Andrea DE Jesus Martinez
Pediatric Emergency Medicine (Pediatrics) Physician · Houston, TX 77030 · NPI 1225552797
121%of Medicare
BCBSTX pays Andrea DE Jesus Martinez $116.53 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 pediatric emergency medicine (pediatrics) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 19% of 82 Houston pediatric emergency medicine (pediatrics) physicians |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 15% of 82 Houston pediatric emergency medicine (pediatrics) 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 pediatric emergency medicine (pediatrics) physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by pediatric emergency medicine (pediatrics) physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by pediatric emergency medicine (pediatrics) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by pediatric emergency medicine (pediatrics) 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 Andrea DE Jesus Martinez performs these services, and they are kept out of the benchmark above.