Diane Johnston, RN, WHNP
Women's Health Nurse Practitioner · Houston, TX 77030 · NPI 1356431175
46%of Medicare
BCBSTX pays Diane Johnston, RN, WHNP $44.12 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 women's health nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.12 | $96.33 | 46% | above 0% of 64 Houston women's health nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $68.00 | $137.41 | 49% | above 0% of 64 Houston women's health nurse practitioners |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $83.64 | $317.92 | 26% | not typically billed by women's health nurse practitioners |
| 72148MRI lumbar spine, without contrast | $150.24 | $192.38 | 78% | not typically billed by women's health nurse practitioners |
| 74177CT abdomen and pelvis, with contrast | $237.24 | $300.72 | 79% | not typically billed by women's health nurse practitioners |
| 77067Screening mammography, bilateral | $99.39 | $126.38 | 79% | not typically billed by women's health 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 Diane Johnston, RN, WHNP performs these services, and they are kept out of the benchmark above.