Based on public Medicaid payment data.
Ismael Rafael Montane
Medicaid Provider in Rockville, MD
Type
Individual Provider
Address
702 King Farm Blvd Ste 160
Rockville, MD 208506536
Phone
2404158492
NPI
1669787651
Procedures
3
Total Claims
1.4K
Patients Served
1.2K
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 |
|---|---|---|---|
| Dental Cleaning & Exam | $43.97 | 1,156 | 1,087 |
| Dental Filling | $135.61 | 208 | 137 |
| Tooth Extraction | $89.16 | 19 | 13 |
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