Jose Soto, MD
Interventional Cardiology Physician · Houston, TX 77074 · NPI 1497756449
57%of Medicare
BCBSTX pays Jose Soto, MD $55.19 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 interventional cardiology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $55.19 | $96.33 | 57% | above 18% of 86 Houston interventional cardiology physicians |
| 99214Office visit, established patient, moderate complexity | $117.40 | $137.41 | 85% | above 65% of 86 Houston interventional cardiology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $96.65 | $317.92 | 30% | not typically billed by interventional cardiology physicians |
| 74177CT abdomen and pelvis, with contrast | $139.96 | $300.72 | 47% | not typically billed by interventional cardiology physicians |
| 77067Screening mammography, bilateral | $56.52 | $126.38 | 45% | not typically billed by interventional cardiology 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 Jose Soto, MD performs these services, and they are kept out of the benchmark above.