Sujit Prabhu, M.D.
Neurological Surgery Physician · Houston, TX 77030 · NPI 1336245133
134%of Medicare
BCBSTX pays Sujit Prabhu, M.D. $129.07 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 neurological surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $129.07 | $96.33 | 134% | above 84% of 107 Houston neurological surgery physicians |
| 99214Office visit, established patient, moderate complexity | $189.08 | $137.41 | 138% | above 90% of 107 Houston neurological surgery physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $157.20 | $317.92 | 49% | not typically billed by neurological surgery physicians |
| 72148MRI lumbar spine, without contrast | $101.41 | $192.38 | 53% | not typically billed by neurological surgery physicians |
| 77067Screening mammography, bilateral | $186.80 | $126.38 | 148% | not typically billed by neurological 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 Sujit Prabhu, M.D. performs these services, and they are kept out of the benchmark above.