CERTUS HEALTH HEALTHCARE PROVIDER LIST

Transcription

1 HEALTHCARE PROVIDER LIST Category Provider Name Locations Convenience Care & Laboratories My Healthy Access 6 Family Practice Holmsten and Associates 3 Endocrinology Diabetes Centers of America 7 Imaging Services Excel Diagnostics 1 Pediatrics Memorial City Pediatrics 1 Dental Woodlake Dental 1 Dental Houston Dental Care 1 Pharmacy Wal-Mart Pharmacies 20 Vision Wal-Mart Vision Centers 20 Chiropractic Brando Chiropractic 3 Wellness Vitality Skills 1 Total 64

2 My Healthy Access S. Kirkwood Drive Northwest Freeway Houston, TX Houston, TX (281) M-Sat 8-8; Sun 12-5 M-Sat 8-8; Sun Dunvale Road Broadway Houston, TX Pearland, TX M-Sat 8-8; Sun 12-5 M-Sat 8-8; Sun Fry Road 1107 S. Shaver St. Katy, TX Pasadena, TX M-Sat 8-8; Sun 12-5 M-Sat 8-8; Sun 12-5 All Physicals (Routine, Sports, Insurance, Work) $39.00 All Minor Illnesses $39.00 Laboratories Complete Blood Count (CBC) $24.00 Complete Metabolic Panel (CMP) $24.00 Cholesterol (Lipid) Profile $24.00 Comprehensive Panel (CBC, CMP, Lipid Profile) $64.00 Glucose Screening $12.00 Hemoglobin A1c (HbA1c) $24.00 Basic Diabetic Panel (BDP) = glucose + HbA1c $49.00 Premium Diabetic Panel = BDP + homocysteine + C-reactive protein $54.00 Prostate Specific Antigen (PSA) $34.00 Basic Men s Health Panel (BMHP) = cholesterol + BDP + PSA + CMP $64.00 Premium Men s Health Panel = BMHP + CBC $84.00 Basic Women s Health Panel (BWHP) = cholesterol + BDP + Osteoporosis + CMP $54.00 Premium Women s Health Panel = BWHP + CBC $74.00 Hepatitis B Titer (Screening) $29.00 Chickenpox Titer (Screening) $16.00

3 Measles, Mumps, Rubella (Screening) $99.00 Basic Allergy Profile $69.00 Premium Allergy Profile $ Premium Plus Allergy Profile $ Vaccinations and Immunizations Chickenpox $89.00 HIB $39.00 Hepatitis A $69.00 Hepatitis B $59.00 Human Papillomavirus $94.00 Oral Polio Poliovirus $39.00 Influenza Nasal $29.00 Influenza Vaccine Injection $14.00 Measles, Mumps, Rubella (MMR) $54.00 Meningococcal $89.00 Pneumococcal $ Tetanus, Diphtheria, Pertussis $34.00 Tuberculosis (TB) Skin Test $14.00

4 Holmsten and Associates Braeswood Medical Clinic Pasadena Medical Clinic 7545 S. Braeswood 3122 Spencer Highway Houston, TX Pasadena, TX Tel: (713) Tel: (713) Richmond-Rosenberg Medical Clinic 117 Lanc Drive, Suite #2 Rosenberg, TX Tel: (281) Physical Exam $50.00 New Office Visit $50.00 Return Office Visit $40.00 Immigration Physical $70.00 Visual Acuity $10.00 Chest X-Ray $35.00 EKG Printout w/physician interpretaion $40.00 Urinalysis $10.00 Tetanus Immunization $35.00 PPD (Tuberculosis) $10.00 Lab Services Chem 7 $20.00 Glucose (Sugar) $10.00 PSA $20.00 Thyroid Test (TSH) $15.00 Urine analysis, Microscopic $10.00 Complete Blood Count (CBC) $10.00 Executive Profile Chem 23, TSH, CBC $45.00

5 Diabetes Centers of America Appointment Line: 866-MYDIABETES Cypress Fairbanks Medical Center Texas Medical Center/Kirby Glen Fallbrook Drive 2495 S. Braeswood Houston, TX Houston, TX phone phone Sugar Land Medical Building I St. Catherine s Medical Center S US 59 Hwy. Ste S. Fry Road Ste. 290 Sugar Land, TX Katy, TX phone phone Pearland Bayshore Medical Center Pearland Medical Office Building Bayshore Medical Building Shadow Creek Parkway Suite Bayshore Blvd. Ste. 240 Pearland, TX Pasadena, TX phone phone St. John's Medical Center 2020 NASA Pkwy Suite 210 Houston, TX phone Office Visit Package (Initial or Follow Up) $ Visit with the Physician 2. Labs: HbA1C 3. Labs: Lipid Panel 4. Labs: Microalbumin/Creatinine (Urine) 5. Labs: ALT/AST 6. Labs: Glucose 7. Designated education/nutrition visit 8. Metabolic Testing (if appropriate) Ancillary Services (Additional Cost) Retinal Fundus Scan with Report $75.00 Carotid Ultrasound Study $ Cardiopulmonary Stress Test $ Vaccinations $25.00

6 Westchase District 9701 Richmond Av. Ste 122 Houston, TX (713) M-F 8:30-5:00 X-Rays Mandible, <4V $ Mandible, Complete>4V $ Mastoids, <3V $ Mastoids, Complete, 3V Each Side $ IAC (Internal Auditory Canal) $ Facial Bones, <3V (AKA Maxilla) $ Facial Bones, Complete >3V $ Nose, Complete $ Orbits, Complete 4 V Minimum $ Sinus 2 VWS $85.00 Sinus 3V Minimum (Routine) $ Skull, Less than 4 VWS $ Skull Series, >4V $ Xray, Teeth Complete Full Month $ TMJ, Unilateral $ TMJ, Bilateral $ Chest 1 VW $74.00 Chest 1 VW, Stereo, Frontal $85.00 Chest 2 VWS $85.00 Chest w/obliques $ Chest, 4V Minimum (Cardiac Series) $ Ribs, Unilateral 2VW $ Ribs, Unilateral, Include PA Chest $ Ribs, Bilateral $ Ribs, Bilateral, Including PA Chest $ Sternoclavicular JNTS 3+VWS $ Spine, Entire AP & LAT (Scolioss 2VW) $ Spine, 1 view, specify level $85.00 Cervical 2V/3V $91.00 Cervical Spine Series, >4VW $ Cervical 7 VWS (Davis Series) w/ffl&ext $ Spine, standing for Scoliosis $ Thoracic 2 VWS $91.00 Thoracic 3 VWS $ Thoracic Minimum of 4 VWS $ Thoracolumbar, 2V $142.00

7 Lumbar 2V or 3V $97.00 Lumbar, Minimum of 4V $ Lumbar Series 7 VWS (w/ FLX & EXT) $ Spine, Lumbar Bending $ Pelvis 1V or 2V $80.00 Pelvis, Complete w/hips $ Clavicle $91.00 Scapula 2 VWS $ Shoulder 1 VW $62.00 Shoulder 2 +Views $ AC Joints w/ or w/o weights $ Humerus $92.00 Elbow AP & LAT 2 Vws. $91.00 Elbow, complete $96.00 Forearm $74.00 Wrist AP & LAT $69.00 Wrist Complete $96.00 Hand, 2 VWS $74.00 Hand 3 VWS $91.00 Fingers $70.00 Hip Joint, Unilateral, 1 VW $96.00 Hip Joint, Unilat, w/ oblique (2VWS) $ Hip Joint Bilateral 2 VWS Minimum $ Hip & Pelvis, Child or Infant, 2 VW Min Xray, Saroiliacjoint, Supervison, INT Femur 2 VWS $91.00 Knee AP & LAT 2 VWS $80.00 Knee with obliques 3 VWS $ Knee, compl (w/obl.tunn/patel/stand) Bilateral Knees, standing AP $ Tibia/Fibula, 2V (Lower Leg) $85.00 Low Et. Infant/Child, 2 VW MIN (Leg Lt Ankle, 2VWS $74.00 Ankle 3 VWS $96.00 Foot 2 VWS $73.00 Foot, 3 VWS $85.00 Calcaneus (Heel) $85.00 Toes 2 VW MIN $80.00 Abdomen 1 VW (Kub) $73.00 Abdomen w/oblique and Cone View $96.00 Abdomen compl w/ decubitus or ERT V $ Limited IVP w/o tomo $ Hematuria protocol w/limited IVP $1, CT Angio/CVCT CTA calcium scoring ONLY $ CTA lower ext. runoffs, head/neck $ CTA coronary without calcium scoring $ CTA Heart $ CTA coronary with calcium scoring $ CT Scan

8 CT without contrast $ CT with contrast $ CT with and without contrast $ Mammography Mammo spot compression $ Digital Mammo w/cad $ Diagnostic Digital Mammo w/cad $ Mammo & ultrasound $ MRI MRI without contrast $ MRI with contrast $ MRI with and without contrast $ MRI + Arthrogram $1, PET Scan PET Brain (Altzimer only) $1, PET Scan $2, Ultrasound Ultrasound Breast (1) $ Ultrasound $ Venous Doppler $ Ultrasound pelvic & transvag. (together) $ Nuclear Medicine Treadmill exercise test only $ Muga Scan $ Venogram $ Stress Test (myocardial perfusion) $1, Brain Spect $1, Thyroid scan only $ Thyroid uptake and scan $ Parathyroid scan $ Whole body thyroid cancer survey I-131 $ Whole body thyroid cancer survey/ Dosimetry $ Octreoscan $3, I-311 MIBG $4, Liver Spect $ Gastric Emptying $ G.I bleeding Study $ Hida scan $ Liver Hemangioma $ Renogram GFR determination $ Renogram Mag3 $ Renal Scan $ Gallium scan for infection $ Gallium scan for tumor local whole body $ Gallium scan for infection whole body $ Indium 111 WBC $1, Bone Mineral Density $ phase bone scan $ Whole body bone scan $ Bone spect $675.00

9 Sestamibi Tumor Local (breast) $ Gallium scan for tumor local $ Gallium scan tumor spect $1, Prosticant scan $4, I-131 therapy (hyperthyroidism) $ I-131 therapy for thyroid cancer 100mCi $1, I-131 therapy for thyroid cancer 150mCi $1, I-131 therapy for thyroid cancer 200mCi $2, Breath Test C-14 $ Sulfur Colloid $ Xray arthrogram only $ Anti CEA scan $3,500.00

10 Memorial City Pediatrics 915 Gessner, Suite 985 Houston, TX (713) M-F 8:45-4:45; Sat 9:00-11:00 First-year WELL visits Package (6 visits at 2 $ weeks, 2, 4, 6, 9,12 Months) Second-year WELL visits Package (3 visits at 15, $ , 24 months) Annual WELL visit (>= 3 yrs. old) $ STANDARD SICK visit (less than 20 min.) $ STANDARD SICK visits Package $ COMPLICATED SICK visit (more than 20 min. - i.e. Admission to hospital, asthma attack, ADHD $75.00 evaluation, dehydration) Other Services Urinalysis (clean catch) $20.00 Urinalysis for infants (by bladder catherization) $40.00 Urine pregancy test $20.00 TB skin test $20.00 Strep test $20.00 Nebulizer treatment for asthma $32.00 Ear irrigation $25.00 Small abscess drainage $60.00 Ear piercing $40.00 First-year Vaccinations Hep B X 3 (THREE) DTaP X 3 (THREE) Hib X 3 (THREE) PCV X 3 (THREE) IPV X 2 (TWO) MMR (at 12 months) Varivax (at 12 months) Hib: Hemophilius Influenza type B PCV: Pneumococcus (Prevnar) IPV: Polio MMR: Measles, Mumps, Rubella Varivax: Chickenpox Eligible patients through the VFC program ("Vaccines for Children") will be charged a small administrative fee ($10-$15)

11 Woodlake Dental 2600 S. Gessner, Ste 414 Houston, TX M,W,Th 9-6; Tu 8-5 First Visit $ Comprehensive Exam $ Bitewings X-Rays $ Prophylaxis Cleaning $60.00 Follow-Up Visits (every 6 months) $ Comprehensive Exam $ Prophylaxis Cleaning $60.00 Panoramic X-Rays $76.00 Full Mouth Debridement (FMD) $ Scaling & Root Planning (SRP) per quad $ Resin (Bond) $126-$220 Root Canals $420-$620 Crowns $658-$680 Extractions $107-$276 Cosmetic Services 20% OFF Infection Control Fee $13.00 Notes A panoramic x-ray provides a full view of the upper and lower jaws, teeth, temporomandibular joints, and sinuses. It clearly shows impacted teeth or other intrabony abnormalities, and surrounding anatomy. Required once every THREE years Cleaning broken up into 3 levels: Prophylaxis (regular cleaning; if regularly get cleaning), Full Mouth Debridement (uses an ultrasonic scaler), and Scaling and Root Planning (goes BELOW the gum line to remove bacteria) Visit packages are based on REGULAR visits. Some patients might need more extensive cleaning (i.e. full mouth debridement or SRP). Dentist will assess the necessary cleaning level Resin costs depend on the type of tooth and the number of surfaces worked on Root canal costs depend on the type of tooth Crown costs depend on whether the crown is all porcelain (more expensive) or porcelain with metal (more economical) Extraction costs depend on whether the type of tooth being extracted - from anterior (more economical) to wisdom (more expensive) Any cosmetic service would be at a 20% discount from the regular cash price - i.e. full constructive on front teeth, gap correction, etc. There will be an infection control fee of $13.00 for any procedure - This is for the sterilization of the room, masks, etc.

12 Houston Dental Care 6060 Richmond Ave., Ste. 210 Houston, TX M,W 9-6; T-Th 9-8; F 9-1 First Visit $ Comprehensive Exam $ Bitewings X-Rays $ Prophylaxis Cleaning $59.00 Follow-Up Visits (every 6 months) $ Comprehensive Exam $ Prophylaxis Cleaning $59.00 Panoramic X-Rays $75.00 Full Mouth Debridement (FMD) $ Scaling & Root Planning (SRP) per quad $ Resin (Bond) $126-$225 Root Canals $497-$728 Crowns $750-$810 Extractions $113-$293 Notes A panoramic x-ray provides a full view of the upper and lower jaws, teeth, temporomandibular joints, and sinuses. It clearly shows impacted teeth or other intrabony abnormalities, and surrounding anatomy. Required once every FIVE years Cleaning broken up into 3 levels: Prophylaxis (regular cleaning; if regularly get cleaning), Full Mouth Debridement (uses an ultrasonic scaler), and Scaling and Root Planning (goes BELOW the gum line to remove bacteria) Visit packages are based on REGULAR visits. Some patients might need more extensive cleaning (i.e. full mouth debridement or SRP). Dentist will assess the necessary cleaning level Resin costs depend on the type of tooth and the number of surfaces worked on Root canal costs depend on the type of tooth Crown costs depend on whether the crown is all porcelain (more expensive) or porcelain with metal (more economical) Extraction costs depend on whether the type of tooth being extracted - from anterior (more economical) to wisdom (more expensive) No infection control fees

13 Brando Chiropractic Clinics 5710 Memorial Dr N Main St Houston, TX Houston, TX (713) (713) M-F 8:30-12:00, 2:00-6:00; Sat 8:30-11:00 M-F 8:30-12:00, 2:00-6: Dashwood Dr Houston, TX (713) M-F 8:30-12:00, 2:00-6:00; Sat 8:30-11:00 Complete Initial Visit: Consultation + X-rays (1 area) + Diagnosis Follow up Treatment Visits/Manupulation plus 1 Therapy $ $50.00 X-Rays Cervical views $55.00 Thoracic - 2 views $58.00 Lumbosacral - 2 views $60.00 Shoulder - 2 views (min) $60.00 Elbow - 2 views $44.00 Wrist views $46.00 Knee - 2 views $50.00 Foot - 2 views $46.00

14 Athletic Orthopedics and Knee Center 9180 Old Katy Road, Suite 200 Houston, TX Phone (713) Fax (713)