Shane Pahlavan, M.D.
Otolaryngology Physician · Houston, TX 77030 · NPI 1124271689
84%of Medicare
BCBSTX pays Shane Pahlavan, M.D. $80.69 for a 99213 — Office visit, established patient, low complexity. Medicare pays $96.33 for the same service in this locality. Commercial insurance is widely assumed to pay above Medicare.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston otolaryngology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $80.69 | $96.33 | 84% | above 63% of 132 Houston otolaryngology physicians |
| 99214Office visit, established patient, moderate complexity | $118.20 | $137.41 | 86% | above 70% of 132 Houston otolaryngology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $289.94 | $317.92 | 91% | not typically billed by otolaryngology physicians |
| 77067Screening mammography, bilateral | $32.25 | $126.38 | 26% | not typically billed by otolaryngology physicians |
A payer’s file carries a rate for every code in the contract’s fee class, whether or not the clinician will ever bill it. These rows are real, and they are how the fee class shows through — but they are not evidence that Shane Pahlavan, M.D. performs these services, and they are kept out of the benchmark above.