provider directory 28-11-2017 - medical · acupunture/acupuntura vidachiropracticmiami...

ONE PLUSMedical Plan

PROVIDER DIRECTORYPROVIDER DIRECTORY20172017

Specialist Pg 7Especialistas

Urgent Care Centers Pg 11Centros de Urgencia

Dental Service Pg 12Odontología

Optical Services Pg 21Óptica

Clinical Lab Pg 22Laboratorio Clínico

Diagnostic Center Pg 24Centros de Diagnóstico

Pharmacy Pg 25Farmacia

Supplies Pg 26Suministros


2

PROVIDER DIRECTORYPROVIDER DIRECTORY

Welcome & Disclosure Pg 3Bienvenida e Información Legal

Primary Care Pg 5Médicos Primarios


WELCOME TO

En este directorio encontrará la red demédicos y servicios que podrá utilizarcomo miembro de nuestro plan. Loinvitamos a revisar los beneficios queadquirió con su membresía, los cuales lebrindarán la mejor protección para usted ysu familia quienes podrán asistir a cualquiermédico o centro de salud en nuestrodirectorio sin necesidad de ser referido, tansólo solicitando su cita a nuestrodepartamento de Servicio al cliente (786871 1920) dónde le indicaremos el mejormédico, especialista, centro dediagnóstico, dentista o laboratorio deacuerdo a su necesidad.

Este es un plan de uso sencillo ya que alpresentar su tarjeta de membresía anuestros proveedores, ellos verificarán siusted se encuentra activo y obtendrá undescuento significativo al momentoinmediato de recibir y pagar su servicio.

Gracias por escogernos como su planmédico de descuento.

This is your provider directory; here youwill find your doctors and specialistnetwork. We invite you to take a look atthis directory, so you can see also thebenefits that you are entitled to as a ONEPLUS MEDICAL PLAN member, which willgive you and your family the best care.

You as a member, can choose anappointment with the specialist of yourpreference with no necessity of beingtransferred, you can just make a directappointment by just calling our customerservice line (786 871 1920) where we willguide you and help you also choosing theprimary doctor, dentist or specialist, thebest option for you, depending on whatyou are looking for.

It is very easy to use the plan, becausewhen you use your membership card whitour providers they will verify if you arecurrently active, and you will receive asignificant discount at the moment of usingand paying your service.

Thanks for choosing us as your medicaldiscount plan.

BIENVENIDO A

DISCLOSURE

4

5

MIAMI-DADE

GENERAL MEDICINE VLADIMIRSANTOS

7490 SW 23 ST #201MIAMI FL 33155786 953 8221

MON-FRIWEDNESDAY 10:00-5:00SATURDAY 8:00-2:00AGE 18 +1ST VISIT $30 / FOLLOW-UP $20

PREVENTIVE AND PRIMARYCARE MEDICAL CENTER

10250 SW 56 ST SUITE C101MIAMI, FL 33165786 558 8901

1ST VISIT $ 30 / FOLLOW UP $ 20

FAMILY PRACTICE VICENTEFRANCO

1884 SW 57 AVEMIAMI FL 33155305 262-9333

MON-FRI 9:00-5:00AGE 18+1ST VISIT $30 / FOLLOW-UP $20

HOPE HEALTH CARE ODALYSFRONTELA

801 W 48TH SUITE AHIALEAH, FL 33012305 698 7172

1ST VISIT $30 / FOLLOW UP $20

MOBILE DOCTORVISIT: $100MASSAGE THERAPY

WELLNESS THERAPY ANDMEDICAL CENTER

1140 W 50 ST SUITE 301HIALEAH, FL 33012305 827 0208

MON-FRI8:00 - 5:00AGE 15 +1ST VISIT $30 / FOLLOW-UP $20

COMPETENT GROUP SERVICES

8370 W FLAGLER ST SUIT 234MIAMI, FL, 33134305 226 1987

1ST VISIT $30 / FOLLOW-UP $20ULTRASOUND $ 70 DÓLARESCOLPOSCOPY $ 250 DOLARESIUD REMOVAL $150 DOLARES

MEDICINA GENERAL RODOLFOBINKER

6700 SW 21 STMIAMI, FL 33155305 266 0006


Primary CareMédicos Primarios

BROWARD COUNTY

5

MIRAMAR MEDICAL CENTER

11904 MIRAMAR PARK WAYMIRAMAR, FL 33025954 639 7560

1ST VISIT $ 30 / FOLLOW UP $ 20ACUPUNTURA $ 65

SW FLORIDA REGIONALMEDICAL CENTER

5580 19TH CT SW #2NAPLES, FL 34116239 304 2471


CENTRO DE SALUD PRIMARIA

4801 HOLLYWOOD BL SUITE BHOLLYWOOD FL 33021954 927 5905

1ST VISIT 30 / FOLLOW-UP $20ANDRES OZUAL

JOHNSON MEDICAL SERVICES

2531 N DIXIE HIGHWAYLAKE WORTH, FL 33460561 582 0330

1ST VISIT 50 / FOLLOW-UP $50

Primary CareMédicos Primarios

LUIS GUTIERREZ MD

9690 W SAMPLE ROAD # 101CORAL SPRINGS, FL 33065754 529 8633

1 ST VISIT $ 30 / FOLOW UP $ 20

7

MIAMI-DADE

ALLERGY AND IMMUNOLOGY /ALERGIA E INMUNOLOGÍA

VICENTE A CHAVARRIA

1490 W 49 PLACE SUITE 508HIALEAH FL 33012305 670 7006

1ST VISIT $90

ACUPUNTURE / ACUPUNTURA

VIDA CHIROPRACTIC MIAMI

3420 W 84 ST UNIT 102HIALEAH FL 33018305 603 8408

1ST VISIT 60 / FOLLOW-UP $40ACUPUNTURE $60.00

ALLERGY AND IMMUNOLOGY /ALERGIA E INMUNOLOGÍA

VICENTE A CHAVARRIA

10700 N KENDALL DRIVE SUITE304MIAMI FL 33176305 670 7006

1ST VISIT $90

CARDIOLOGIST /CARDIOLOGÍA

JOSÉ ESCALANTE

777 E 25 ST SUITE 214HIALEAH FL 33013305 836 1997

1ST VISIT $60 / FOLLOW-UP $50

COSMETIC SURGERY / CIRUGÍACOSMÉTICA

RODOLFO BINKER

6700 SW 21 STMIAMI FL 33155305 266 0006

DERMATOLOGY /DERMATOLOGÍA

JAIME GARCIA

935 W 49 SR SUITE 107HIALEAH FL 33012305 827 2268

1ST VISIT $ 60 / FOLLOW-UP $40

ENDOCRINOLOGY /ENDOCRINOLOGÍA

CARLOS BARRERA

7190 SW 87 AVE SUITE 306MIAMI, FL 33173305 274 4339


ENT /OTORRINOLARINGOLOGÍA

LLOPIZ MEDICAL PRACTICE



GASTROENTEROLOGY /GASTROENTEROLOGÍA

CARLOS SELEMA

747 PONCE DE LEON BLVDSUITE 510CORAL GABLES. FL 33134305 443 2611

1ST VISIT $75 / FOLLOW-UP $60COLONOSCOPY $600 /ENDOSCOPY $400

GENERAL SURGERY / CIRUGÍAGENERAL

RODOLFO BINKER

6700 SW 21 STMIAMI FL 33155305 266 0006

GYNECOLOGY / GINECOLOGÍA

ESPERANZA ARCE-NÚÑEZ

1840 W 49 ST SUITE 420HIALEAH, FLORIDA 33012305 823 3000


INTERNAL MEDICINE /MEDICINA INTERNA

CARLOS BARRERA







SpecialistsEspecialistas





DERMATOLOGY /DERMATOLOGÍA




8

MIAMI-DADE

OPHTALMOLOGIST /OFTALMOLOGÍA

RODRIGO BELALCAZAR



ORTHOPEDIC / ORTOPEDIA

MANUEL FRADE

8080 W FLAGLER ST.MIAMI FL 33144305 262 8227 - 305 262 8280



PETER J MILLHEISER

9299 SW 152 ST #104MIAMI, FL 33157305 251 2240

1ST VISIT $ 80 / FOLLOW UP $ 60X- RAY $ 35.00INJECTION JOIN $ 70.00


PETER J MILLHEISER


1ST VISIT $ 80 / FOLLOW UP $ 60MONDAY 8:00 - 5:00


JOSE PONCE DE LEON

3501 SW 107 AVEMIAMI, FL 33165305 229 1227

SCHEDULE:TUESDAY, THURSDAY Y FRIDAY 9:00PM A 4:00 PM1ST VISIT $60 / FOLLOW UP $ 40

PEDIATRIC / PEDIATRÍA

DIANA E VARGAS

10250 SW 56 ST B-103MIAMI FL 33165305 207 7333

1ST VISIT 40 / FOLLOW-UP $30

PEDIATRIC / PEDIATRÍA

OTNIEL HERNANDEZ

1275 W 47 PLACE SUITE 422HIALEAH, FL 33012305 676 2300


PSYCHIATRY / PSIQUIATRÍA

OTNIEL HERNANDEZ



PODIATRIST / PODIATRA

GILBERTO J ACOSTA

613 EAST 49 STHIALEAH, FL 33013305 828 2288


PODIATRIST / PODIATRA




PSYCHIATRY / PSIQUIATRÍA




PSYCHOLOGY / PSICOLOGÍA

VANESSA PAGES

6262 BIRD ROADMIAMI FL 33155305 663 7979



NEUROLOGY / NEUROLOGÍA

HECTOR LALAMA

801 SANTIAGO STCORAL GABLES, FL 33134305 448 9797


NEUROLOGY / NEUROLOGÍA




NEPHROLOGIST / NEFROLOGÍA

GARCÍA-ESTRADA, MD KIDNEYASSOCIATES PA

550 SW 27 AVEMIAMI FL 33135305 541 2655


9


WEIGHT LOSS / PÉRDIDA DEPESO

RODOLFO BINKER

6700 SW 21 STMIAMI FL 33155305 266 0006

WEIGHT LOSS / PÉRDIDA DEPESO

OTNIEL HERNANDEZ


COMPLETE WEIGHT LOSS PROGRAM1- CLASE: $602- PROGRAMA COMPLETO: $ 600

UROLOGIST / UROLOGÍA

JUAN B SUÁREZ

2601 SW 37 AVEMIAMI FL 33133305 443 1040


MIAMI-DADE

PULMONOLOGIST

CARLOS BARRERA



PSYCHOLOGY / PSICOLOGÍA




10

ENDOCRINOLOGY /ENDOCRINOLOGÍA




ACUPUNTURE / ACUPUNTURA













LUIS M. GONZALEZ M.D.

12005 FEDERAL HWAYHOLLYWOOD, FL 33020954 505 4141


INTERNAL MEDICINE/MEDICINA INTERNA

LUIS GUTIERREZ M.D.

9690 W SAMPLE ROAD # 101CORAL SPRINGS, FL 33065754 529 8633

1 ST VISIT $ 60 / FOLOW UP $ 40

OBSTETRICS-GYN /OBSTETRICIA




PHYSICAL THERAPY / TERAPIAFISICA

LUIS M. GONZALEZ M.D.

12005 FEDERAL HWAYHOLLYWOOD, FL 33020954 505 4141






BROWARD COUNTY


URGENT CARE OTONIELHERNANDEZ


URGENCY $80

11

Urgent Care CenterCentros de Urgencia

BROWARD COUNTY

URGENT CARE SOUTHFLORIDA PEDIATRIC ANDADULTS, IMMIGRATION

302 NW 179 AVE SUITE 103PEMBROKE PINES, FL 33029954 442 8380

MIAMI-DADE

Dental ServicesOdontología

12

MIAMI-DADE

WORLD DENTAL CARE CORP.

1370 EAST 4 AVEHIALEAH FL 33010305 888 1458

BROWARD COUNTY

PINES DENTAL ASOCIATED

17868 NW 2 STPEMBROKE PINES, FL 33029954 538 0047

NEW DENTAL CARE CORP

285 NW 27 AVE SUITE 21MIAMI FL 33125305 649 9443

13

Dentistry Fee ScheduleTarífas de odontología

ADA CODES DESCRIPTION FEE

D 0150 Comprehensive Oral Evaluation (1 anually) $0.00

D 1110 Simple Prophylaxis (1 anually) $0.00

D 2330 Single Restoration one Surface (1 anually) $0.00

D 1203 Topical Application of Fluoride - Child (1 anually) $0.00

D 1204 Topical Application of Fluoride - Adult (1 anually) $0.00

D 7110 Simple Tooth Extraction (1 anually) $0.00


D0210 Full Mouth X-Rays (once) $0.00

D0120 PERIODIC ORAL EXAM $20.00

D0140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED $15.00

D0150 COMPREHENSIVE ORAL EVAL-NEW OR ESTABLISHED PATIENT NO CHARGE

D0160 DETAILED & EXTENSIVE EVAL-PROBLEM FOCUSED NO CHARGE

D0170 RE-EVALUATION-LIMITED, PROBLEM FOCUSED $15.00

D0180 COMPREHENSIVE PERIODONTAL EVALUATION $15.00

D0210 X-RAY - INTRAORAL - COMPLETE SERIES (INCLUDING BITEWINGS) $30.00

D0220 X-RAY - INTRAORAL - PERIAPICAL FIRST FILM $15.00

D0230 X-RAY - INTRAORAL - PERIAPICAL EACH ADDITIONAL FILM $5.00

D0240 X-RAY - INTRAORAL - OCCLUSAL FILM $5.00

D0250 X-RAY - EXTRAORAL - FIRST FILM NO CHARGE

D0260 X-RAY - EXTRAORAL - EACH ADDITIONAL FILM NO CHARGE

D0270 X-RAY - BITEWING- SINGLE FILM $5.00

D0272 X-RAY - BITEWING - 2 FILMS $5.00

* Periodontal scaling and root planing of 4 quadrant cost $240.00

One Plus Medical Plan does not provide emergency dental assistance

One plus Medical Plan no ofrece servicios dentales de emergencia

DENTAL SERVICES OFFERED TO MEMBERS ONCE A YEAR AT NO CHARGE

Servicios dentales gratis una vez al año sólo para miembros

DENTAL SERVICES OFFERED TO MEMBERS ONCE IN A LIFETIME AT NO CHARGE

Servicios dentales gratis una vez en la vida para miembros

RADIOGRAPHY/DIAGNOSTIC DENTISTRY

IMPORTANT NOTICE

14



D0330 PANORAMIC FILM $25.00

D0340 CEPHALOMETRIC FILM, NON-ORTHODONTIC $75.00

D0350 DIAGNOSTIC PHOTOGRAPHS $20.00

D0460 PULP VITALITY TEST $10.00

D0470 DIAGNOSTIC CASTS $25.00

D1110 ROUTINE PROPHYLAXIS ADULT (ONCE EVERY 6 MONTHS) $49.00

D1120 ROUTINE PROPHYLAXIS - CHILDREN UNDER 16 YRS (ONCE EVERY 6 MONTHS) $35.00

D1203 TOPICAL APPLICATION OF FLOURIDE FOR CHILDREN UNDER 16 NO CHARGE

D1204 TOPICAL APPLICATION OF FLOURIDE FOR ADULTS NO CHARGE

D1310 NUTRITIONAL COUNSELING FOR CONTROL OF DENTAL DISEASE NO CHARGE

D1320 TOBBACO COUNSELING FOR CONTROL & PREVENTION OF ORAL DISEASESNO CHARGE

D1330 ORAL HYGIENE INSTRUCTIONS NO CHARGE

D1351 APPLICATION OF SEALANT PER TOOTH - CHILDREN UNDER 16 $15.00

D1510 SPACE MAINTAINER - FIXED $120.00

D1515 SPACE MAINTAINER - FIXED $175.00

D1520 SPACE MAINTAINER - REMOVABLE $160.00

D1525 SPACE MAINTAINER - REMOVABLE $250.00

D1550 RE-CEMENTATION OF SPACE MAINTAINER $25.00

D2330 RESIN-BASED COMPOSITE - 1 SURFACE, ANTERIOR $45.00

D2331 RESIN-BASED COMPOSITE - 2 SURFACES, ANTERIOR $55.00

D2332 RESIN-BASED COMPOSITE - 3 SURFACES, ANTERIOR $65.00

D2335 COMPOSITED RESIN - 4 OR MORE SURFACES $75.00

D2391 RESIN - BASED COMPOSITE - 1 SURFACE, POSTERIOR $60.00

D2392 RESIN-BASED COMPOSITE - 2 SURFACES, POSTERIOR $70.00

D2393 RESIN-BASED COMPOSITE - 3 SURFACES, POSTERIOR $80.00

D2394 RESIN-BASED COMPOSITE - 4 OR + SURFACES, POSTERIOR $90.00

D2410 GOLD FOIL - 1 SURFACE $75.00

D2420 GOLD FOIL - 2 SURFACES $95.00

D2430 GOLD FOIL - 3 SURFACES $125.00

D2510 INLAY - METALLIC - 1 SURFACE $300.00

D2520 INLAY - METALLIC - 2 SURFACES $320.00

D2530 INLAY - METALLIC - 3 OR MORE SURFACES $340.00

D2542 ONLAY - METALLIC - 2 SURFACES $325.00

D2543 ONLAY - METALLIC - 3 SURFACES $330.00

D2544 ONLAY - METALLIC - 4 OR MORE SURFACES $355.00

D2610 INLAY - PORCELAIN/CERAMIC - 1 SURFACE $325.00

PREVENTIVE DENTISTRY TO BE TAKEN IF 274 WAS DONE W/IN PRIOR 6 MOS

PREVENTIVE DENTISTRY

NOT TO BE TAKEN IF 274 WAS DONE W/IN PRIOR 6 MOS

15



D2544 ONLAY - METALLIC - 4 OR MORE SURFACES $355.00

D2610 INLAY - PORCELAIN/CERAMIC - 1 SURFACE $325.00

D2620 INLAY - PORCELAIN/CERAMIC - 2 SURFACES $350.00

D2630 INLAY - PORCELAIN/CERAMIC - 3 OR MORE SURFACES $375.00

D2642 ONLAY - PORCELAIN/CERAMIC - 2 SURFACES $395.00

D2643 ONLAY - PORCELAIN/CERAMIC - 3 SURFACES $415.00

D2644 ONLAY - PORCELAIN/CERAMIC - 4 OR MORE SURFACES $445.00

D2650 INLAY - RESIN - BASED COMPOSITE - 1 SURFACE $195.00

D2651 INLAY - RESIN - BASED COMPOSITE - 2 SURFACES $250.00

D2652 INLAY - RESIN - BASED COMPOSITE - 3 OR MORE SURFACES $275.00

D2662 ONLAY - RESIN - BASED COMPOSITE - 2 SURFACES $250.00

D2663 ONLAY - RESIN - BASED COMPOSITE - 3 SURFACES $275.00

D2664 ONLAY - RESIN - BASED COMPOSITE - 4 OR MORE SURFACES $290.00

D2710 CROWN - RESIN (INDIRECT) $210.00

D2720 CROWN - RESIN WITH HIGH NOBLE METAL $455.00

D2721 CROWN - RESIN WITH PREDOMINNATLY BASE METAL $405.00

D2722 CROWN - RESIN WITH NOBLE METAL $425.00

D2740 CROWN - PORCELAIN/CERAMIC SUBSTRATE $450.00

D2750 CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL $395.00

D2751 CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $495.00

D2752 CROWN - PORCELAIN FUSED TO NOBLE METAL $495.00

D2780 CROWN - 3/4 CAST HIGH NOBLE METAL $530.00

D2781 CROWN - 3/4 CAST PREDOMINANTLY BASE METAL $410.00

D2782 CROWN - 3/4 CAST NOBLE METAL $520.00

D2783 CROWN - 3/4 PORCELAIN/CERAMIC $550.00

D2790 CROWN - FULL CAST HIGH NOBEL METAL $699.00

D2791 CROWN - FULL CAST PREDOMINANTLY BASE METAL $525.00

D2792 CROWN - FULL CAST NOBLE METAL $580.00

D2799 PROVISIONAL CROWN $50.00

D2910 RECEMENT INLAY $25.00

D2920 RECEMENT CROWN $25.00

D2930 PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH $95.00

D2931 PREFABRICATED STAINLESS STEEL CROWN-PERMANENT TOOTH $95.00

D2932 PREFABRICATED RESIN CROWN $95.00

D2933 PREFABRICATED STAINLESS STEEL CROWN WITH RESIN WINDOW $145.00

D2940 SEDATIVE FILLING $40.00

D2950 CORE BUILDUP, INCLUDING ANY PINS $85.00

D2951 PIN RETENTION - PER TOOTH, IN ADDITION TO RESTORATION $20.00


16



D2952 CAST POST & CORE IN ADDITION TO CROWN $120.00

D2953 EACH ADDITIONAL CAST POST - SAME TOOTH $105.00

D2954 PREFABRICATED POST & CORE IN ADDITION TO CROWN $125.00

D2955 POST REMOVAL (NOT IN CONJUNTION WITH ENDODONTIC THERAPY) $30.00

D2957 EACH ADDITIONAL PREFABRICATED POST - SAME TOOTH $30.00

D2960 LABIAL VENEER (RESIN LAMINATE) - CHAIRSIDE $205.00

D2961 LABIAL VENEER (RESIN LAMINATE) - LABORATORY $260.00

D2962 LABIAL VENEER (PORCELAIN LAMINATE) - LABORATORY $425.00

D2970 TEMPORARY CROWN (FRACTURED TOOTH) $50.00

D2980CROWN REPAIR/ When crown and/or bridgework exceeds six(6)consecutive units, there will be an additional charge of $30.00 perunit.

$95.00

D3110 PULP CAP-DIRECT (EXCLUDING FINAL RESTORATION) $25.00

D3120 PULP CAP-INDIRECT (EXCLUDING FINAL RESTORATION) $25.00

D3220 THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) $75.00

D3221 PUPAL DEBRIDEMENT, PRIMARY AND PERMANENT TEETH $95.00

D3230 PUPAL THERAPY (RESORB FILLING) - ANTERIOR, PRIMARY $80.00

D3240 PUPLAM THERAPY (RESORBABLE FILLING) - POSTERIOR, PRIMARY $90.00

D3310 ROOT CANAL THERAPY - ANTERIOR $350.00

D3320 ROOT CANAL THERAPY - BICUSPID $450.00

D3330 ROOT CANAL THERAPY - MOLAR $550.00

D3331TREATMENT OF ROOT CANAL OBSTRUCTION, NON-SURGICALACCESS

$85.00

D3346 RETREAT, PREV RCT - ANTERIOR $495.00

D3347 RETREAT, PREV RCT - BICUSPID $595.00

D3348 RETREAT, PREV RCT - MOLAR $695.00

D3950CANAL PREPARATION AND FITTING OF PREFORMED DOWEL ORPOST

$75.00

D4211 GINGIVECTOMY/GINGIVOPLASTY - 1 TO 3 TEETH, PER QUAD $50.00

D4220GINGIVAL CURETTAGE PER QUADRANT EXCLUDING ROOTPLANNING

$75.00

D4240 GINGIVAL FLAP PROCEDURE- 4 OR MORE $325.00

D4241 GINGIVAL FLAP PROCEDURE - 1 TO 3 TEETH PER QUAD $250.00

D4245 APICALLY POSITIONED FLAP $150.00

D4341PERIODONTAL SCALING & ROOT PLANING - 4 OR MORECONTIGUOUS TEETH

$60.00

D4342PERIODONTAL SCALING $ ROOT PLANING - 1 TO 3 TEETH, PERQUAD

$45.00

D4355FULL MOUTH DEBRIDEMENT TO ENABLE COMPREHENSIVEEVALUATION

$80.00


ENDODONTIC SERVICES

PERIODONTIC SERVICES

17


D4381 LOCAL DELIVERY ANTIBIOTIC (ARESTIN) $30.00

D4910 PERIODONTAL MAINTENANCE $55.00

D5110 COMPLETE DENTURE - MAXILLARY BASIC $375.00

D5120 COMPLETE DENTURE - MANDIBULAR BASIC $375.00

D5211MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDINGCLASPS)

$450.00

D5212MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDINGCLASPS)

$450.00

D5213 PARTIAL DENTURE - MAXILLARY CAST METAL - ACRYLIC $395.00

D5214 PARTIAL DENTURE - MANDIBULAR VAST METAL - ACRYLIC $395.00

D5410 ADJUSTMENT - COMPLETE DENTURE - MAXILLARY $20.00

D5411 ADJUSTMENT - COMPLETE DENTURE - MANDIBULAR $20.00

D5421 ADJUSTMENT - PARTIAL DENTURE - MAXILLARY $20.00

D5422 ADJUSTMENT - PARTIAL DENTURE - MANDIBULAR $20.00

D5510 REPAIR BROKEN COMPLETE DENTURE BASE $75.00

D5520 REPLACE BROKEN TOOTH - COMPLETE DENTURE (EACH TOOTH) $70.00

D5610 REPAIR DENTURE RESIN BASE $50.00

D5620 REPAIR CAST FRAMEWORK $55.00

D5630 REPAIR OR REPLACE BROKEN CLASP $55.00

D5640 REPAIR BROKEN TEETH - PER TOOTH $45.00

D5650 ADD TOOTH TO EXISTING PARTIAL DENTURE $65.00

D5660 ADD CLASP TO EXISTING PARTIAL DENTURE $75.00

D5710 REBASE COMPLETE MAXILLARY DENTURE $195.00

D5711 REBASE COMPLETE MANDIBULAR CENTURE $195.00

D5720 REBASE MAXILLARY PARTIAL DENTURE $175.00

D5721 REBASE MANDIBULAR PARTIAL DENTURE $175.00

D5730 RELINE COMPLETE MAXILLARY DENTURE (CHAIRSIDE) $85.00

D5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $85.00

D5740 RELINE PARTIAL COMPLETE MAXILLARY DENTURE (CHAIRSIDE) $65.00

D5741 RELINE PARTIAL COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) $65.00

D5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) $150.00

D5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) $150.00

D5760 RELINE PARTIAL MAXILLARY DENTURE (LABORATORY) $110.00

D5761 RELINE PARTIAL MANDIBULAR DENTURE (LABORATORY) $110.00

D5810 INTERIM COMPLETE DENTURE - MAXILLARY $250.00

D5811 INTERIM COMPLETE DENTURE - MANDIBULAR $250.00

D5820 INTERIM PARTIAL DENTURE - MAXILLARY $250.00

D5821 INTERIM PARTIAL DENTURE - MANDIBULAR $250.00

D5850 TISSUE CONDITIONING - MAXILLARY $55.00



18


D5851 TISSUE CONDITIONING - MANDIBULAR $55.00

D5862 PRECISION ATTACHMENT $150.00

D6210 PONTIC - CAST HIGH NOBLE METAL $400.00

D6211 PONTIC - CAST PREDOMINANTLY BASE METAL $400.00

D6212 PONTIC - CAST NOBLE METAL $400.00

D6240 PONTIC - PORCELAIN FUSED TO HIGH NOBLE METAL $400.00

D6241 PONTIC - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL $400.00

D6242 PONTIC - PORCELAIN FUSED TO NOBLE METAL $400.00

D6245 PONTIC - PORCELAIN/CERAMIC $595.00

D6740 CROWN - PORCELAIN/CERAMIC $595.00

D6750 CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL $495.00

D6751 CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASED METAL $495.00

D6752 CROWN - PORCELAIN FUSED TO NOBLE METAL $495.00

D6780 CROWN - 3/4 CAST HIGH NOBLE METAL $530.00

D6781 CROWN - 3/4 CAST PREDOMINANTLY BASED METAL $510.00

D6782 CROWN - 3/4 CAST NOBLE METAL $520.00

D6783 CROWN - 3/4 PORCELAIN/CERAMIC $510.00

D6790 CROWN - FULL CAST HIGH NOBLE METAL $495.00

D6791 CROWN - FULL CAST PREDOMIANTLY BASED METAL $495.00

D6792 CROWN - FULL CAST NOBLE METAL $495.00

D6930 RECEMENT FIXED PARTIAL DENTURE $40.00

D6950 PRECISION ATTACHMENT $150.00

D6970CAST POST & CORE ADDITION TO FIXED PARTIAL DENTURERETAINER

$125.00

D6971 CAST POST AS PART OF A FIXED PARTIAL DENTURE RETAINER $125.00

D6972PREFABRICATED POST & CORE IN ADDITION TO FIXED PARTIALDENTURE

$125.00

D6973 CORE BUILD UP FOR RETAINER, INCLUDING PINS $95.00

D6975 COPING - METAL $95.00

D7110 SINGLE TOOTH EXTRACTION $70.00

D7140 EXTRACTION OF ERUPTED TOOTH OR EXPOSED ROOT $70.00

D7310 ALVEOLOPLASTY WITH EXTRACTIONS - PER QUADRANT $95.00

D7320 ALVEOLOPLASTY WITHOUT EXTRACTIONS - PER QUADRANT $130.00

D7510 INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE $55.00

D9215 LOCAL ANESTHESIA NO CHARGE

D9230 ANALGESIA NITROUS OXIDE PER 1/2 hour $20.00


PROSTHODONTICS - FIXED

ORAL SURGERY

MISCELLANOUS SERVICES


19


D9630 ORAL IRRIGATION/OTHER DRUGS/MEDICAMENT PER QUAD $10.00

D9940 OCCLUSAL GUARD $195.00

D9950 OCCLUSAL ANALYSIS - MOUNTED CASE $75.00

D9951 OCCLUSAL ADJUSTMENT - LIMITED $25.00

D9952 OCCLUSAL ADJUSTMENT - COMPLETE $150.00

MISCELLANOUS SERVICES


20


ED3310 ROOT CANAL THERAPY - ANTERIOR $695.00

ED3320 ROOT CANAL THERAPY - BICUSPID $775.00

ED3330 ROOT CANAL THERAPY - MOLAR $925.00

ED3346 RETREAT, PREV RCT - ANTERIOR $750.00

ED3347 RETREAT, PREV RCT - BICUSPID $825.00

ED3348 RETREAT. PREV RCT - MOLAR $1,125.00

D4210 GINGIVECTOMY 4 OR + PER QUADRANT $450.00

D4249 CLINIC CROWN LENGTHEN - HARD TISSUE $800.00

D4260 OSSEOUS SURGERY 4 OR + PER QUADRANT $900.00

D4263 BONE REPLACE GRAFT - 1ST SITE/QU $650.00

D4264 BONE REPLACE GRAFT - EACH ADD/QU $500.00

D4266 GUIDED TISS REGEN-RESORB-PER $900.00

D4275 SOFT TISSUE ALLOGRAFT RB-PER $1,200.00

D7953 BONE REPL GRAFT RIDGE PRSV/SITE $400.00

D7960 FRENULECTOMY - SEPARATE PROCEDURE $500.00

D7210 EXTRACTION - SURGICAL/ERUPT TOOTH $240.00

D7220 EXTRACTION - IMPACTEDL/SOFT TISSUE $300.00

D7230 EXTRACTION - IMPACTEDL/PART BONY $395.00

D7240 EXTRACTION - IMPACTED/COMPLBONY (Cordales) $450.00

D7241 REMOV IMPACT - COMP BONY W/COMP $500.00

D7250 SURGIC REMOVL RESID TOOTH ROOT $250.00

D7285 BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH) $120.00

D7286 BIOPSY OF ORAL TISSUE - SOFT (ALL OTHER) $95.00

BIOPSY LAB $50.00

D8080 COMPREHENSIVE ORTHO, ADOLESCENT $3,490.00

D8090 COMPREHENSIVE ORTHO, ADULT $3,490.00

D6010 SURG PLACE IMPLANT, ENDOSTEAL $1,200.00

D6010/D6059 COMPLETED CROWN IMPLANT $1,950.00

D0000 OVERDENTURE UPPER WITH 4 IMPLANTS $4,650.00

D0000 OVERDENTURE LOWER WITH 3 IMPLANTS $3,650.00

ENDODONTIC SERVICES

PERDIODONTIC SERVICES

ORAL SURGERY

IMPLANTS

ORTHODONTICS

Dental Specialties Fee ScheduleTarífas de Especialidades Edontológicas

Optical ServicesServicio Óptico

MIAMI-DADE

VISION SPECIALTY CARE

7949 NW 2 STMIAMI FL 33126305 263 9050

EXPRESS VISION CARE


EXAMEN OCULAR COMPLETE $35.00(EVALUATION OF VISION -DILATIONOF THE PUPIL - EVALUATION OFINTRAOCULAR PRESSURE)MONDAY - THURSDAY

DESCRIPTION PRICE

Eyem Exam $35.00

Bifocal Lense Fitting $35.00

Single Vision Contact Lense Fitting $60.00

Standard Stock CR-39 Single Vision $35.00

Standard Stock CR-39 Bi-Focal FT-28 $35.00

Standard Stock CR-39 Tri-Focal 7x28 $45.00

Standard Select Progessive Bi-Focal $60.00

Bifocal Transition Lens $80.00

Transition Progressive Lens $90.00

Frames and Standard Lenses

OPTICAL SERVICES OFFERED TO MEMBERS

Servicios ópticos sólo para miembros

21

Clinical LabLaboratorio Clínico

MIAMI-DADE

DOCTOR'S CLINICALLABORATORY SERVICES, INC.

8280 NW 27 ST #501DORAL, FL 33133305 597 9905

VENIPUNTURA $10 A DOMICILIO

BROWARD COUNTY

CBS LABORATORY MIAMI

41 TAMIAMI CANAL ROADMIAMI, FL 33144PHONE: 305 269 0833FAX: 305-269-0851

CBS LABORATORYHOMESTEAD

239 N. KROME AVEHOMESTEAD, FL 33030PHONE: 786 601 9875FAX: 786 481 5554

CBS LABORATORY HIALEAH

2130 W 68 STHIALEAH,FL 33016PHONE: 786 536 6061FAX: 786 310 7612



LABORATORY - ULTRASOUND - X RAY

PEMBROKE PINES CBSLABORATORY

9872 PINES BLVDPEMBROKE PINES, FL 33024PHONE: 754 209 7782PHONE: 754 209 7777FAX: 754 209 7786

FORT PIERCE CBSLABORATORY

2207 S. 25 STFORT PIERCE, FL 34947PHONE: 772 577 4200FAX: 772 577 4202

FORT PIERCE CBSLABORATORY

2400 RHODE ISLAND AVE.SUITE 4FT. PIERCE, FL 34950PHONE: 772 466 4259FAX: 772 595 9443

PORT ST. LUCIE CBSLABORATORY

1578 SE PORT ST. LUCIE BLVDPORT ST. LUCIE, FL 34952PHONE: 772 207 5951FAX: 772 207 5577

TAMPA CBS LABORATORY

1916 W DR.MARTIN LUTHERKING JR. BLVDTAMPA, FL 33603PHONE: 813 304 0073FAX: 813 304 0077

CBS LABORATORY MAINOFFICE

2546 W 6TH AVEHIALEAH, FL 33010PHONE: 305 882 1051FAX: 305 882 1052

CBS LABORATORY HIALEAH

1275 W 47 PI SUITE 417HIALEAH, FL 33012PHONE: 305 364 4945FAX: 305 364 4946

Todos los laboratorios requieren que los exámenes que se solicitan sean previamente indicados por un profesional de la salud con licencia del estado dela Florida. La orden medica debe ser escrita en una receta medico en el formulario del laboratorio y firmada por el médico que lo indica. El laboratoriocumplirá el procedimiento legal establecido de confidencialidad del paciente y para proteger ese derecho enviaran los resultados a la oficina del doctor.

22

Clinical LabLaboratorio Clínico

KEY WEST CBS LABORATORY

3150 NORTH SIDE DR.KEY WEST, FL 33040PHONE: 305 440 3364FAX: 305 882 1130

LEHIGH ACRES CBSLABORATORY

904 LEE BLVD, UNIT 107LEHIGH ACRES, FL 33936PHONE: 239 491 6948FAX: 239 674 7652

Todos los laboratorios requieren que los exámenes que se solicitan sean previamente indicados por un profesional de la salud con licencia del estado dela Florida. La orden medica debe ser escrita en una receta medico en el formulario del laboratorio y firmada por el médico que lo indica. El laboratoriocumplirá el procedimiento legal establecido de confidencialidad del paciente y para proteger ese derecho enviaran los resultados a la oficina del doctor.

23

BROWARD COUNTY

Diagnostic CenterCentros de Diagnóstico

MIAMI-DADE

BROWARD COUNTY

24

LAKES RADIOLOGY

15600 NW 67 AVE., SUITE 107 &304MIAMI LAKES, FL 33014305 231 1115

B & G DIAGNOSTIC CENTER

444 W 51 PLACEHIALEAH FL 33012305 818 2006

DIGITAL MEDICAL DIAGNOSTIC

41 TAMIAMI CANAL RDMIAMI, FL 33144305 269 0833


8370 W FLANGER ST SUIT 234MIAMI, FL 33144305 226 1987

ULTRADOUND $ 70.00COLPOSCOPY $ 250.00IUD REMOVAL $ 150.00

CARDIOVASCULARDIAGNOSTIC IMAGE

7171 CORAL WAY SUITE 311MIAMI, FL 33155305 480 2000

LAKES RADIOLOGY

7880 WEST OAKLAND PARKBLVD, SUITE 100SUNRISE, FL 33351954 634 5272

PharmacyFarmacia

MIAMI-DADE

25

EL JARDIN

3112 WEST 76TH STREETHIALEAH FL 33018305 818 2214

IN THE FOLLOWING STORES

En los siguientes almacenes

DIABETE SUPPLIES

DIRECT MEDS OF FLORIDA

STARTER KIT $ 19.95

1 GLUCOSE METER100 LANCETS50 TEST STRIPSTEL: 954 454 8118FAX: 954 454 9898

DIRECT MEDS OF FLORIDA

MONTHLY RENEWABLESUPPLIES

1 GLUCOSE METER = $ 2.50100 LANCETS = $ 9.9950 TEST STRIPS = $ 19.99TEL: 954 454 8118FAX: 954 454 9898

26

WHEN ORDERING DIABETIC SUPPLIES, YOU MUST HAVE A VALIDPRESCRIPTION SIGNED BY A ONE PLUS MEDICAL PLAN PARTICIPATINGPHYSICIAN INDICATING THE SUPPLIES NEEDED. NOTE: FREE DELIVERYSERVICE IS PROVIDED AS A COURTESY TO ONE PLUS MEDICAL PLANMEMBERS BUT IS SUBJECT TO THE DIABETES MEDICAL SUPPLYPROVIDERS ABILITY AND THE DISTANCE TO THE MEMBERS DELIVERYADDRESS.

Al pedir suministros para diabetes o algún equipo médico debe tener unareceta de prescripción válida firmada por un Doctor donde se indique lossuministros y los equipos que necesita Nota: el servicio de domiciliogratuito se ofrece como cortesía a los miembros One Plus Medical Plan,pero está sujeto a la capacidad de proveedores de suministros médicos deDiabetes y la distancia donde se encuentre el miembro, como punto deentrada. por favor llame al proveedor para obtener más detalles de entregade los miembros.

SuppliesSuministros

ORTHOPEDICS SUPPLIES

PODORTIS CORPORATION

5841 SW 8TH STWEST MIAMI, FL 33144305 446 2995


1840 W 49 st suite 233Hialeah, FL 33012

Office.: 786 871-1920 Fax.:786 871-1921www.oneplusmedicalplan.com

provider directory 28-11-2017 - medical · acupunture/acupuntura vidachiropracticmiami...

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