Based on public Medicaid payment data.
Thomas R. Gustafson
Medicaid Provider in Pine City, NY
Type
Individual Provider
Address
1243 Pennsylvania Ave
Pine City, NY 148719230
Phone
6077343929
NPI
1720055528
Procedures
3
Total Claims
185
Patients Served
170
About these costs
All amounts reflect Medicaid reimbursement rates, which are typically much lower than private insurance or cash prices. These figures show what state Medicaid programs actually paid this provider per claim.
Procedures & Average Costs
| Procedure | Avg. Paid | Claims | Patients |
|---|---|---|---|
| Office Visit | $90.98 | 83 | 76 |
| Blood Work & Lab Tests | $0.00 | 76 | 68 |
| Vaccines & Immunizations | $11.54 | 26 | 26 |
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