Sandy Jose, NNP
Neonatal Nurse Practitioner · Houston, TX 77030 · NPI 1285006437
46%of Medicare
BCBSTX pays Sandy Jose, NNP $44.19 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 neonatal nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.19 | $96.33 | 46% | above 0% of 106 Houston neonatal nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $94.00 | $137.41 | 68% | above 12% of 106 Houston neonatal nurse practitioners |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $226.31 | $317.92 | 71% | not typically billed by neonatal nurse practitioners |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by neonatal nurse practitioners |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by neonatal nurse practitioners |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by neonatal nurse practitioners |
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 Sandy Jose, NNP performs these services, and they are kept out of the benchmark above.