Based on public Medicaid payment data.
Ebony Jordan
Medicaid Provider in South Pasadena, CA
Type
Individual Provider
Address
1427 Mission St
South Pasadena, CA 910303213
Phone
6264031800
NPI
1891009346
Procedures
2
Total Claims
144
Patients Served
122
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 | $28.45 | 110 | 108 |
| Tooth Extraction | $57.40 | 34 | 14 |
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