Aetna "Select Provider" Listing - High-Tech Radiology Houston - January, PET Imaging of Sugar Land

Transcription

1 Aetna "Select Provider" Listing - High-Tech Radiology TEXAS BRAZORIA COUNTY Angleton Brazoria County CT, Inc , Brazos Pkwy., Suite C Phone: / Fax: Svcs: CT Brazoria County Imaging, LLC 700 North Front Street, Suite B Phone: / Fax: , Brazoria County Imaging on Brazos 2760 Brazos Pkwy., Suite B Phone: / Fax: , Lake Jackson Lake Jackson Imaging, L.P. 217 Oak Drive South, Suite A Lake Jackson, TX Phone: / Fax: , Pearland Pearland MRI Pearland and Imaging , Broadway Street, Suite 109 Pearland, TX Phone: / Fax: CHAMBERS COUNTY Anahuac Bayside Community Hospital & Clinic , Bayside Community Hospital 200 Hospital Drive Anahuac, TX Phone: FORT BEND COUNTY Sugar Land Fort Bend Imaging, Inc , Southwest Frwy. Phone: / Fax: , OMR, CNM, CT, PET Global Imaging, LP Hwy. 6 South, Suite B Phone: / Fax: , PET Imaging of Sugar Land West Grand Pkwy. South, Suite A Sugar Land, TX Phone: / Fax: Svcs: CT, PET , Upright MRI of Sugar Land, LLP 2655 Cordes Drive, Suite 150 Sugar Land, TX Phone: / Fax: , GALVESTON COUNTY Dickinson Fairmont Diagnostic & Open MRI , FM 646 West Dickinson, TX Phone: / Fax: Texas City A1 Imaging of Texas City 9300 East Emmett Lowery Expwy., Suite 148 Texas City, TX Phone: / Fax: , HARRIS COUNTY Baytown Baytown Imaging and Diagnostic , A Garth Road Phone: / Fax: Jacinto MRI and Diagnostic 2800 Garth Road Phone: , CNM, CT , Pars MRI, P.A West Baker Road, Suite 101 Phone: / Fax: , Bellaire Nuclear Imaging of Texas Nuclear Imaging of Texas 5420 West Loop South, Suite 1700 Bellaire, TX Svcs: CNM , Houston A1 Imaging of Houston Northwest Frwy. Houston, TX Phone: / Fax: , Advanced Diagnostic 8305 Knight Road Phone: / Fax: , CNM, CT , Bellaire Diagnostic Imaging, LLC 9440 Bellaire Blvd., Suite 100 Houston, TX Phone: / Fax: , OMR, CNM, CT , Champions MRI and Diagnostic Walters Road, Suite A Houston, TX Phone: / Fax: , Clarus Imaging Clairus Imaging 9901 Town Park Drive Houston, TX Phone: / Fax: , Diagnostic MRI West Sam Houston Pkwy., Suite 150 Houston, TX Phone: / Fax: , Diagnostic MRI Central 2256 West Holcombe Blvd. Phone: / Fax: , Diagnostic Radiology of Houston , Gessner Drive, Suite 150 Houston, TX Phone: / Fax: , OMR , East Sam Houston Pkwy. North Houston, TX Phone: / Fax: East Side Imaging, Inc East Frwy. Houston, TX Phone: / Fax: , CNM, CT, PET , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 1 of 3

2 Aetna "Select Provider" Listing - High-Tech Radiology Excel Diagnostics, LTD 9701 Richmond Avenue, Suite 122 Houston, TX Svcs: CNM, PET , Gulf Coast MRI and Diagnostics 1051 Pineloch Drive, Suite 175 Houston, TX Phone: , CNM, CT, PET , Heights Diagnostic Imaging, Inc 427 West 20th Street, Suite 401 Houston, TX Phone: / Fax: , Houston Medical Imaging , Audley Street, CNM, CT, PET , Richmond Avenue, OMR, CNM, CT, PET , Katy Freeway, Suite 100, CNM, CT, PET Houston MRI & Diagnostic Gulf Frwy. Phone: / Fax: , I. Imaging, P.A. 837 FM 1960 West, Suite 108 Phone: / Fax: , Main Imaging, Inc South Main Street, Suite B5 Phone: / Fax: , Memorial MRI and Diagnostic, LLC , Campbell Road Phone: / Fax: , CNM, CT , Campbell Road Phone: / Fax: , CNM, CT MRI Central Houston 3301 South Shepherd Drive Phone: / Fax: , Normandy MRI & Diagnostic East Frwy. Houston, TX Phone: / Fax: , North Houston Xray, Inc. 411 West Parker Road, Suite A Houston, TX Phone: / Fax: , NWDC Diagnostic Imaging 1140 Cypress Station Drive Phone: / Fax: , CNM, CT , One Step Diagnostic II Inc Fannin Street, Suite 102 Phone: / Fax: , One Step Diagnostic, Inc Red Oak Drive, Suite 100 Phone: / Fax: , OMR, CNM, CT , PET Imaging of Houston 2493 South Braeswood Blvd., Suite A Phone: / Fax: Svcs: PET , PET Imaging of Willowbrook Hargrave Road, Suite 130 Houston, TX Phone: / Fax: Svcs: CT, PET , Rice Nuclear Diagnostics, LP 1414 South Loop West, Suite 120 Phone: / Fax: , PET , Scarsdale Imaging, Inc Scarsdale Blvd., Suite A Houston, TX Phone: / Fax: , South Loop MRI, LP 2616 South Loop West, Suite 170A Phone: / Fax: , , Steeplechase Diagnostic, Inc Jones Road, Suite 150 Phone: / Fax: , OMR, CNM, CT, PET , Town & Country Open MRI Katy Frwy. Houston, TX Phone: / Fax: , OMR , Unicare MRI & Diagnostic, LLC 7007 North Frwy., Suite 110 Houston, TX Phone: / Fax: , Westchase Imaging, LTD 9701 Richmond Avenue, Suite 124 Houston, TX , Woodlake Imaging, L.L.C Gessner Drive, Suite 100 Phone: / Fax: , Humble Deerbrook Diagnostic Imaging, LLC , FM 1960 Bypass Road West, Suite 104 Phone: / Fax: Humble MRI and Diagnostic Hwy. 59, Suite 100 Phone: / Fax: , Katy Katy Open MRI 954 South Fry Road Katy, TX Phone: / Fax: , OMR, CNM, CT, PET , Nassau Bay Upright MRI of Clear Lake, LLC 1202 Nasa Pkwy. Nassau Bay, TX Phone: / Fax: , Pasadena MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 2 of 3

3 Gulf Coast MRI and Diagnostics 5233 Fairmont Pkwy., Suite A Pasadena, TX Phone: / Fax: , OMR, CNM, CT, PET , Spring 2920 Open MRI & Digital Imaging, L.P FM 2920, Suite 170 Spring, TX Phone: / Fax: , Webster Lakeside Open MRI and Diagnostic , Hwy. 3 Phone: / Fax: Pulse Imaging, Inc. 202 Texas Avenue, Suite 500 Phone: / Fax: , JEFFERSON COUNTY Beaumont Beaumont MRI, Inc , College Avenue Phone: / Fax: Diagnostic Health Beaumont 3220 Medical Drive Phone: / Fax: , OMR, CNM, CT, PET , HealthSouth Imaging of Beaumont Joint Venture , Medical Drive, Suite 100 Phone: / Fax: Aetna "Select Provider" Listing - High-Tech Radiology The MRI, L.L.C Dowlen Road Beaumont, TX Phone: / Fax: , Port Arthur Diagnostic Health Port Arthur 3445 Regional Drive Port Arthur, TX Phone: / Fax: , Gulf Coast Open MRI Unit, Ltd Memorial Blvd. Port Arthur, TX Phone: / Fax: , LIBERTY COUNTY Liberty Liberty Dayton Regional Medical , North Travis Street Liberty, TX Phone: / Fax: MATAGORDA COUNTY Palacios Palacios Community Medical , Green Avenue Palacios, TX Phone: Svcs: CT MONTGOMERY COUNTY Conroe Aurum Diagnostic Imaging, LLP , River Pointe Drive, Suite 180 Phone: / Fax: Conroe MRI - Diagnostic LTD 200 River Pointe Drive, Suite 130 Phone: / Fax: , OMR , Spring The Woodlands Open MRI and Imaging , West Panther Creek Drive, Suite 150 Spring, TX Phone: The Woodlands I. Imaging, P.A , , Six Pines Drive, Suite 190 The Woodlands, TX Phone: / Fax: PET Imaging of The Woodlands 3091 College Park Drive, Suite 340 The Woodlands, TX Phone: / Fax: Svcs: PET , Woodstead MRI, Inc Woodstead Court, Suite 100 The Woodlands, TX Phone: / Fax: , WHARTON COUNTY El Campo El Campo Memorial Hospital , Sandy Corner Road El Campo, TX Phone: , CNM, CT, PET Wharton Open MRI of Wharton 1307 Hospital Drive Wharton, TX Phone: / Fax: , OMR Note(s): These procedures may require preauthorization. Aetna's radiology management vendors may have more current information that will replace the information contained within this List. Effective January 1, 2012, Aetna requires all providers administering high-tech radiology services to be accredited by the American College of Radiology and/or the Intersocietal Accreditation Commission. Any provider who performs these services but is not accredited at the time of service may not be eligible for payment. Aetna s radiology management vendors will offer alternative accredited providers in accordance with these standards , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 3 of 3

4 Aetna "Select Provider" Listing - Low-Tech Radiology TEXAS BRAZORIA COUNTY Angleton Brazoria County CT, Inc , Brazos Pkwy., Suite C Phone: / Fax: Svcs: X Lake Jackson Lake Jackson Imaging, L.P. 217 Oak Drive South, Suite A Lake Jackson, TX Phone: / Fax: , Pearland Pearland MRI Pearland and Imaging , Broadway Street, Suite 109 Pearland, TX Phone: / Fax: Sound Choices, LLC 3901 East Pear Street Pearland, TX Phone: / Fax: Svcs: US , CHAMBERS COUNTY Winnie Winnie Community Hospital , Broadway Avenue Winnie, TX Phone: / Fax: Svcs: X FORT BEND COUNTY Sugar Land Fort Bend Imaging, Inc , Southwest Frwy. Phone: / Fax: , S, M Global Imaging, LP Hwy. 6 South, Suite B Phone: / Fax: , M , Mammography and Ultrasound Specialists , Hwy. 6, Suite 700 Phone: , M GALVESTON COUNTY Dickinson Fairmont Diagnostic & Open MRI , FM 646 West Dickinson, TX Phone: / Fax: HARRIS COUNTY Baytown Baytown Imaging and Diagnostic , A Garth Road Phone: / Fax: Jacinto MRI and Diagnostic 2800 Garth Road Phone: , M , Pars MRI, P.A West Baker Road, Suite 101 Phone: / Fax: , Bellaire Nuclear Imaging of Texas Nuclear Imaging of Texas 5420 West Loop South, Suite 1700 Bellaire, TX , The Rose Diagnostic 5420 West Loop South, Suite 3300 Bellaire, TX Phone: / Fax: , M , Houston Advanced Diagnostic 8305 Knight Road Phone: / Fax: , Bellaire Diagnostic Imaging, LLC 9440 Bellaire Blvd., Suite 100 Houston, TX Phone: / Fax: , BD , Champions MRI and Diagnostic Walters Road, Suite A Houston, TX Phone: / Fax: , Cypress-Fairbanks Medical Steepletop Drive Phone: , M , Diagnos PET CT Imaging 2000 North Loop West, Suite 100 Houston, TX Phone: / Fax: , Diagnostic MRI West Sam Houston Pkwy., Suite 150 Houston, TX Phone: / Fax: , Diagnostic MRI Central 2256 West Holcombe Blvd. Phone: / Fax: Svcs: X, FL , Diagnostic Radiology of Houston , Gessner Drive, Suite 150 Houston, TX Phone: / Fax: , East Sam Houston Pkwy. North Houston, TX Phone: / Fax: East Side Imaging, Inc East Frwy. Houston, TX Phone: / Fax: , S, M , Excel Diagnostics, LTD 9701 Richmond Avenue, Suite 122 Houston, TX , Gulf Coast MRI and Diagnostics 1051 Pineloch Drive, Suite 175 Houston, TX Phone: , Heights Diagnostic Imaging, Inc 427 West 20th Street, Suite 401 Houston, TX Phone: / Fax: , M , Houston Medical Imaging 3303 Audley Street, S, M , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 1 of 3

5 Aetna "Select Provider" Listing - Low-Tech Radiology , Richmond Avenue, S, BD, M , Katy Freeway, Suite 100, M Houston MRI & Diagnostic Gulf Frwy. Phone: / Fax: , Houston Northwest Medical 710 FM 1960 West Phone: , M , I. Imaging, P.A. 837 FM 1960 West, Suite 108 Phone: / Fax: Svcs: X, FL , Main Imaging, Inc South Main Street, Suite B5 Phone: / Fax: , Memorial MRI and Diagnostic, LLC , Campbell Road Phone: / Fax: , M , Campbell Road Phone: / Fax: , M MRI Central Houston 3301 South Shepherd Drive Phone: / Fax: Svcs: X, FL , Normandy MRI & Diagnostic East Frwy. Houston, TX Phone: / Fax: , North Houston Xray, Inc. 411 West Parker Road, Suite A Houston, TX Phone: / Fax: , NWDC Diagnostic Imaging 1140 Cypress Station Drive Phone: / Fax: , BD , One Step Diagnostic II Inc Fannin Street, Suite 102 Phone: / Fax: , One Step Diagnostic Inc Red Oak Drive, Suite 100 Phone: / Fax: , Physician Care & Diagnostic, LLC , Bellaire Blvd., Suite 134 Houston, TX Phone: / Fax: R.I.T.A. Foundation 9701 Richmond Avenue, Suite 120 Houston, TX , Rice Nuclear Diagnostics, LP 1414 South Loop West, Suite 120 Phone: / Fax: , Scarsdale Imaging, Inc Scarsdale Blvd., Suite A Houston, TX Phone: / Fax: , Shriners Hospital for Children-Houston TX , Main Street Phone: / Fax: Svcs: X South Loop MRI, LP , , South Loop West, Suite 170A Phone: / Fax: Steeplechase Diagnostic, Inc Jones Road, Suite 150 Phone: / Fax: , S, M , Texas Mobile Health Glenshannon Drive Houston, TX Phone: , The Breast , Fannin Street Phone: / Fax: , Fannin Street Phone: , M The Rose Diagnostic North Featherwood Drive, Suite 260 Phone: / Fax: , M , Town & Country Open MRI Katy Frwy. Houston, TX Phone: / Fax: , Unicare MRI & Diagnostic, LLC 7007 North Frwy., Suite 110 Houston, TX Phone: / Fax: , S, M , Westchase Imaging, LTD 9701 Richmond Avenue, Suite 124 Houston, TX 77042, M , Woman's Imaging 7900 Fannin Street Phone: / Fax: , M , Woodlake Imaging, L.L.C Gessner Drive, Suite 100 Phone: / Fax: , Humble Deerbrook Diagnostic Imaging, LLC , FM 1960 Bypass Road West, Suite 104 Phone: / Fax: Humble MRI and Diagnostic Hwy. 59, Suite 100 Phone: / Fax: , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 2 of 3

6 Aetna "Select Provider" Listing - Low-Tech Radiology Katy Katy Open MRI 954 South Fry Road Katy, TX Phone: / Fax: , Texas Mobile Health 701 South Fry Road, Suite 105 Katy, TX Phone: , Nassau Bay Upright MRI of Clear Lake, LLC 1202 Nasa Pkwy. Nassau Bay, TX Phone: / Fax: Svcs: X , Pasadena Gulf Coast MRI and Diagnostics 5233 Fairmont Pkwy., Suite A Pasadena, TX Phone: / Fax: , Spring 2920 Open MRI & Digital Imaging, L.P FM 2920, Suite 170 Spring, TX Phone: / Fax: , Webster Lakeside Open MRI and Diagnostic , Hwy. 3 Phone: / Fax: , BD Pulse Imaging, Inc. 202 Texas Avenue, Suite 500 Phone: / Fax: , JEFFERSON COUNTY Beaumont Beaumont Bone & Joint Institute , Laurel Street Beaumont, TX Phone: Beaumont MRI, Inc College Avenue Phone: / Fax: , Diagnostic Health Beaumont 3220 Medical Drive Phone: / Fax: , M , HealthSouth Imaging of Beaumont Joint Venture , Medical Drive, Suite 100 Phone: / Fax: , M The MRI, L.L.C Dowlen Road Beaumont, TX Phone: / Fax: Svcs: X, S , Port Arthur Diagnostic Health Port Arthur 3445 Regional Drive Port Arthur, TX Phone: / Fax: , M , Gulf Coast Open MRI Unit, Ltd Memorial Blvd. Port Arthur, TX Phone: / Fax: , BD , LIBERTY COUNTY Cleveland Cleveland Regional Medical, L.P , East Crockett Street Cleveland, TX Phone: , M Liberty Liberty Dayton Regional Medical 1353 North Travis Street Liberty, TX Phone: / Fax: , MONTGOMERY COUNTY Conroe Aurum Diagnostic Imaging, LLP , River Pointe Drive, Suite 180 Phone: / Fax: Conroe MRI - Diagnostic LTD 200 River Pointe Drive, Suite 130 Phone: / Fax: , M , Spring The Woodlands Open MRI and Imaging , West Panther Creek Drive, Suite 150 Spring, TX Phone: The Woodlands I. Imaging, P.A , Six Pines Drive, Suite 190 The Woodlands, TX Phone: / Fax: , Woodstead MRI, Inc Woodstead Court, Suite 100 The Woodlands, TX Phone: / Fax: Svcs: X, FL , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 3 of 3

7 Aetna "Select Provider" Listing - Ambulatory Surgery TEXAS BRAZORIA COUNTY Angleton Angleton Danbury Medical , Hospital Drive Phone: / Fax: Brazoria County Surgery 2760 Brazos Pkwy. Phone: / Fax: , Lake Jackson Brazosport Eye Institute 103 Parking Way Lake Jackson, TX Phone: / Fax: , South Oak Drive, Suite 700 Lake Jackson, TX Phone: , The Endoscopy 109 Parking Way Street Lake Jackson, TX Phone: / Fax: , Pearland St. Luke's Episcopal Hospital SLC ER - Pearland Shadow Creek Pkwy. Pearland, TX Phone: / Fax: , Sweeny Sweeny Community Hospital 305 North McKinney Street Sweeny, TX Phone: , CHAMBERS COUNTY Anahuac Bayside Community Hospital & Clinic , Bayside Community Hospital 200 Hospital Drive Anahuac, TX Phone: Winnie Winnie Community Hospital 538 Broadway Avenue Winnie, TX Phone: / Fax: , COLORADO COUNTY Columbus Columbus Community Hospital , Shult Drive Columbus, TX Phone: / Fax: Eagle Lake Rice Medical 600 South Austin Road Eagle Lake, TX Phone: , FORT BEND COUNTY Richmond , Southwest Frwy., Suite 200 Richmond, TX Phone: Sugar Land St. Luke's Sugar Land Hospital 1317 Lake Pointe Pkwy. Phone: / Fax: , Sugar Land Ambulatory Surgery Cntr - HCA Affiliate , Southwest Frwy., Suite 100 Phone: / Fax: Sugar Land Surgical Hospital 1211 Hwy. 6, Suite 70 Phone: , GALVESTON COUNTY Galveston , Avenue North Galveston, TX Phone: Shriners Hospital for Children- Galveston TX , Market Street Galveston, TX Phone: / Fax: University of Texas Medical Branch at Galveston , University Blvd. Galveston, TX Phone: GRIMES COUNTY Navasota Grimes St. Joseph Health , South Judson Street Navasota, TX Phone: HARRIS COUNTY Houston Advanced Laser Vision & Surgical Institute , Fuqua Street, Suite 250 Phone: / Fax: Bay Area Endoscopy, LC 444 FM 1959 Road, Suite B Phone: / Fax: , Baylor College of Medicine Ambulatory Surgery , Cambridge Street, BLDG. B, Suite 1 Phone: / Fax: Ben Taub General Hospital 1504 Taub Loop Phone: / Fax: , Caplan Surgery 3100 Weslayan Street, Suite 400 Houston, TX Phone: / Fax: , Children's Memorial Hermann Hospital 6411 Fannin Street Phone: , Cypress-Fairbanks Medical Steepletop Drive Phone: , Doctors Hospital - Tidwell 510 West Tidwell Road Houston, TX Phone: , East Houston Surgery East Frwy., Suite 100 Houston, TX Phone: , Fannin Surgicare - HCA Affiliate 7700 Fannin Street Phone: / Fax: , of 3

8 Aetna "Select Provider" Listing - Ambulatory Surgery Gramercy Outpatient Surgery - HCA Affiliate , Gramercy Street Phone: HEA Surgery 2855 Gramercy Street, Suite 100 Phone: / Fax: , Heights Surgery, Inc. 427 West 20th Street, Suite 102 Houston, TX Phone: / Fax: , Houston Northwest Medical 710 FM 1960 West Phone: , , Preston Street Houston, TX Phone: , Holcombe Blvd. Phone: Lyndon B. Johnson General Hospital 5656 Kelley Street Houston, TX Phone: / Fax: , Mann Cataract Surgery 5115 Main Street Houston, TX Phone: / Fax: , MEC Endoscopy, LLC 1233 Campbell Road Phone: / Fax: , Medical Cath Lab 6550 Fannin Street, Suite 333 Phone: / Fax: , Medical Endoscopy, LLP 6560 Fannin Street, Suite 600 Phone: / Fax: , Physicians Endoscopy 3030 South Gessner Road, Suite 150 Houston, TX Phone: / Fax: , Quentin Mease Community Hospital 3601 North MacGregor Way Houston, TX Phone: / Fax: , SCA Houston Hospital for Specialized Surgery , LaBranch Street Houston, TX Phone: / Fax: Shriners Hospital for Children-Houston TX , Main Street Phone: / Fax: St. Joseph Medical 1401 St. Joseph Pkwy. Houston, TX Phone: / Fax: , St. Luke's Episcopal Hospital , SL Diag & Treat Cnter - Kirby Glen 2457 South Braeswood Blvd. Phone: / Fax: , SLC ER - Holcombe 2727 West Holcombe Blvd. Phone: / Fax: , SLC ER - San Felipe 5749 San Felipe Street Houston, TX Phone: / Fax: , Bertner Street Phone: / Fax: St. Luke's Hospital at The Vintage Chasewood Park Drive Houston, TX Phone: / Fax: , Texas International Endoscopy, L.P , Main Street, Suite 1500 Phone: / Fax: The Diagnostic Heart of St. Luke's , Main Street, Suite 1520 Phone: / Fax: TOPS Surgical Specialty Hospital Red Oak Drive Phone: , Town Park Surgery 9901 Town Park Drive Houston, TX Phone: / Fax: , United Surgery Southeast North Featherwood Drive, Suite 100 Phone: , Woman's Hospital of Texas - HCA Affiliate , Fannin Street Phone: / Fax: Wortham Surgery FM 1960 Road West, Suite 118 Phone: / Fax: , Humble Humble Kingwood Endoscopy Mckay Drive, Suite 101 Phone: / Fax: , Mann Cataract Surgery South Memorial Drive Phone: / Fax: , Pasadena St. Luke's Patients Medical 4600 East Sam Houston Pkwy. South Pasadena, TX Phone: / Fax: , Tomball Tomball Regional Hospital Authority 605 Holderrieth Blvd. Tomball, TX Phone: / Fax: , Webster Bay Area Houston Endoscopy 1015 Medical Blvd., Suite 1200 Phone: / Fax: , Bay Area Surgicare - HCA Affiliate , Medical Blvd. Phone: / Fax: JEFFERSON COUNTY Beaumont Beaumont Bone & Joint Institute , Laurel Street Beaumont, TX Phone: Beaumont Surgical Affiliates, LLC 3560 North College Phone: / Fax: , of 3

9 Aetna "Select Provider" Listing - Ambulatory Surgery CHRISTUS St. Elizabeth Hospital 2830 Calder Avenue Beaumont, TX Phone: / Fax: , Christus St. Elizabeth Outpatient Surg 3050 Liberty Street Beaumont, TX Phone: / Fax: , Veterans Circle Beaumont, TX Phone: , The Endoscopy of Southeast Texas, LP , North 14th Street, Suite 200 Beaumont, TX Phone: Groves Renaissance Hospital - Groves th Street Groves, TX Phone: , LIBERTY COUNTY Cleveland Cleveland Regional Medical, L.P , East Crockett Street Cleveland, TX Phone: MATAGORDA COUNTY Bay City Matagorda Regional Medical , th Street Bay City, TX Phone: MONTGOMERY COUNTY Conroe Conroe Surgery , River Pointe Drive, Suite 200 Phone: / Fax: Riverwood Court Phone: , River Oaks Endoscopy 1501 River Pointe Drive, Suite 260 Phone: / Fax: , Shenandoah Woodlands Endoscopy 111 Vision Park Blvd., Suite 160 Shenandoah, TX Phone: / Fax: , The Woodlands St. Luke's Lakeside Hospital, LLC St. Lukes Way The Woodlands, TX Phone: / Fax: , St. Luke's The Woodlands Hospital St. Luke's Way The Woodlands, TX Phone: / Fax: , WHARTON COUNTY El Campo El Campo Memorial Hospital , Sandy Corner Road El Campo, TX Phone: Note(s): Some ambulatory procedures require the physician to notify Aetna prior to performing services (e.g., colonoscopy and other scope procedures). These procedures were not used to determine this listing. 3 of 3

10 TEXAS BRAZORIA COUNTY Pearland Pearland Premier Sleep Study Pearland Premier Sleep Study , Sunrise Blvd., Suite 103 Pearland, TX Phone: / Fax: COLORADO COUNTY Columbus Columbus Community Hospital , Shult Drive Columbus, TX Phone: / Fax: FORT BEND COUNTY Stafford Rest Technologies, Inc , South Kirkwood Road, Suite 200 Stafford, TX Phone: / Fax: HARRIS COUNTY Houston Apnix , Bellaire Blvd., Suite F Phone: / Fax: , Bellaire Blvd., Suite B Phone: / Fax: Conroe Premier Sleep Memorial Drive, Suite 1125 Houston, TX Phone: / Fax: , Aetna "Select Provider" Listing - Sleep Studies Cypress-Fairbanks Medical Steepletop Drive Phone: , HMS Diagnostics, Inc Fannin Street, Suite 420 Phone: , Houston Northwest Medical 710 FM 1960 West Phone: , I Sleep Diagnostics, L.P , FM 1960 West, Suite 100 Phone: / Fax: , Southwest Freeway, Suite 170 Houston, TX Phone: Park Plaza Hospital and Medical 1313 Hermann Drive Houston, TX L.P , Phone: Rest Technologies, Inc , Sugar Land 2201 West Holcombe Blvd., Suite 325 Sugar Land Cancer , Phone: / Fax: Southwest Frwy. The Houston Sleep , Phone: / Fax: San Felipe Street, Suite 550 Houston, TX Sugar Land Premier Sleep Sugar Phone: / Fax: Land Premier Sleep , Sweetwater Blvd., Suite 210 The Sleep Well, Inc , Sugar Land, TX Mitchelldale Street, Suite E16 Phone: / Fax: Houston, TX Phone: / Fax: , Katy The Houston Sleep Kingsland Blvd., Suite 101 Katy, TX Phone: / Fax: Pasadena The Sleep Well, Inc , Vista Road Baylor College of Medicine - Department Pasadena, TX of Interna l Medicine Phone: / Fax: , South Main Street, Suite A Spring Phone: / Fax: Northwest Premier Sleep , , Spring Cypress Road, Suite E Spring, TX Phone: / Fax: JEFFERSON COUNTY Beaumont Elite Sleep Solutions , Eastex Freeway, Suite C Beaumont, TX Phone: / Fax: , Sleep Labs of Texas, Inc. 42 North 11th Street Beaumont, TX Phone: , Nederland Southeast Texas Sleep Diagnostics, LLC 1112 North Hwy. 69, Suite A Nederland, TX Phone: / Fax: , LIBERTY COUNTY Liberty Liberty - Dayton Community Hospital, 1353 North Travis Street Liberty, TX Phone: / Fax: MATAGORDA COUNTY Bay City Matagorda Regional Medical , th Street Bay City, TX Phone: MONTGOMERY COUNTY Conroe Conroe Premier Sleep , North Loop 336 West, Suite B Phone: / Fax: Montgomery Montgomery Sleep Diagnostic, LLC , Hwy. 105 West, Suite 133 Montgomery, TX Phone: / Fax: Shenandoah Woodlands Premiere Sleep 114 Vision Park, Suite 100 Shenandoah, TX Phone: / Fax: , of 2

11 Aetna "Select Provider" Listing - Sleep Studies The Woodlands Sleep Diagnostics of Texas, Inc West Panther Creek Drive, Suite 101 The Woodlands, TX Phone: / Fax: , WALKER COUNTY Huntsville Huntsville Sleep, LLC , Medical Park Lane, Suite B Huntsville, TX Phone: / Fax: WHARTON COUNTY Wharton Gulf Coast Medical , US 59 Road Wharton, TX Phone: of 2