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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
ONE PLUSMedical Plan
2
PROVIDER DIRECTORYPROVIDER DIRECTORY
Welcome & Disclosure Pg 3Bienvenida e Información Legal
Primary Care Pg 5Médicos Primarios
ONE PLUSMedical Plan
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
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
1ST VISIT $ 30 / FOLLOW UP $ 20
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
1ST VISIT $ 50 / FOLLOW UP $ 40
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
1ST VISIT $ 125 / FOLLOW UP $ 95
ENT /OTORRINOLARINGOLOGÍA
LLOPIZ MEDICAL PRACTICE
330 SW 27 AVE SUITE 603MIAMI, FL 33135305 649 5455
1ST VISIT $100 / FOLLOW-UP $70
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
1ST VISIT $60 / FOLLOW-UP $40
INTERNAL MEDICINE /MEDICINA INTERNA
CARLOS BARRERA
7190 SW 87 AVE SUITE 306MIAMI, FL 33173305 274 4339
1ST VISIT $ 125 / FOLLOW UP $ 95
INTERNAL MEDICINE /MEDICINA INTERNA
HOPE HEALTH CARE ODALYSFRONTELA
801 W 48TH SUITE AHIALEAH, FL 33012305 698 7172
1ST VISIT $60 / FOLLOW-UP $40
SpecialistsEspecialistas
GYNECOLOGY / GINECOLOGÍA
COMPETENT GROUP SERVICES
8370 W FLAGLER ST SUIT 234MIAMI, FL, 33134305 226 1987
1ST VISIT $ 60 / FOLLOW-UP $40
DERMATOLOGY /DERMATOLOGÍA
COMPETENT GROUP SERVICES
8370 W FLAGLER ST SUIT 234MIAMI, FL, 33134305 226 1987
1ST VISIT $ 60 / FOLLOW-UP $40
8
MIAMI-DADE
OPHTALMOLOGIST /OFTALMOLOGÍA
RODRIGO BELALCAZAR
1840 W 49 ST SUITE 601HIALEAH, FL 33012305 828 0201
1ST VISIT $80 / FOLLOW-UP $40
ORTHOPEDIC / ORTOPEDIA
MANUEL FRADE
8080 W FLAGLER ST.MIAMI FL 33144305 262 8227 - 305 262 8280
1ST VISIT $ 60 / FOLLOW UP $ 40
ORTHOPEDIC / ORTOPEDIA
PETER J MILLHEISER
9299 SW 152 ST #104MIAMI, FL 33157305 251 2240
1ST VISIT $ 80 / FOLLOW UP $ 60X- RAY $ 35.00INJECTION JOIN $ 70.00
ORTHOPEDIC / ORTOPEDIA
PETER J MILLHEISER
900 W 49 ST SUITE 450HIALEAH, FL 33157305 251 2240
1ST VISIT $ 80 / FOLLOW UP $ 60MONDAY 8:00 - 5:00
ORTHOPEDIC / ORTOPEDIA
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
1ST VISIT $40 / FOLLOW UP $30
PSYCHIATRY / PSIQUIATRÍA
OTNIEL HERNANDEZ
1275 W 47 PLACE SUITE 422HIALEAH, FL 33012305 676 2300
1ST VISIT $60 / FOLLOW-UP $40
PODIATRIST / PODIATRA
GILBERTO J ACOSTA
613 EAST 49 STHIALEAH, FL 33013305 828 2288
1ST VISIT $60 / FOLLOW-UP $40
PODIATRIST / PODIATRA
PREVENTIVE AND PRIMARYCARE MEDICAL CENTER
10250 SW 56 ST SUITE C101MIAMI, FL 33165786 558 8901
1ST VISIT $60 / FOLLOW-UP $40
PSYCHIATRY / PSIQUIATRÍA
PREVENTIVE AND PRIMARYCARE MEDICAL CENTER
10250 SW 56 ST SUITE C101MIAMI, FL 33165786 558 8901
1ST VISIT $60 / FOLLOW-UP $40
PSYCHOLOGY / PSICOLOGÍA
VANESSA PAGES
6262 BIRD ROADMIAMI FL 33155305 663 7979
1ST VISIT $80 / FOLLOW-UP $50
SpecialistsEspecialistas
NEUROLOGY / NEUROLOGÍA
HECTOR LALAMA
801 SANTIAGO STCORAL GABLES, FL 33134305 448 9797
1ST VISIT $100 / FOLLOW-UP $75
NEUROLOGY / NEUROLOGÍA
HOPE HEALTH CARE ODALYSFRONTELA
801 W 48TH SUITE AHIALEAH, FL 33012305 698 7172
1ST VISIT $80 / FOLLOW UP $50
NEPHROLOGIST / NEFROLOGÍA
GARCÍA-ESTRADA, MD KIDNEYASSOCIATES PA
550 SW 27 AVEMIAMI FL 33135305 541 2655
1ST VISIT $80 / FOLLOW-UP $50
9
SpecialistsEspecialistas
WEIGHT LOSS / PÉRDIDA DEPESO
RODOLFO BINKER
6700 SW 21 STMIAMI FL 33155305 266 0006
WEIGHT LOSS / PÉRDIDA DEPESO
OTNIEL HERNANDEZ
1275 W 47 PLACE SUITE 422HIALEAH, FL 33012305 676 2300
COMPLETE WEIGHT LOSS PROGRAM1- CLASE: $602- PROGRAMA COMPLETO: $ 600
UROLOGIST / UROLOGÍA
JUAN B SUÁREZ
2601 SW 37 AVEMIAMI FL 33133305 443 1040
1ST VISIT $60 / FOLLOW-UP $20
MIAMI-DADE
PULMONOLOGIST
CARLOS BARRERA
7190 SW 87 AVE SUITE 306MIAMI, FL 33173305 274 4339
1ST VISIT $ 125 / FOLLOW UP $ 95
PSYCHOLOGY / PSICOLOGÍA
PREVENTIVE AND PRIMARYCARE MEDICAL CENTER
10250 SW 56 ST SUITE C101MIAMI, FL 33165786 558 8901
1ST VISIT $80 / FOLLOW-UP $50
10
ENDOCRINOLOGY /ENDOCRINOLOGÍA
MIRAMAR MEDICAL CENTER
11904 MIRAMAR PARK WAYMIRAMAR, FL 33025954 639 7560
1ST VISIT $ 95 / FOLLOW UP $ 75
ACUPUNTURE / ACUPUNTURA
MIRAMAR MEDICAL CENTER
11904 MIRAMAR PARK WAYMIRAMAR, FL 33025954 639 7560
1ST VISIT $ 95 / FOLLOW UP $ 75
GYNECOLOGY / GINECOLOGÍA
JOHNSON MEDICAL SERVICES
2531 N DIXIE HIGHWAYLAKE WORTH, FL 33460561 582 0330
1ST VISIT $ 100 / FOLLOW UP $ 100
INTERNAL MEDICINE /MEDICINA INTERNA
JOHNSON MEDICAL SERVICES
2531 N DIXIE HIGHWAYLAKE WORTH, FL 33460561 582 0330
1ST VISIT $ 50 / FOLLOW UP $ 50
INTERNAL MEDICINE /MEDICINA INTERNA
LUIS M. GONZALEZ M.D.
12005 FEDERAL HWAYHOLLYWOOD, FL 33020954 505 4141
1ST VISIT $ 90 / FOLLOW UP $ 60
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
JOHNSON MEDICAL SERVICES
2531 N DIXIE HIGHWAYLAKE WORTH, FL 33460561 582 0330
1ST VISIT $ 100 / FOLLOW UP $ 100
PHYSICAL THERAPY / TERAPIAFISICA
LUIS M. GONZALEZ M.D.
12005 FEDERAL HWAYHOLLYWOOD, FL 33020954 505 4141
1ST VISIT $ 60 / FOLLOW UP $ 50
GYNECOLOGY / GINECOLOGÍA
MIRAMAR MEDICAL CENTER
11904 MIRAMAR PARK WAYMIRAMAR, FL 33025954 639 7560
1ST VISIT $ 60 / FOLLOW UP $ 40
BROWARD COUNTY
SpecialistsEspecialistas
URGENT CARE OTONIELHERNANDEZ
1275 W 47 PLACE SUITE 422HIALEAH, FL 33012305 676 2300
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
ADA CODES DESCRIPTION FEE
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
Dentistry Fee ScheduleTarífas de odontología
ADA CODES DESCRIPTION FEE
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
Dentistry Fee ScheduleTarífas de odontología
ADA CODES DESCRIPTION FEE
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
PREVENTIVE DENTISTRY
16
Dentistry Fee ScheduleTarífas de odontología
ADA CODES DESCRIPTION FEE
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
PREVENTIVE DENTISTRY
ENDODONTIC SERVICES
PERIODONTIC SERVICES
17
ADA CODES DESCRIPTION FEE
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
PERIODONTIC SERVICES
Dentistry Fee ScheduleTarífas de odontología
18
ADA CODES DESCRIPTION FEE
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
PERIODONTIC SERVICES
PROSTHODONTICS - FIXED
ORAL SURGERY
MISCELLANOUS SERVICES
Dentistry Fee ScheduleTarífas de odontología
19
ADA CODES DESCRIPTION FEE
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
Dentistry Fee ScheduleTarífas de odontología
20
ADA CODES DESCRIPTION FEE
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
1550 W 84 ST SUITE 15HIALEAH, FL 33014786 558 9043
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
MIRAMAR MEDICAL CENTER
11904 MIRAMAR PARK WAYMIRAMAR, FL 33025954 639 7560
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
COMPETENT GROUP SERVICES
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