James Murphy, M.D.
Diagnostic Radiology Physician · Houston, TX 77040 · NPI 1215932934
60%of Medicare
BCBSTX pays James Murphy, M.D. $190.74 for a 70553 — MRI brain, with and without contrast. Medicare pays $317.92 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 diagnostic radiology physicians |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $190.74 | $317.92 | 60% | above 53% of 667 Houston diagnostic radiology physicians |
| 72148MRI lumbar spine, without contrast | $123.04 | $192.38 | 64% | above 61% of 666 Houston diagnostic radiology physicians |
| 74177CT abdomen and pelvis, with contrast | $151.88 | $300.72 | 51% | above 62% of 667 Houston diagnostic radiology physicians |
| 77067Screening mammography, bilateral | $123.38 | $126.38 | 98% | above 49% of 664 Houston diagnostic radiology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $134.22 | $96.33 | 139% | not typically billed by diagnostic radiology physicians |
| 99214Office visit, established patient, moderate complexity | $196.63 | $137.41 | 143% | not typically billed by diagnostic radiology 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 James Murphy, M.D. performs these services, and they are kept out of the benchmark above.