Rafik Ghobrial M.d., M.D., PHD
Transplant Surgery Physician · Houston, TX 77030 · NPI 1326072604
54%of Medicare
BCBSTX pays Rafik Ghobrial M.d., M.D., PHD $51.98 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 transplant surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 39% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 26% of 24,759 all Houston clinicians |
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 transplant surgery physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by transplant surgery physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by transplant surgery physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by transplant surgery 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 Rafik Ghobrial M.d., M.D., PHD performs these services, and they are kept out of the benchmark above.