Based on public Medicaid payment data.
Charles Lee Clark
Medicaid Provider in San Antonio, TX
Type
Individual Provider
Address
9150 Huebner Rd Ste 125
San Antonio, TX 782401658
Phone
2106143915
NPI
1659331650
Procedures
2
Total Claims
52
Patients Served
24
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 |
|---|---|---|---|
| Tooth Extraction | $410.36 | 40 | 12 |
| Dental Cleaning & Exam | $65.15 | 12 | 12 |
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