Based on public Medicaid payment data.
Andres Wilson Setaputri
Medicaid Provider in Southgate, MI
Type
Individual Provider
Address
16060 Holz Dr Unit 77
Southgate, MI 481952991
Phone
7342501473
NPI
1710393095
Procedures
1
Total Claims
319
Patients Served
319
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 | $26.78 | 319 | 319 |
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