dentales que no aparecen en la lista anterior se encuentran en la lista
de precios que aparece en las páginas siguientes.
Los miembros podrán disfrutar de estos servicios en Med Dental a partir del tercer mes de su afiliación.
* Periodontal scaling and root planing of 4 quadrant costs $240.00
* La limpieza profunda de los 4 cuadrantes tiene un costo de $240.00.
MP. D. FS 01/13
37
GENERAL DENTISTRY FEE SCHEDULE
ADA CODES
D0120
D0140
D0150
D0160
D0170
D0180
D0210
D0220
D0230
D0240
D0250
D0260
D0270
D0272
D0330
D0340
D0350
D0460
D0470
D1110
D1120
D1201
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
D2542
D2543
D2544
D2610
D2620
D2630
D2642
D2643
D2644
D2650
D2651
D2652
D2662
D2663
D2664
D2710
38
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
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
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 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 (EMPASTES)
RESIN-BASED COMPOSITE - 2 SURFACES, ANTERIOR (EMPASTES)
RESIN-BASED COMPOSITE - 3 SURFACES, ANTERIOR (EMPASTES)
COMPOSITED RESIN - 4 OR MORE SURFACES (EMPASTES)
RESIN - BASED COMPOSITE - 1 SURFACE, POSTERIOR (EMPASTES)
RESIN-BASED COMPOSITE - 2 SURFACES, POSTERIOR (EMPASTES)
RESIN-BASED COMPOSITE - 3 SURFACES, POSTERIOR (EMPASTES)
RESIN-BASED COMPOSITE - 4 OR + SURFACES, POSTERIOR (EMPASTES)
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
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)
Fees
NO CHARGE
$10.00
$20.00
NO CHARGE
NO CHARGE
$15.00
$30.00
$15.00
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
$25.00
$75.00
$20.00
$10.00
$25.00
$49.00
$35.00
NO CHARGE
NO CHARGE
$20.00
NO CHARGE
NO CHARGE
NO CHARGE
$15.00
$120.00
$175.00
$160.00
$250.00
$25.00
$60.00
$70.00
$80.00
$90.00
$60.00
$70.00
$80.00
$90.00
$75.00
$95.00
$125.00
$300.00
$320.00
$340.00
$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
MP. D. FS 01/13
ADA CODES
D2720
D2721
D2722
D2740
D2750
D2751
D2752
D2780
D2781
D2782
D2783
D2790
D2791
D2792
D2799
D2910
D2920
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
D4211
D4220
D4240
D4241
D4245
D4341
D4342
D4355
D4381
D4910
D5110
D5120
D5211
D5212
D5213
MP. D. FS 01/13
DESCRIPTION
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
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.
ENDODONTICS 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
PERIODONTICS SERVICES
GINGIVECTOMY/GINGIVOPLASTY - 1 TO 3 TEETH, PER QUAD
GINGIVAL CURETTAGE PER QUADRANT EXCLUDING ROOT PLANNING
GINGIVAL FLAP PROCEDURE- 4 OR MORE
GINGIVAL FLAP PROCEDURE - 1 TO 3 TEETH PER QUAD
APICALLY POSITIONED FLAP
PERIODONTAL SCALING & ROOT PLANING - 4 OR MORE CONTIGUOUS TEETH
PERIODONTAL SCALING $ ROOT PLANING - 1 TO 3 TEETH, PER QUAD
FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVE EVALUATION
LOCAL DELIVERY ANTIBIOTIC (ARESTIN)
PERIODONTAL MAINTENANCE
COMPLETE DENTURE - MAXILLARY BASIC
COMPLETE DENTURE - MANDIBULAR BASIC
MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING CLASPS)
MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING CLASPS)
PARTIAL DENTURE - MAXILLARY CAST METAL - ACRYLIC
Fees
$455.00
$405.00
$425.00
$595.00
$495.00
$495.00
$495.00
$530.00
$410.00
$520.00
$550.00
$699.00
$525.00
$580.00
$50.00
$25.00
$25.00
$95.00
$95.00
$95.00
$145.00
$40.00
$85.00
$20.00
$155.00
$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
$395.00
$495.00
$595.00
$85.00
$495.00
$595.00
$695.00
$75.00
$50.00
$75.00
$325.00
$250.00
$150.00
$75.00
$60.00
$80.00
$30.00
$55.00
$495.00
$495.00
$450.00
$450.00
$575.00
39
ADA CODES
D5214
D5410
D5411
D5421
D5422
D5510
D5520
D5610
D5620
D5630
D5640
D5650
D5660
D5710
D5711
D5720
D5721
D5730
D5731
D5740
D5741
D5750
D5751
D5760
D5761
D5810
D5811
D5820
D5821
D5850
D5851
D5862
D6210
D6211
D6212
D6240
D6241
D6242
D6245
D6740
D6750
D6751
D6752
D6780
D6781
D6782
D6783
D6790
D6791
D6792
D6930
D6950
D6970
D6971
D6972
D6973
D6975
D7110
D7140
D7310
D7320
D7510
D9215
40
DESCRIPTION
PARTIAL DENTURE - MANDIBULAR VAST METAL - ACRYLIC
ADJUSTMENT - COMPLETE DENTURE - MAXILLARY
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)
RELINE PARTIAL COMPLETE MANDIBULAR DENTURE (CHAIRSIDE)
RELINE COMPLETE MAXILLARY DENTURE (LABORATORY)
RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY)
RELINE PARTIAL MAXILLARY DENTURE (LABORATORY)
RELINE PARTIAL MANDIBULAR DENTURE (LABORATORY)
INTERIM COMPLETE DENTURE - MAXILLARY
INTERIM COMPLETE DENTURE - MANDIBULAR
INTERIM PARTIAL DENTURE - MAXILLARY
INTERIM PARTIAL DENTURE - MANDIBULAR
TISSUE CONDITIONING - MAXILLARY
TISSUE CONDITIONING - MANDIBULAR
PRECISION ATTACHMENT
PROSTHODONTICS - FIXED
PONTIC - CAST HIGH NOBLE METAL
PONTIC - CAST PREDOMINANTLY BASE METAL
PONTIC - CAST NOBLE METAL
PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL
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
PREFABRICATED POST & CORE IN ADDITION TO FIXED PARTIAL DENTURE
CORE BUILD UP FOR RETAINER, INCLUDING PINS
COPING - METAL
ORAL SURGERY
SINGLE TOOTH EXTRACTION (EXTRACCION)
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
Fees
$575.00
$20.00
$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
$65.00
$150.00
$150.00
$110.00
$110.00
$250.00
$250.00
$250.00
$250.00
$55.00
$55.00
$150.00
$400.00
$400.00
$400.00
$400.00
$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
$125.00
$95.00
$95.00
$70.00
$70.00
$95.00
$130.00
$55.00
NO CHARGE
MP. D. FS 01/13
ADA CODES
D9230
D9630
D9940
D9950
D9951
D9952
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
Fees
$20.00
$10.00
$195.00
$75.00
$25.00
$150.00
DENTAL SPECIALTIES FEE SCHEDULE
ADA CODES
ED3310
ED3320
ED3330
ED3346
ED3347
ED3348
ENDODONTICS
Fees
ROOT CANAL THERAPY - ANTERIOR
ROOT CANAL THERAPY - BICUSPID
ROOT CANAL THERAPY - MOLAR
RETREAT, PREV RCT - ANTERIOR
RETREAT, PREV RCT - BICUSPID
RETREAT. PREV RCT - MOLAR
$695.00
$775.00
$925.00
$750.00
$825.00
$1,125.00
D4210
D4249
D4260
D4263
D4264
D4266
D4275
D7953
D7960
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
$450.00
$800.00
$900.00
$650.00
$500.00
$900.00
$1,200.00
$400.00
$500.00
D7210
D7220
D7230
D7240
D7241
D7250
D7285
D7286
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
D8080
D8090
COMPREHENSIVE ORTHO, ADOLESCENT
COMPREHENSIVE ORTHO, ADULT
$3,490.00
$3,490.00
SURG PLACE IMPLANT, ENDOSTEAL
COMPLETED CROWN IMPLANT (IMPLANTE Y CORONA)
OVERDENTURE UPPER WITH 4 IMPLANTS
OVERDENTURE LOWER WITH 3 IMPLANTS
$1,200.00
$1,950.00
$4,650.00
$3,650.00
D6010
D6010/D6059
D0000
D0000
PERIODONTICS
ORAL SURGERY
ORTHODONTICS
IMPLANTS
$240.00
$300.00
$395.00
$450.00
$500.00
$250.00
$120.00
$95.00
$50.00
*The basic cleaning does not apply if you have any periodontal disease.
* The dental procedures not listed in your pricing list will apply to a discount of 25%. The dentists and specialists are
the only responsible parties for the treatment and its charges. Med Plan is not responsible for payments nor for orthodontics indications performed by the dentists or specialists associated with our plan.
*La limpieza simple no aplica si Usted tiene evidencia de enfermedad periodontal.
*A los procedimientos que no aparecen en su lista de precios se les aplicara un descuento del 25% de lo usual y razonable.
Los dentistas y especialistas son los unicos responsables por el tratamiento y precio del mismo. Med Plan no es responsable
por los pagos ni por las indicaciones odontologicas hechas por los dentistas y especialistas asociados a nuestro plan.
MP. D. FS 01/13
41
SPECIAL FEES FOR VISION SERVICES PROVIDED EXCLUSIVELY AT:
MED-VISION ASSOCIATES, INC and VISION SPECIALTY CARE
Vision Specialty Care
Miami - Dade
MED-VISION
7200 NW 7th St Suite 207
Miami, Fl. 33126
For appointments: 305-263-9050
Open Hours:
Tuesday & Friday
1:00 PM - 5:00 PM
OPTOMETRY PROCEDURES
Without
Med Plan
Refraction
Single Vision Lens With Frame
Bifocal Lens With Frame
Trifocal Lens With Frame
Progressive Lens With Frame
Bifocal Transition Lens With Frame
Progressive Transition Lens With Frame
Refraction Under 16 Years
Single Vision Lens With Frame Under
16 Years
Luxury Frames (Guess, Kenneth Cole, Sketchers,
Harley Davidson, Fendi, etc)
$70.00*
$90.00*
$115.00*
$115.00*
$150.00*
$190.00*
$250.00*
$70.00*
With
Polycarbonate
lens
$130.00
$155.00
$155.00
$190.00
$230.00
$290.00
$150.00/$250.00
$30.00
$30.00
$35.00
$40.00
$50.00
$75.00
$85.00
$25.00
$45.00
$60.00
$65.00
$75.00
$100.00
$110.00
$57.00
$60.00 (70% discount)
Miami - Dade
Osvaldo Caffa, M.D.
9000 SW 87 Ct Suite 206
Miami, Fl. 33176
Phone: (305) 596-1717
Corrective Laser Surgery Both Eyes and Three Post
op Consultation
Laser Surgery for Retina, Glaucoma and Diabetic
Treatment
Fee
With
Polycarbonate
lens
$150.00
Lasik Surgery - Corrective Laser Surgery
OPHTHALMOLOGY PROCEDURES
VISION SPECIALTY CARE
(Vision Center/ Optica)
5190 NW 167 St Suite 109
Miami, Fl. 33014
Phone: (305) 263-9050
Osvaldo Caffa, M.D.
Rodrigo Belalcazar, M.D.
7949 NW 2 St
Miami, Fl. 33126
Phone: (305) 263-9050
Without
Med Plan
Fee
$2400.00
$1900.00
$1500.00
$1100.00
*Vision Specialty Care Inc agrees that any Med Plan member whose status is not “ACTIVE” will be charged the rate
indicated on column “Without Med Plan” on exhibit “A”. Failure to comply with this is grounds for immediate termination
of this agreement and Med Plan LLC will seek legal recourse for damages resulting in non compliance of this pricing
schedule.
42
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.
Optical & Vision Centers / Centros Opticos
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 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
(OPTICA ARIAS). **
9160 NW 122th Street, Suite 28
Hialeah Gardens , Fl. 33018
Phone: (305) 512-4408
(VISION CENTER OPTICA). **
Gerald D. Furnari O.D. F.A.A.O.
Patrick F. Vecchio O.D. F.A.A.O.
8501 SW 124 Ave # 109
Miami Fl. 33183
Phone: (305) 665-5712
Broward
Eric Dupuis, OD.
Christopher Boalding, OD.
Laurie Lesser, OD.
2551 South University Drive
Davie, Fl. 33324
Phone: (954) 370-5883
Fax: (954) 370-8799
Eric Dupuis, OD.
Christopher Boaldin, OD.
Robert Coppola, OD.
2900 W. Cypress Creek Rd. # 1
Ft. Lauderdale Fl. 33309
Phone: (954) 979-2191
Fax: (954) 979-8988
Mirian Faraq, OD.
Jerrold Mills, OD.
3181 North State Rd. # 7
Margate Fl. 33063
Phone: (954) 974-7695
Fax: (954) 974-4211
Laura DeMarco, OD.
1666 East Oakland Park Blvd..
Ft. Luderdale Fl. 33334
Phone: (954) 566--1404
Fax: (954) 566-0291
Harold Forrest, OD.
Laurie Lesser, OD.
12538 Pines Blvd.
Phone: (954) 430-4030
Robert Coppola, OD.
1205 S. Powerline Rd.
Pompano Beach, Fl. 33069
Phone: (954) 977-6636
Fax: (954) 977-3822
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.
43
Palm Beach
Ashley Nochomson, OD.
Karen Puchalski, OD.
Miriam Farag, OD.
9851- B South Military Trail.
Boynton Beach, Fl. 33436
Phone: (561) 742-8701
Fax: (561) 742-4212
143 N. Powerline Road
Deerfield Beach, Fl. 33442
Phone: (954) 429-9600
Fax: (954) 429-9956
Ronie Zaruches, OD.
143 N. Powerline Road
Phone: (954) 429-9600
Fax: (954) 429-9956
Mitchell Biderman, OD.
Lori Raynor, OD.
6618 West. Atlantic Ave.
Delray Beach, Fl. 33446
Phone: (561) 498-5007
Fax: (561) 496-3088
Mitchell Biderman, OD.
Lori Raynor, OD.
Ashley Nochomson, OD.
6266 S. Congress Ave. # 9
Lantana, Fl. 33462
Phone: (561) 966-9000
Jason Aronson, OD.
2905-G N. Military Trail
Phone: (561) 684-5548
Fax: (561) 684-6229
St. Lucie
(ST. LUCIE VISION CENTER). **
Mitchell Biderman, OD. **
10077 South Federal Hwy.
Port St. Lucie, Fl. 34952
Phone: (772) 398-3244
Fax: (772) 398-8090
(VISTA VISION EYE CARE). **
12320 South Cleveland Ave.
Ft. Myers Fl. 33907
Phone: (239) 936-5591
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.
44
Ft. Myers
VISION AND OPTICAL FEE SCHEDULE
TARIFAS DE SERVICIOS OPTICOS
SOUTH FLORIDA VISION**
EYE EXAM
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
Bifocal Transition
Lens
Transition
Progressive Lens
39 (Single Vision)
$35.00
(Bi-Focal FT-28)
$35.00
(Tri focal 7x28)
$45.00
(Bi-Focal)
$60.00
$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
Standard Select
Progressive
Bifocal Transition
Lens
Transition
Progressive Lens
39 (Single Vision)
$35.00
(Bi-Focal FT-28)
$30.00
(Tri focal 7x28)
$40.00
(Bi-Focal)
$55.00
$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
Standard Select
Progressive
Bifocal Transition
Lens
Transition
Progressive Lens
39 (Single Vision)
$35.00
(Bi-Focal FT-28)
$30.00
(Tri focal 7x28)
$40.00
(Bi-Focal)
$55.00
$80.00
$90.00
TRIANGLE VISION CENTER ***
EYE EXAM
SINGLE VISION
$30.00
$30.00
Standard Stock
CR-39
Standard Stock
CR-39
Standard Stock
CR-39
Standard Select
Progressive
Bifocal Transition
Lens
Transition
Progressive Lens
39 (Single Vision)
$35.00
(Bi-Focal FT-28)
$30.00
(Tri focal 7x28)
$40.00
(Bi-Focal)
$55.00
$80.00
$90.00
(**) 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.
MP.V.FS 01/13
45
CLINICAL LABS / LABORATORIOS CLINICOS
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 / Laboratorio Clínico
Complete Bio Solutions
7200 NW 7 ST # 202
Miami, Fl. 33126
Phone: (305) 267-7784
Veni puncture Fee: $10.00
10550 NW 77 Court
Hialeah, Fl. 33016
Phone: (305) 826-3072
5850 West Flagler ST
Miami, Fl. 33144
Phone: (305) 263-9590
3720 SW 107 ave
Miami, Fl. 33165
Phone: (305) 554-4270
2546 West 6th ave
Hialeah, Fl. 33010
Phone: (305) 477-6520
26799 S. Dixie Hwy
Naranja, Fl. 33032
Phone: (305) 258-6070
Miramar, Fl. 33025
Phone: (954) 639-7560
46
Miami - Dade
Broward
Palm Beach
The providers send the test requisition by fax to the laboratory.
Fax: 305-477-6519
Collier
Complete Bio Solutions (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
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.
Phone: (239) 772-1194 / 1195
Orange
Venipuncture Center for Med Plan Members at a cost of $10.00
ECCO LAB GROUP
1130 South Semoran Blvd
Orlando, Fl. 32807
Phone: (407) 480-2938
ANNUAL FREE PANELS (5 per member) AT ALL ECCO LAB GROUP AND VENIPUNCTURE FOR $10.
Hillsborough
Venipuncture Center for Med Plan Members at a cost of $10.00
ECCO LAB GROUP
2801 Waters Ave Suite B-1
Tampa, Fl. 33614
Phone: (813) 932-9525
Contact: Nadina Rodriguez
ANNUAL FREE PANELS (5 per member) AT ALL ECCO LAB GROUP AND VENIPUNCTURE FOR $10.
47
ANNUAL HEALTH SCREEN LAB / EXAMENES DE LABORATORIO ANUAL
Med Plan offers all its members a group of essential blood exams to ensure you stay healthy and strong. These tests are provided
once a year for each member of your family.
Med Plan ofrece a todos sus miembros un grupo esencial de examenes de sangre con el objetivo de asegurar que se mantengan
fuertes y saludables. Estos exámenes son efectuados a cada miembro de la familia una vez al año.
Tests Provided / Examenes ofrecidos
Complete Blood Count (CBC). It measures the following:
Conteo completo de células sanguíneas (CBC).
The number of red blood cells (RBC count)
The number of white blood cells (WBC count)
The total amount of hemoglobin in the blood
The fraction of the blood composed of red blood cells
(hematocrit)
Average red blood cell size (MCV)
Hemoglobin amount per red blood cell (MCH)
The amount of hemoglobin relative to the size of the cell
(hemoglobin concentration) per red blood cell (MCHC)
Conteo completo de células sanguíneas o “CBC”, cuenta la
cantidad de glóbulos rojos, glóbulos blancos y plaquetas
que hay en la sangre. Además de los conteos de células
sanguíneas, muchas sustancias químicas en la sangre pueden
indicar el nivel de funcionamiento de otras partes del cuerpo,
por ejemplo el hígado, los riñones, el corazón y los pulmones.
Comprehensive Metabolic Panel. It measures:
How your kidneys and liver are working
Blood sugar, cholesterol, and calcium levels
Sodium, potassium, and chloride levels (called electrolytes)
Protein levels
TSH (Thyroid-Stimulating Hormone)
It measures the amount of thyroid stimulating hormone (TSH)
in your blood. TSH is produced by the pituitary gland. It tells
the thyroid gland to make and release thyroid hormones into
the blood.
Lipid Profile
Lipid profile or lipid panel, is a panel of blood tests that serves
as an initial broad medical screening tool for abnormalities in
lipids, such as cholesterol and triglycerides. The results of this
test can identify certain genetic diseases and can determine
approximate risks for cardiovascular disease, certain forms of
pancreatitis, and other diseases. Lipid panels are commonly
ordered as part of a physical exam, along with other panels
such as the complete blood count (CBC) and basic metabolic
panel (BMP).
Urinalysis
It is an array of tests performed on urine, and one of the most
common methods of medical diagnosis. The target parameters
that can be measured or quantified in urinalysis include many
substances and cells, as well as other properties, such as
specific gravity.
48
Panel Metabólico Completo
Este mide la glucosa, los niveles de calcio, la albúmina y
proteína total, el sodio, el potasio, el dióxido de carbono y el
cloruro, el nitrógeno ureico en sangre (NUS) y la creatinina, la
fosfatasa alcalina, las enzimas alanina aminotransferasa, y la
aspartato amino transferasa, y la bilirrubina.
TSH (Hormona estimulante de la tiroides)
Se utiliza para evaluar el funcionamiento de la glándula
tiroides, ubicada en la parte inferior delantera del cuello. La
TSH es producida por la glándula pituitaria, que está ubicada
en la base del cerebro.Cuando la glándula tiroides no produce
cantidades suficientes de hormona tiroidea (una afección que
recibe el nombre de “hipotiroidismo”), la glándula pituitaria
produce más TSH con la intención de estimular a la tiroides e
incrementar su producción de hormonas.
Perfil de Lípidos
Este mide el colesterol total, que es la suma de los diferentes
tipos de colesterol, las lipoproteínas de alta densidad
(HDL) colesterol, que suelen recibir el nombre de colesterol
“bueno”, las lipoproteínas de baja densidad (LDL) colesterol,
generalmente conocidas como colesterol “malo”. Las
lipoproteínas LDL que se acumulan en el torrente sanguíneo
pueden tapar los vasos sanguíneos e incrementar el riesgo
de afecciones cardíacas y los triglicéridos, que almacenan
energía hasta que el organismo la necesita.
Analisis de Orina
Un reporte típico comprende la descripción de la densidad,
aspecto y color, peso especifico, pH, cuerpos cetónicos,
proteínas, nitritos, urobilinógeno, bilirrubina, conteo de globulos
rojos, conteo de globulos blancos, glucosa y gonadotropina
coriónica humana.
MP.LAB.FS 01/13
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
PATHOLOGY TEST / EXAMENES DE PATOLOGIA
TEST CODE
FEE
PAP SMEAR (slide)
TEST NAME
9161
$12.00
PAP LIQUID SUREPATH
9142
$25.00
HUMAN PAPILOMA VIRUS hc2
1845
$38.00
CHLAMYDIA & GC DNA
5344
$25.00
CHLAMYDIA & GC DNA hc2
9193
$35.00
PAP PANEL (liquid pap+HPVhc2+chlamydia&GC hc2
9190
$99.00
TEST CODE
FEE
BIOPSY Level I - Gross only
9181
$30.00
BIOPSY Level II
9182
$40.00
BIOPSY Level III
9183
$65.00
BIOPSY Level IV
9184
$85.00
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.
MP.LAB.FS 01/13
49
50
TEST NAME
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
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 CODE
1106
7200
1274
8170
3525
1102
8160
7302
7304
1673
8260
8154
1695
1104
5200
4259
4201
8152
8794
7272
8118
1404
8149
8166
9181
4108
4200
1430
8142
4110
6115
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
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
$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
MP.LAB.FS 01/13
TEST NAME
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
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)
TEST CODE
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
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
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
$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
MP.LAB.FS 01/13
51
52
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)
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
MP.LAB.FS 01/13
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
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
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
$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
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
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
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
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
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
$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
MP.LAB.FS 01/13
53
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.
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.
Diagnostic Radiology / Centro de Diagnóstico
54
Miami - Dade
Digital Medical Diagnostic
41 Tamiami Canal Rd
Miami Fl. 33166
Phone: (305) 269-0833
Fax: (305) 269-0851
Digital Mammography
Mamografía digital
por sólo $50.00
CT Imaging Inc.
395 West 10 Street, Suite 2
Hialeah Fl. 33010
Phone: (305) 887-7562
Refer to Fee Schedule
Eiber Radiology.
49 West 49th Street.
Hialeah, Fl. 33012
Phone: (305) 557- 0330
Fax: (305) 556-5133
B & G Diagnostic Services
444 West 51 Place
Hialeah, Fl. 33012
Phone: (305) 818 - 2006
Free Transportation in Miami-Dade
and Broward County
Bay Imaging Group.
1755 NE 127th Street.
North Miami Fl. 33181
Phone: (305) 891-1900
Virtual Imaging Service.
3320 Palm Avenue.
Hialeah, Fl. 33012
Phone: (305) 596-9992
Transportation Available
Universal Imaging of Florida.
14462 Commerce Way.
Phone: (305) 821-8585
Pinnacle Imaging
2390 NW 7 St, Suite 103
Miami, Fl. 33125
Phone: (305) 642-7388
Virtual Imaging.
(Sleep Studies / Estudio del Sueño)
Miami, Fl. 33173
Phone: (305) 596-9992
Fax: (305) 779-9096
Precio: $500.00
Virtual Imaging Service.
7101 SW 99 Avenue, Suite 106
Miami, Fl. 33173
Phone: (305) 596-9992
Systems Associate Inc.
(Neurological Diagnostic)
Home and Office Service
7374 SW 93 Ave, Suite 201
Miami, Fl. 33173
CMS Open MRI
9601 SW 40 St
Miami, Fl. 33165
Phone: (305) 227-2500
Phone: (305) 270-7771
Virtual imaging
692 N. Homestead Blvd, Ste 106
Phone: (305) 596-9992
Miami - Dade
Lab Test Discount
5311 NW 79 ave
Doral, Fl. 33166
Phone: (305) 646-1363
Ultrasound Only
All X Ray Diagnostic Service, Corp
5040 NW 7 ST # 170
Miami, Fl. 33126
Phone: (305) 445-9462
Diagnostic Professional, Inc.
7301 NW 4th Street #107
Phone: (954) 449-7023
Fax: (954) 449-7027
Diagnostic Professional, Inc. 1799 West Oakland Park Blvd 105
Ft Lauderdale Fl. 33311
Phone: (954) 777-3466
Fax: (954) 777-3510
10950 Pines Boulevard
Phone: (954) 430-2044
Fax: (954) 430-2055
6808 N. State Road 7
Coconut Creek, Fl. 33073
Phone: (954) 570-5560
Fax: (954) 571- 5240
Broward Pet Imaging Center
4850 W. Oakland Park Blvd Suite 1A
Phone: (954) 735-6330
Bersa Mobil X Ray
7300 W Menab Rd Suite 112
Tamarac, Fl. 33121
Phone: (954) 515-7080
RX, Eco-Cardiac, Ultrasound EKG
Mobile Services / Servicio Movil
All X Ray Diagnostic Service, Corp
1800 Forest Hill Blvd Suite # A 1-2
Phone: (561) 318-5493
Broward
West Palm Beach
Mobile Quality Diagnostic
All West Palm Beach County
24 Hours
Phone: 305-820-8720
Fax: 305-820-8721
Call for appointment.
A1 Imaging Centers, LLC -- Florida Locations (MRI Only) (MRI solamente)
A1 Imaging of Boynton Beach
3795 Boynton Beach Blvd Ste. C
Boynton Beach, Fl. 33436
Phone: (561) 740-9305
Fax: (561) 740-9305
Services: Open MRI
A1 Imaging of Orange Park
1566 Kingsley ave
Orange Park, Fl. 32073
Phone: (904) 278-2128
Fax: (904) 278-2129
Services: Closed and Open MRI
A1 Imaging of Deerfield
1890 W. Hillsboro Blvd.
Phone: (954) 429-8381
Fax: (954) 429-2705
Services: Open MRI
A1 Imaging of Ft. Lauderdale
5100 N federal Hwy, Ste 102
Phone: (954) 202-3400
Fax: (954) 202-3448
Services: Open MRI
A1 Imaging of Pembroke Pines
8384 Pines Blvd
Phone: (954) 450-4020
Fax: (954) 432-8674
Services: Open MRI
A1 Imaging of Orlando
500 N Semoran Blvd., Ste 103
Orlando, Fl. 32807
Phone: (407) 275-6072
Fax: (407) 275-7301
Services: Open MRI
A1 Imaging of Ocoee
9450 W. Colonial Dr. Ste 12
Ocoee, Fl. 34761
Phone: (407) 822-0999
Fax: (407) 822-0990
Services: Open MRI
A1 Imaging of St. Augustine
200 S. Park Blvd.,Ste 210
St. Augustine, Fl. 32086
Phone: (904) 819-0920
Fax: (904) 819-0299
Services: Open MRI
A1 Imaging of West Palm Beach
1117 N. Olive Ave #101
Phone: (561) 651-7410
Fax: (561) 651-7417
Services: Open MRI
A1 Imaging of Plantation
150 N. University Dr. Ste 110
Phone: (954) 423-3674
Fax: (954) 916-0674
A1 Imaging of Mandarin
3753 Cardinal Point Dr.
Jacksonville, Fl. 32223
Phone: (904) 636-5674
Fax: (904) 448-4674
Services: Open MRI
A1 Imaging of Cape Coral
1003 Del Prado Blvd., Unit 102
cape Coral, Fl. 33990
Phone: (239) 573-6333
Fax: (239) 573-8674
Services: Open MRI
A1 Imaging of Kissimmee
810 North John Young Pkwy
Kissimmee, Fl. 34741
Phone: (407) 847-6745
Fax: (407) 847-8749
Services: Open MRI
A1 Imaging of Ocala
301 SE 17th St., Unit 102
Ocala, Fl. 34471
Phone: (352) 622-7459
Fax: (352) 622-9238
Services: Open MRI
A1 Imaging of Aventura
20880 W. Dixie Hwy, Suite 111/106
North Miami Beach, Fl. 33180
Phone: (305) 933-9565
Fax: (305) 933-8105
55
DIAGNOSTIC AND RADIOLOGY SERVICES FEE SCHEDULE
ABDOMEN & RETROPERITINIUM
ULTRASOUNDS
PROCEDURE
Abdomen Complete
RUQ (Liver, Gallbladder & Pancreas)
Liver
Gallbladder
Pancreas
Spleen
Renal
Bladder
Renal & Bladder
CPT
76700
76705
76705
76705
76705
76705
76775
76857
76770
FEE
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
$70.00
Pelvic Complete
Pelvic Transvaginal
Prostate Transabdominal
Prostate Transrectal
Scrotum & Contents
76856
76830
76857
76872
76870
$70.00
$70.00
$70.00
$70.00
$70.00
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
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)
56
MP.D/R.FS 01/13
PELVIS
ECHOGRAPHY
PROCEDURE
Echo Complete W/Color & Flow
Echo Stress Test W/Color & Flow
Abdominal Aorta
Carotid Doppler
SMALL PARTS
CPT
93306
93306
FEE
$150.00
$350.00
Arterial Upper Extremity Bilateral
93979
93880
93925
93923
93926
93923
93930
93923
Arterial Upper Extremity Unilateral
93931
93923
$90.00
93970
93971
$90.00
$90.00
Arterial Lower Extremity Bilateral
Arterial Lower Extremity Unilateral
Venous Duplex Bilateral
Venous Duplex Unilateral
DIGITAL X-RAYS
VENOUS STUDIES
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)
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
$90.00
$90.00
$100.00
$100.00
$90.00
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
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
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
“MRI” MAGNETIC RESONANCE IMAGING
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
FEE
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$325.00
$375.00
$275.00
$475.00
$475.00
$475.00
$325.00
$375.00
$375.00
$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
PROCEDURE
ILIAC W/O
Knee W
Knee W & W/O
Knee W/O
Leg-Femur-TIB-FIB W
Leg-Femur-TIB-FIB W&W/O
Leg-Femur-TIB-FIB W/O
Lumbar Spine W
Lumbar Spine W & W/O
Lumbar Spine W/O
Neck W
Neck W & W/O
Neck W/O
Orbit W
Orbit W & W/O
Orbit W/O
Pelvis W
Pelvis W & W/O
Pelvis W/O
Pituitary W
Pituitary W & W/O
Pituitary W/O
Prostate W
Prostate W & W/O
Prostate W/O
Scrotum W
Scrotum W & W/O
Scrotum W/O
Shoulder W
Shoulder W & W/O
Shoulder W/O
Thoracic Spine W
Thoracic Spine W & W/O
Thoracic Spine W/O
TMJ Joints W/O
Wrist W
Wrst W & W/O
Wrist W/O
“CT SCAN” COMPUTED TOMOGRAPHY
CPT
74160
74170
74150
72126
72127
72125
71260
71270
71250
70460
70470
70450
70481
70482
70480
73701
73702
73700
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
PROCEDURE
Lumbar Spine W
Lumbar Spine W & W/O
Lumbar Spine W/O
Maxilofacial W
Maxilofacial W & W/O
Maxilofacial W/O
Pelvis W
Pelvis W & W/O
Pelvis W/O
Sinuses W
Sinuses W & W/O
Sinuses W/O
Soft Tissue Neck W
Soft Tissue W & W/O
Soft Tissue Neck W/O
Thoracic Spine W
Thoracic Spine W & W/O
Thoracic Spine W/O
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
CPT
72132
72133
72131
70487
70488
70486
72193
72194
72192
70487
70488
70486
70491
70492
70490
72129
72130
72128
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
57
MP.D/R.FS 01/13
BREAST DIAGNOSTIC RADIOLOGY PROCEDURES
PROCEDURE
FEE SCHEDULE
Diagnostic Digital Mammo
Screening Digital Mammo
US Breast Unilateral or Bilateral
Breast Biopsy Unilateral or Bilateral
CPT
G0204
G0202
76645
19103
19295*
76942**
G0206***
77051****
FEE
$70.00
$70.00
$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)
58
MP.D/R.FS 01/13
PERINATAL DIAGNOSTIC SERVICES FEE SCHEDULE
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
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
HIGH RISK PREGNANCY TESTS
Ultrasound
AMNIO
CVS
1ST TRIMESTER
SCREENING
INTEGRATED
SCREENING
SEQUENTIAL
SCREENING
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 Trimester 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
LOCATIONS
South Miami
6200 Sunset Drive - Suite 301
Ph: 305-669-9521 Fax: 305-669-9735
Mercy Hospital
3663 S. Miami Ave - 5th floor, Room 5335
Ph: 305-403-7600 Fax: 305-403-7663
Kendall Regional Medical Office
11760 Bird Road - Suite 714
Ph: 786-621-5300 Fax: 786-621-5303
Mt. Sinai Medical Center
4308 Alton Road - Suite 730
Ph: 305-403-1234 Fax: 305-403-0345
Baptist Medical Arts Building
8940 N. Kendall Drive - Suite 901E
Ph: 786-621-7770 Fax: 786-621-7771
Hialeah Hospital Office
777 East 25th St - Suite 402
Ph: 305-835-7909 Fax: 305-835-9353
North Shore Medical Center
1100 NW 95th St, South Lobby-1st Floor
Ph: 305-691-2180 Fax: 305-691-2182
59
MP. PN. FS 01/13
ANCILLARY SERVICES/ SERVICIOS AUXILIARES
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:
•
•
•
•
Wheel Chairs
Walkers
Hospital Beds
Oxygen Concentrators
Offered 80% savings off of Providers Usual and Customary Fees.
Unlimited Access to all Durable Medical Services.
SERVICIO DE 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.
60
61
61
ORTHOPEDIC SUPPLIES / SUPLEMENTOS ORTOPEDICOS
Podortis Corp.
(Orthopedic Supplies)
5841 SW 8 St Miami, Fl. 33144 Phone: (305) 446-2995 Fax: (305) 446-2996
L CODE
A5500 X 2
A5512 X 2
A5513 X 2
L3002 X 2
L5000 X 1
A6530 X 2
A6531 X 2
A6532 X 2
A6533 X 2
A6534 X 2
A6535 X 2
A6539 X 2
A6540 X 2
A6541 X 2
L4350 X 1
L4360 X 1
L4386 X 1
L4396 X 1
L3000 X 2
L3010 X 2
L3020 X 2
L1902 X 2
L1906 X 1
L1930 X 1
L1940 X 1
L1960 X 1
L8000 X 1
L8020 X 1
L8030 X 1
L1810 X 1
L1832 X 1
L1845 X 1
L1847 X 1
L0120 X 1
L0190 X 1
L0700 X 1
L0710 X 1
L1300 X 1
L0462 X 1
L0464 X 1
L0482 X 1
L0486 X 1
L0488 X 1
L0627 X 1
L0631 X 1
L1686 X 1
L2112 X 1
L2114 X 1
L2116 X 1
L2128 X 1
L2134 X 1
62
L3670 X 1
L3760 X 1
L3908 X 1
L3931 X 1
L3980 X 1
L3982 X 1
L3984 X 1
L3995 X 1
L8300 X 1
L8310 X 1
PROSTHETIC ORTHOTIC FEE SCHEDULE
OFF THE SHELF DIAB SHOE / ZAPATOS PARA DIABETICOS
DIAB MULTIDENSITY INSERTS / SOPORTES DE DIAB PREFAB
DIAB MULTIDENSITY CUSTOM INSERTS / SOPORTES DE DIABETICO
DIAB PLASTAZOTE CUSTOM INSERT / SOPORTES ACOMODATIVOS DE DIABETICOS
INSERT FOR MISSING TOES / SOPORTE PARA DEDOS AMPUTADOS
BELOW KNEE 18-30 COMRESSION STOCKING / MEDIAS PARA CIRCULACION A LA RODILLA 18-30
THIGH LENGTH 18-30 COMPRESSION STOCKING / MEDIAS PARA LA CIRCULACION AL MUSLO 18-30
WAIST LENGTH 18-30 COMPRESSION STOCKING / MEDIAS PARA CIRCULACION PANTY 18-30 MMHG
AIR CAST PREFAB
PNEUMATIC CAM WALKER PREFAB / BOTA DE MARCHA INMOVILIZADORA-NEUMATICA
REGULAR CAM WALKER PREFAB / BOTA DE MARCHA INMOVILIZADORA CORTA O LARGA
NIGTH 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 GAUNLET PREFAB / AFO, APARATO PARA EL PIE TIPO GUANTE PREFAB
AFO FOR PPTD PREFAB / AFO, PARA ESTABILIZAR EL PIE PREFAB
AFO PLASTIC PREFAB
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 FOAM
BREAST PROSTHESIS SILICONE OR EQUAL / PROTESIS DE SENO EN SILICONA
KO, ELASTIC WITH JOINTS PREFAB / RODILLERA SENCILLA PREFAB
KO, ADJUSTABLE KNEE JOINTS, RIGID SUPPORT, PREFAB /RODILLERA CON ARTICULACION PREFAB
KO, DOUBLE UPRIGHT, THIGH AND CALF, PREFAB
KO, DOUBLE UPRIGHT, AIR, PREFAB / RODILLERA CON AIRE, PREFAB
CERVICAL COLLAR, FOAM, PREFAB
CERVICAL COLLAR TAYLOR TYPES / COLLAR CERVICAL TIPO TAYLOR
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 SHELLS / TLSO MODULAR SEGMENTADO, 4 PLASTICOS
TLSO,TRIPLANAR CONTROL, ONE PIECE RIGID PLASTIC SHELL / TLSO, CONTROL TRIPLANAR UNA PIEZA RIGIDA
PLASTICA
TLSO,TRIPLANAR CONTROL, TWO PIECES RIGID PLASTIC SHELL / TLSO, CONTROL TRIPLANAR, 2 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 ORTHIOSIS, ABDUCTION CONTROL, PREFAB / APARATO DE CADERA, CONTROLA ABDUCTION
AFO TIBIAL FRACTURE ORTHOSIS, SOFT, PREFAB / AFO, APARATO PARA FRACTURA TIBIAL SUAVE
AFO TIBIAL FRACTURE ORTHOSIS, SEMI RIGID, PREFAB
AFO TIBIAL FRACTURE ORTHOSIS, RIGID, PREFAB / APARATO PARA FRACTURA TIBIAL RIGIDO
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, PREFAB
SO, (CANVAS AND WEBBING TYPE) PREFAB / CABESTRILLO DE BRAZO, PREFAB
ELBOW ORTHOSIS, WITH ADJUSTABLE POSITION, PREFAB / APARATO DE CODO AJUSTABLE
WRIST HAND ORTHOSIS PREFAB / MUNEQUERA PREFAB
WRIST HAND FINGER ORTHOSIS PREFAB / MUNEQUERA CON DEDO GORDO PREFAB
HUMERAL FRACTURE ORTHOSIS PREFAB / APARATO DE FRACTURA DE HUMERUS PREFAB
RADIUS/ULNAR FRACTURE ORTHOSIS PREFAB
WRIST FRACTURE ORTHOSIS PREFAB / APARATO DE FRACTURA DE MUNECA, PREFAB
ADDIT FRACTURE SOCK OR EQUAL
SINGLE ABDOMINAL BINDER / FAJA ABDOMINAL SENCILLA
BILATERAL ABDOMINAL BINDER / FAJA ABDOMINAL BILATERAL
Fees
$100.80
$38.74
$57.82
$155.20
$129.96
$55.87
$62.30
$115.82
$73.33
$73.33
$77.40
$200.79
$200.79
$211.95
$57.13
$166.30
$107.73
$94.62
$337.56
$155.20
$155.20
$39.29
$83.91
$79.06
$215.34
$251.23
$26.13
$128.65
$139.15
$79.06
$531.35
$543.69
$348.25
$12.13
$281.30
$1,406.50
$1,552.00
$727.50
$518.99
$518.99
$933.85
$1021.88
$227.53
$299.45
$747.83
$539.08
$331.74
$465.60
$465.60
$976.31
$439.11
$55.29
$268.57
$17.46
$128.55
$121.25
$218.25
$244.44
$11.64
$59.90
$161.26
HEARING AIDS / SUPLEMENTOS AUDITIVOS
Belgica Mock
(Hearing Specialist)
(Crystal Clear Hearing)
11342 Quail Roost Drive
Miami, Fl. 33157
Phone: (305) 235-4035
Home Health Service
Ali Asghar Danesh, M.D.
(Audiology))
1500 NW 10 Ave. Suite #104
Phone: (561) 807-7873
Miami - Dade / Broward
ALC Home Health.
Home Health Services
(Physical Therapy)
13275 SW 124 St.
Miami Fl. 33186
Phone: (305) 828-5310
Home Health Aid: $15.00 per Visit
RN: $ 29.00 per Visit
Physical Therapy: $80.00 per Visit
Occupational Therapy: $80.00 per Visit
Speech Therapy: $95.00 per Visit
HHA or CAN Visit: $15.00 per visit
C&O Home Healthcare Corp
(Home Health Services)
(Physical Therapy)
1100 West 29th street Suite H
Hialeah Fl. 33012
Tel: (305) 360-4104
Home Health Aid: $30.00 per Visit
Skilled Nursing: $45.00 per Visit
Physical Therapy: $80.00 per Visit
Occupational Therapy: $80.00 per Visit
Speech Therapy: $80.00 per Visit
Home Health Care.
Preferred Home Health Agency, Inc.
13903 NW 67 Avenue, Suite 420
Phone: (305) 231-4250
Home Health Aid: $ 30.00 per Visit
Skilled Nursing: $ 45.00 per Visit
Physical Therapy: $ 80.00 per Visit
Occupational Therapy: $ 80.00 per Visit
Speech Therapy: $ 80.00 per Visit
Capital Health Services Inc.
(Home Health Services)
85 Gran Canal Dr. Suite 201
Miami, Fl. 33144
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
Holistic Nursing Care Agency
Home Health Services
7400 NW 7 St.
Miami Fl. 33126
Phone: 305-265-9618
Skilled Nursing: $30.00
Home health Aid: $15.00
Physical Therapy: $80.00
Occupational Therapy: $80.00
Speech Therapy: $80.00
HHA or CAN: $15.00
63
Physical Therapy
Miami - Dade
Claudius Galen Therapy Center
(Physical and Speech Therapy)
489 E Hialeah Drive #10
Hialeah, Fl. 33010
Phone: (786) 953-6302
Language: English/Spanish
Davila Medical Center
(Family Medicine)
782 NW 42 Av. Ste 318
Miami, Fl. 33126
Phone: (305) 441-2760
Fax: (305) 441-2760
RT Professional, Inc.
(Physical Therapy)
7374 NW 35 Terr #102
Miami, Fl. 33122
Phone: (305) 418-8990
Therapy for Nasiff
(Therapeutic Massage)
10025 SW 32 St.
Miami Fl. 33165
Phone: (786) 316 - 8152
Sunrise Relax Health Care Corp.
(Physical Therapy)
636 SW 109 avenue
Miami Fl. 33174
Phone: (305) 221-8500
The New City Medical Center
(Physical Therapy)
4118 W 12 Ave
Hialeah Fl. 33012
Phone: (305) 824-8787
Selecta Physical Therapy
Miami Fl. 33135
Phone: (786) 953-6735
Fax: (786) 953-6943
Language: English/Spanish
Leal Medical Center
(Physical Therapy)
632 Washington Ave
Phone: (305) 938-5088
THERAPY SERVICES FEE SCHEDULE
64
CODES
SERVICES
Fees
CODES
SERVICES
Fees
97010
97010
97012
97014
97018
97026
97032
97034
97035
97039
Hot / Cold Pack
Ice / Cryo therapy
Mechanical Traction
E.M.S
Paraffin Bath
Infrared
E.M.S Attended
Contrast Bath
Ultrasound
Vibratory Massage
$12.00
$12.00
$33.34
$26.50
$18.40
$13.20
$34.16
$32.00
$27.50
$17.50
97110
97112
97124
97139
97140
97140
E0217
E0218
97535
Therapeutic Exercise
Neuromuscular Re-Education
Massage
Hydro massage
Manual Therapy
Manual Traction
Water Circulating Cold
Water Circulating Hot
Self / Home Care
$57.00
$63.00
$47.00
$17.00
$65.00
$65.00
$91.00
$91.00
$41.00
MP.TS.FS 01/13
Alternative Medicine / Medicina Alternativa
Lab Test Discount
(Acupuncture)
5311 NW 79 ave
Doral, Fl. 33166
Phone: (305) 646-1363
Initial Visit (60 min) $60.00
Follow Up (45 min) $50.00
Services: Weight Management,
Pain Management, Depression,
Anexity, Insomnia, Allergy and
Respiratory Problems,
Muscle-skeletal treatments, etc
Miami - Dade
Ines Valencia, M.D.
South Florida Rehabilitation & Wellness Center
(Acupuncture)
7990 SW 117 ave #205
Miami, Fl. 33183
Phone: (305) 271-7447
Alternative Medicine / Medicina Alternativa
Broward
(Acupuncture)
Miramar, Fl. 33025
Phone: (954) 639-7560
Services: Weight Management,
Pain Management, Depression,
Anexity, Insomnia, Allergy and
Respiratory Problems,
Muscle-skeletal treatments, etc
Magnet Therapy / Terapia Magnética
Miami-Dade
Panamerican Sports Medicine Institute of Miami
(Magnet Therapy)
7480 SW 40 St, Ste 440
Miami, Fl. 33155Phone: (305) 227-3350
Evaluation and First Session $30.00
Follow Up Sessions: $30.00 each
65
SUPLEMENTOS
DIABETES SUPPLY FEE SCHEDULE / PARA
LA DIABETES
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.
Entrega gratis a domicilio.
Acceso ilimitado de todos los suministros para diabéticos.
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.
DIABETES SUPPLY STARTER KIT
PRODUCT
QUANTITY
Glucose Meter (Glucometro)
1
Lancets
100
Test Strips
50
TOTAL FEE
$19.95
MONTHLY RENEWABLE SUPPLIES
PRODUCT
QUANTITY
FEE
Glucose Meter Replacement (Glucometro)
1
$2.50
Lancets
100
$9.99
Test Strips
50
$19.99
Provided by:
DIRECT MEDS OF FLORIDA
Telf: 954-454-8118
Fax: 954-454-9898
Free Shipping anywhere in the United States
66
MP.DIAB.FS 01/13
PHARMACY SERVICES
•
•
•
•
•
•
Exclusive Pharmacy Services in Miami Dade County with Navarro Pharmacy.
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.
SERVICIOS DE FAMACIA
•
•
•
•
•
•
Servicios exclusivos en el condado Miami Dade brindados por Navarro Pharmacy
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.
Pharmacy / Farmacia
Navarro Discount Pharmacy.
(North Miami Lakes)
6410 NW 186 St.
Hialeah Fl. 33015
Phone: (305) 825-3386
Fax: (786) 621-1097
Mon - Sat: 8:00 Am To 10:00 Pm
Sun: 9:00 Am To 7:00 Pm
Miami - Dade
(Miami Lakes)
16801 NW 67 Ave.
Miami Fl. 33015
Phone: (305) 822-9522
Fax: (305) 822-9775
Mon - Sun: 6:00 Am To 12:00 Am
(Okeechobee)
2399 W 52 St.
Hialeah Fl. 33016
Phone: (305) 822-3385
Fax: (786) 621-0866
Sun: 9:00 Am To 7:00 Pm
67
Pharmacy / Farmacia
68
Miami - Dade
(East Hialeah)
366 E 4 Ave.
Hialeah Fl. 33010
Phone: (305) 883-0852
Fax: (786) 621-0861
Sun: 9:00 Am To 7:00 Pm
(Hialeah Palm)
3915 Palm Ave.
Hialeah Fl. 33012
Phone: (305) 822-2210
Fax: (786) 621-7863
Sun: 9:00 Am To 7:00 Pm
(West Hialeah)
3960 W 12 Ave.
Hialeah Fl. 33012
Phone: (305) 556-3117
Fax: (786) 621-0860
Sun: 9:00 Am To 7:00 Pm
(Hialeah)
775 W 49 St. Suite 1
Hialeah Fl. 33012
Phone: (305) 823-0823
Fax: (305) 823-0030
(Hialeah Gardens)
3141 W 76 St Suite 5
Hialeah Fl. 33018
Phone: (305) 231-8200
Fax: (305) 557-4707
Sun: 9:00 Am To 7:00 Pm
(Flamingo Plaza)
4410 West 16 Ave.
Hialeah Fl. 33012
Phone: (305) 556-8585
Fax: (305) 824-9601
Sun: 9:00 Am To 7:00 Pm
13250 Biscayne Blv.
North Miami , Fl. 33181
Phone: (305) 891-3551
Fax: (305) 891-3902
Sun: 9:00 Am To 7:00 Pm
(Doral)
11402 NW 41 St # 127.
Doral Fl. 33178
Phone: (305) 471-8184
Fax: (305) 471-8189
Sun: 9:00 Am To 7:00 Pm
(Miracle Mile)
93 Miracle Mile,
Coral Gables Fl. 33134
Phone: (305) 445-1059
Sun: 9:00 Am To 7:00 Pm
(Ponce De Leon)
3949 SW 8 St.,
Miami Fl. 33134
Phone: (305) 444-7530
Fax: (305) 442-2805
(Sunset)
10720 SW 72 St.,
Miami Fl. 33173
Phone: (305) 271-9909
Fax: (305) 412-1851
24 Hrs
(Flagler)
5252 West Flagler St.
Miami Fl. 33134
Phone: (305) 442-9946
Fax: (305) 442-7320
Sun: 9:00 Am To 10:00 Pm
(Sweetwater)
Miami Fl. 33174
Phone: (305) 223-3555
Fax: (305) 485-8037
Sun: 9:00 Am To 7:00 Pm
(Little Havana)
1243 SW 8th St.
Miami Fl. 33135
Phone: (305) 854-8544
Fax: (305) 854-6463
Sun: 9:00 Am To 7:00 Pm
(Hammocks)
14665 SW 104th St.
Miami Fl. 33186
Phone: (305) 752-0600
Fax: (305) 752-4272
Sun: 10:00 Am To 7:00 Pm
(Country Walk)
13796 SW 152th St.
Miami Fl. 33177
Phone: (305) 256-9800
Fax: (786) 249-0014
Sun: 10:00 Am To 7:00 Pm
(Westchester)
9686 SW 24th St.
Miami Fl. 33165
Phone: (305) 225-9307
Fax: (786) 621-0859
Sun: 9:00 Am To 7:00 Pm
(Coral Way)
11865 SW 26th St.
Miami Fl. 33175
Phone: (305) 227-0023
Fax: (305) 227-3021
Sun: 9:00 Am To 7:00 Pm
(West Sunset)
15000 SW 72th St.
Miami Fl. 33193
Phone: (305) 387-1300
Fax: 305) 388-2310
Sun: 9:00 Am To 7:00 Pm
(East Flagler)
Miami Fl. 33135
Phone: (305) 643-9762
Fax: (786) 621-5810
Sun: 9:00 Am To 7:00 Pm
(FIU)
12000 SW 8th St.
Miami Fl. 33184
Phone: (305) 225-8900
Fax: (305) 485-9009
Pharmacy / Farmacia
Miami - Dade
(Sunny Isles)
18500 Collins Ave.
Sunny Isles Fl. 33160
Phone: (305) 792-4099
Fax: (305) 792-4492
Sun: 9:00 Am To 7:00 Pm
(North Shore)
631 71th St.
Miami Beach Fl. 33141
Phone: (305) 865-0075
Fax: (305) 865-1886
(West Bird Rd)
14491 SW 42 St.
Miami Fl. 33175
Phone: (305) 229-1044
Fax: (305) 229-9039
Sun: 9:00 Am To 7:00 Pm
(Galloway)
8760 SW 40 St.
Miami Fl. 33165
Phone: (305) 552-1498
Fax: (305) 559-3193
Sun: 9:00 Am To 7:00 Pm
Presidente Pharmacy.
10845 SW 40th St
Miami, Fl. 33165
Phone: (305) 485-8888
President Pharmacy
Miami, Fl. 33157
Phone: (305) 235-8244
Cardenas Pharmacy.
2741 Coral Way.
Miami, Fl. 33145
Phone: (305) 529-0003
Fax: (305) 529-1022
My Pharmacy of Homestead.
806 N. Krome Ave.
Phone: (305) 247-6949
Fax: (305) 247-6072
Pro Pharmacy
Miami, Fl. 33157
Phone: (305) 971-3388
Las Villas Pharmacy
716 W 29th ST
Hialeah, Fl. 33012
Phone: (305) 883-7476
Redondo Pharmacy Discount
19533 N.W 57 Ave.
Miami, Fl. 33055
Phone: (305) 625-0225
Pharmacy / Farmacia
Direct Meds of Florida
800 E. Hallandale Beach Blvd
Hallandale Beach Fl. 33009
Tel: (954) 454-8118
Fax: (954) 454-9898
Refer to Drug Pricing Fee Schedule
Home Delivery Service
Free Mail Order Delivery Service
Broward
Navarro Pharmacy
15895 Pines Blvd
Pembroke Pines Fl. 33028
Tel: (954) 251- 6270
Pharmacy / Farmacia
Palm Beach
Garcia Pharmacy
2525 N. Dixie Hwy
Lake Worth Fl. 33460
Phone: (561) 588-2252
Pharmacy / Farmacia
Cape Coral Express Pharmacy
4419 Del Prado Blvd North
Tel: (239) 574-8846
Fax: (239) 574-7080
Lee / Cape Coral
St. Jude Pharmacy
1202 N.E Pine Island Road Ste 1V
Tel: (239) 673-7777
69
Navarro Pharmacy Fee Schedule
100 tablets on over 400 generic medications for ONLY $9.99
DRUG NAME
ALLERGY
CETIRIZINE 10MG TAB
CETIRIZINE 5MG TAB
CLEMASTINE 1.34MG TAB
CYPROHEPTADINE 4MG TAB
DYPHENHYDRAMINE HCL 50MG TAB
DYPHENHYDRAMINE HCL 25MG TAB
LORATADINE
ANTIFUNGAL
FLUCONAZOLE 50 MG TAB
ANTIVIRAL TREATMENTS
ACYCLOVIR 200MG TAB
ACYCLOVIR 400MG TAB
ARTHRITIS AND PAIN
ALLOPURINOL 100MG TAB
ALLOPURINOL 300MG TAB
ASPIRIN E/C 325MG TAB
BACLOFEN 10MG TAB
BACLOFEN 20MG TAB
BUTALB/APAP/CAF 50/325MG TAB
CHOLINE MAG 750MG TAB
CHLORZOXAZONE 250MG TAB
CHLORZOXAZONE 500MG TAB
CYCLOBENZAPRINE 10MG TAB
CYCLOBENZAPRINE 5MG TAB
DICLOFENAC POT 50MG TAB
ETODOLAC 400MG TAB
FLURBIPROFEN 50MG TAB
GABAPENTIN 100MG CAP
GABAPENTIN 100MG TAB
IBUPROFEN 200MG TAB
IBUPROFEN 400MG TAB
IBUPROFEN 600MG TAB
IBUPROFEN 800MG TAB
KETOPROFEN 50MG CAP
KETOPROFEN 75MG CAP
MELOXICAN 7.5MG TAB
MELOXICAN 15MG TAB
METHOCARBAMOL 500MG TAB
METHOCARBAMOL 750MG TAB
NAPROXEN SOD 275MG TAB
NAPROXEN SODIUM 550MG TAB
NAPROXEN EC 375MG TAB
NAPROXEN EC 500MG TAB
NAPROXEN 250MG TAB
NAPROXEN 375MG TAB
NAPROXEN 500MG TAB
NAPROXEN 250MG TAB
NAPROXEN 375MG TAB
NAPROXEN 500MG TAB
OXAPROZIN 600MG TAB
PHENYLGESIC 325/30MG TAB
PIROXICAM 10MG CAP
SALSALATE 500MG TAB
SALSALATE 750MG TAB
SULFASALAZINE 500MG TAB
TIZANIDINE 2MG TAB
QTY
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
DRUG NAME
TIZANIDINE 4MG TAB
TRAMADOL 50MG TAB
ASTHMA AND COPD
ALBUTEROL 2MG TAB
ALBUTEROL 4MG TAB
AMINOPHYLLINE 100MG TAB
AMINOPHYLLINE 200MG TAB
THEOPHYLLINE ANHYD 100MG SR TAB
THEOPHYLLINE ANHYD 200MG SR TAB
BLOOD PRESSURE & HEART DISEASE
AMILORIDE/HCTZ 5/50MG TAB
ATENOLOL 25 MG TAB
ATENOLOL 50MG TAB
ATENOLOL 100MG TAB
ATENOLOL/CHLO 100/25MG TAB
ATENOLOL/CHLO 50/25MG TAB
BENAZEPRIL 10MG TAB
BENAZEPRIL 20MG TAB
BENAZEPRIL 40MG TAB
BENAZEPRIL 5MG TAB
BENAZEPRIL/HCTZ 10/ 12.5MG TAB
BENAZEPRIL/HCTZ 20/ 12.5MG TAB
BENAZEPRIL/HCTZ 20/ 25MG TAB
BISOPROLOL/HCTZ 10/6.25MG TAB
BISOPROLOL/HCTZ 2.5/6.25MG TAB
BISOPROLOL/HCTZ 5/6.25MG TAB
BUMETANIDE 0.5MG TAB
BUMETANIDE 1MG TAB
CAPTOPRIL 100MG TAB
CAPTOPRIL 12.5MG TAB
CAPTOPRIL 25MG TAB
CAPTOPRIL 50MG TAB
CAPTOPRIL/HCTZ 25/15MG TAB
CHLOROTHIAZIDE 250MG TAB
CHLOROTHIAZIDE 500MG TAB
CHLORTHALIDONE 25MG TAB
CLONIDINE 0.1MG TAB
CLONIDINE 0.3MG TAB
DIGOXIN 0.125MG TAB
DIGOXIN 0.25MG TAB
DILTIAZEM 120MG TAB
DILTIAZEM 30MG TAB
DILTIAZEM 60MG TAB
DILTIAZEM 90MG TAB
DOXAZOSIN 2MG TAB
DOXAZOSIN 1MG TAB
DOXASOZIN 4MG TAB
ENALAPRIL 10MG TAB
ENALPRIL 2.5MG TAB
ENALAPRIL 20MG TAB
ENALAPRIL 5MG TAB
ENALAPRIL/HCTZ 10/25MG TAB
ENALAPRIL/HCTZ 5/12.5MG TAB
FOSINOPRIL 10MG TAB
FOSINOPRIL 20MG TAB
FOSINOPRIL 40MG TAB
100
100
QTY
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Disclaimer: Pricing for Navarro Saving Club members ONLY. The above list of drugs is subject to change. Not all prescription drugs are covered by this
program. This program is NOT insurance. For more information about this program visit us at www.navarro.com or contact Navarro pharmacist.
70
M.P. N-Rx. FS 01/13
DRUG NAME
FUROSEMIDE 20MG TAB
DILTIAZEM 60MG TAB
FUROSEMIDE 40MG TAB
FUROSEMIDE 80MG TAB
GUANFACINE 1MG TAB
GUANFACINE 2MG TAB
HYDRALAZINE 10MG TAB
HYDROCHLOROTHIAZIDE 12.5MG CAP
HYDROCHLOROTHIAZIDE 25MG TAB
HYDROCHLOROTHIAZIDE 50MG TAB
INDAPAMIDE 1.25MG TAB
INDAPAMIDE 2.5MG TAB
ISOSORBIDE DINITRATE 10MG TAB
ISOSORBIDE DINITRATE 2.5MG SL TAB
ISOSORBIDE DINITRATE 5MG SL TAB
ISOSORBIDE MONONITRATE 20MG TAB
LABETALOL 100MG TAB
LISINOPRIL 10MG TAB
LISINOPRIL 2.5MG TAB
LISINOPRIL 20MG TAB
LISINOPRIL 30MG TAB
LISINOPRIL 40MG TAB
LISINOPRIL 5MG TAB
LISINOPRIL/HCTZ 10/12.5MG TAB
LISINOPRIL/HCTZ 20/12.5MG TAB
LISINOPRIL/HCTZ 20/25MG TAB
METHAZOLAMIDE 25MG TAB
METHYLDOPA 250MG TAB
METOPROLOL 25MG TAB
METOPROLOL 50MG TAB
METOPROLOL TARTRATE 25MG TAB
NADOLOL 20MG TAB
NICARDIPINE 30MG CAP
NITROGLYCERIN 2.5MG CAP
NITROGLYCERIN SR 9MG CAP
NITROQUICK SL 0.3MG TAB
PENTOXIFYLLINE
PINDOLOL 5MG TAB
PRAZOSIN 1MG CAP
PROPRANOLOL 80MG TAB
PROPRANOLOL 40/25MG TAB
PROPRANOLOL 80/25MG TAB
QUINAPRIL 10MG TAB
QUINAPRIL 20MG TAB
QUINAPRIL 40MG TAB
QUINAPRIL 5MG TAB
QUINIDINE SUL 200MG TAB
RAMIPRIL 1.25MG CAP
SPIRONOLACTONE 25MG TAB
SOTALOL AF 80MG TAB
SOTALOL HCL 80MG TAB
SOTALOL HCL 120MG TAB
TERAZOSIN 10MG CAP
TERAZOSIN 1MG CAP
TERAZOSIN 2MG CAP
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
QTY
DRUG NAME
TERAZOSIN 5MG CAP
TICLOPIDINE 250MG TAB
TORSEMIDE 5MG TAB
TORSEMIDE 10MG TAB
TRIAMTERENE/HCTZ 37.5/25MG CAP
TRIAMTERENE/HCTZ 37.5/25MG TAB
TRIAMTERENE/HCTZ 75/50MG TAB
VERAPAMIL 120MG TAB
VERAPAMIL 80MG TAB
WARFARIN SOD 1MG TAB
WARFARIN SOD 2.5MG TAB
WARFARIN SOD 7.5MG TAB
CHOLESTEROL
GEMFIBROZIL 600MG TAB
LOVASTATIN 10MG TAB
LOVASTATIN 20MG TAB
LOVASTATIN 40MG TAB
NIACIN ER 500MG CAP
PRAVASTATIN 10MG TAB
PRAVASTATIN 20MG TAB
COUGH, COLD, ALLERGY
GUAIF/PSUEDO 600/120MG TAB
ORGAN-I NR TAB
PSEUDO-GEST 30MG TAB
DIABETES
GLYBURIDE MICRONIZED 6MG TAB
CHLORPROPAMIDE 100MG TAB
CHLORPROPAMIDE 250MG TAB
GLIMEPIRIDE 1MG TAB
GLIMEPIRIDE 2MG TAB
GLIMEPIRIDE 4MG TAB
GLIPIZIDE 10MG TAB
GLIPIZIDE 5MG TAB
GLIPIZIDE ER 5MG TAB
GLYBURIDE/METFORMIN 1.25/250MG TAB
GLYBURIDE/METFORMIN 5/500MG TAB
GLYBURIDE 1.25MG TAB
GLYBURIDE 2.5MG TAB
GLYBURIDE 5MG TAB
GLYBURIDE MICRONIZED 1.5MG TAB
METFORMIN 1000MG TAB
METFORMIN 500MG TAB
METFORMIN 850MG TAB
METFORMIN ER 500MG TAB
METFORMIN ER 750MG TAB
GASTROINTESTINAL DISEASE
BELLADONNA PB TAB
CIMETIDINE 300MG TAB
DICYCLOMINE 10MG CAP
DICYCLOMINE 20MG TAB
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
QTY
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
M.P. N-Rx. FS 01/13
71
DRUG NAME
DOCUSATE CALCIUM 240MG CAP
DOCUSATE SODIUM 250MG CAP
FAMOTIDINE 20MG TAB
FAMOTIDINE 4MG TAB
LOPERAMIDE 2MG CAP
METOCLOPRAMIDE 10MG TAB
METOCLOPRAMIDE 5MG TAB
PANGESTYME EC CAP
PROCHLORPERAZINE 10MG TAB
PROCHLORPERAZINE 5MG TAB
RANITIDINE 150MG TAB
RANITIDINE 300MG TAB
INFECTIOUS DISEASE
AMOXICILLIN 125MG CHEW TAB
AMOXICILLIN 250MG CHEW TAB
AMOXICILLIN 250MG CAP
AMOXICILLIN 500MG CAP
AMPICILLIN 250MG CAP
CEPHALEXIN 500MG CAP
CLINDAMYCIN HCL 150MG CAP
DOXYCYCLINE 100MG CAP
DOXYCYCLINE 100MG TAB
DOXYCYCLINE HYCLATE 50MG CAP
ERYTHROMYCIN STEARATE 250MG TAB
ISONIAZID 100MG TAB
ISIONAZID 300MG TAB
METRONIDAZOLE 250MG TAB
METRONIDAZOLE 500MG TAB
PENICILLIN VK 250MG TAB
PENICILLIN VK 500MG TAB
SULFAMETHOXAZOLE/TRIMETH 400/80MG TAB
SULFAMETHOXAZOLE/TRIMETH 800/160MG TAB
TETRACYCLINE 250MG CAP
TETRACYCLINE 500MG CAP
MENTAL DISORDERS
BENZTROPINE MES 0.5MG TAB
BENZTROPINE MES 1MG TAB
BENZTROPINE MES 2MG TAB
AMITRIPTYLINE 10MG TAB
BUSPIRONE 10MG TAB
BUSPIRONE 15MG TAB
BUSPIRONE 5MG TAB
CARBAMAZEPINE 100MG CHEW TAB
CARBAMAZEPINE 200MG TAB
CHLORPROMAZINE 10MG TAB
CHLORPROMAZINE 25MG TAB
CITALOPRAM 10MG TAB
CITALOPRAM 20MG TAB
CITALOPRAM 40MG TAB
CLOMIPRAMINE HCL 25MG CAP
DESIPRAMINE 10MG TAB
DOXEPIN 10MG CAP
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
QTY
DRUG NAME
DOXEPIN 100MG CAP
DOXEPIN 25MG CAP
DOXEPIN 50MG CAP
DOXEPIN 75MG CAP
FLUOXETINE 10MG TAB
FLUOXETINE 10MG CAP
FLUOXETINE 20MG CAP
FLUPHENAZINE 1MG TAB
FLUPHENAZINE 2.5MG TAB
HALOPERIDOL 0.5MG TAB
HALOPERIDOL 1MG TAB
HALOPERIDOL 2MG TAB
HALOPERIDOL 5MG TAB
HYDROXYZINE PAM 25 CAP
HYDROXYZINE PAM 50MG CAP
IMIPRAMINE 10MG TAB
LITHIUM CARB 150MG CAP
LITHIUM CARB 300MG CAP
NORTRIPTYLINE 10MG CAP
PERPHENAZINE/AMITRIPTYLINE 2/10MG TAB
THIORIDAZINE 10MG TAB
THIORODAZINE 25MG TAB
THIOTHIXENE 1MG CAP
THIOTHIXENE 2MG CAP
TRAZODONE 100MG TAB
TRAZODONE 150MG TAB
TRAZODONE 50MG TAB
TRIHEXYPHENIDYL 2MG TAB
TRIHEXYPHENIDYL 5MG TAB
ZONISAMIDE 25MG CAP
ZONISAMIDE 50MG CAP
THYROID CONDITIONS
LEVOTHYROXINE 25MCG TAB
METHIMAZOLE 5MG TAB
PROPYLTHIOURIL(PTU) 50MG TAB
THYROID 1/2GR TAB
THYROID 1GR TAB
THYROID 2GR TAB
THYROID 3GR TAB
VITAMINS & NUTRITIONAL HEALTH
ETHEDENT 0.25MG CHEW TAB
ETHEDENT 0.25MG TAB
ETHEDENT 0.5MG CHEW TAB
ETHEDENT 1MG CHEW TAB
FABB 2.2/25/1MG TAB
FOLCAPS CAP
FOLIC ACID 1MG TAB
FOLIC ACID 2.5/25/1MG TAB
FORMULA B PLUS TAB
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
QTY
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
72
M.P. N-Rx. FS 01/13
DRUG NAME
MAGNESIUM OX 400MG TAB
MIRTAZAPINE 15MG TAB
MULTI VIT/FL 0.5MG CHW TAB
MULTI VIT/FL 1MG CHW TAB
MULTIVIT W/FLUR & FE 5MG TAB
NATALCARE RX TAB
NATALCARE PIC TAB
NATALCARE THREE TAB
NATATAB FA VAN TAB
POTASSIUM CHL 20MEQ XR TAB
POTASSIUM CHL 8MEQ ER TAB
POTASSIUM CHL 10MG TAB
PRENATAL 1+1 VITAMIN TAB
PRENATAL MR 90 FE TAB
PRENATAL MTR W/SELEN TAB
SODIUM FLUORIDE 1.0MG CHW TAB
SODIUM FLUORIDE CHEW 1.1MG TAB
SODIUM FLUORIDE CHEW 2.2MG TAB
TRI-VITA BETS W/FLUOR 1MG CHEW TAB
VI-C FORTE CAP
VITAPLEX TAB
WOMEN’S HEALTH
ESTRADIOL 0.5MG TAB
ESTRADIOL 1MG TAB
ESTRADIOL 2MG TAB
ESTROPIPATE 0.75MG TAB
ESTROPIPATE 1.5MG TAB
MEDROXYPROGESTERONE 2.5G TAB
MEDROXYPROGESTERONE 5MG TAB
MEDROXYPROGESTERONE
OTHER
ANAGRELIDE 0.5MG CAP
BETHANECHOL 5MG TAB
DEXAMETHASONE 0.5MG TAB
DEXAMETHASONE 1MG TAB
DEXAMETHASONE 4MG TAB
PHENAZOPYRIDINE 100MG TAB
PHENAZOPYRIDINE 200MG TAB
PHOSPHA 250 NEUTRA
PREDNISONE 2.5MG TAB
PREDNISONE 20MG TAB
PREDNISONE 5MG TAB
HYDROCORTISONE 20MG TAB
HYDROXYCLOROQUINE 200MG TAB
METHYLPREDNISOLONE 4MG TAB
OXYBUTYNIN 5MG TAB
PAPAVERINE 150MG CAP
PREDNISOLONE 5MG TAB
PREDNISONE 1MG TAB
PREDNISONE 10MG TAB
TAMOXIFEN CITRATE 10MG TAB
YOHIMBINE 5.4MG TAB
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
QTY
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
M.P. N-Rx. FS 01/13
73
Seduction Cosmetic Center
2500 NW 107 Ave # 102
Doral, Fl. 3172
Phone: 305-406-9055
COSMETIC PROCEDURES / TRATAMIENTOS ESTETICOS
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
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
SPA TREATMENTS / TRATAMIENTOS DE SPA
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)
74
MP . C-S . FS 01/13
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
$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
$2,800
$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
$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
$750.00
$85.00
$500.00
$85.00
$300.00
$35.00
$300.00
$35.00
$350.00 FEE
SPA TREATMENTS / TRATAMIENTOS DE SPA
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
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
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
$85.00
$100.00
$425.00
$750.00
$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
$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
MP . C-S . FS 01/13
75
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)
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
76
MP . C-S . FS 01/13
GENERIC PRODUCTS / PRODUCTOS GENERICOS
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
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
$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

medical center / centro medico

Transcription

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