Kristi Prophet, MD
Family Medicine Physician · Houston, TX 77028 · NPI 1134680671
95%of Medicare
BCBSTX pays Kristi Prophet, MD $91.45 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 family medicine physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 75% of 762 Houston family medicine physicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 82% of 754 Houston family medicine physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by family medicine physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by family medicine physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by family medicine physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by family medicine 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 Kristi Prophet, MD performs these services, and they are kept out of the benchmark above.