John Miller, M.D.
Retina Specialist (Ophthalmology) Physician · Houston, TX 77002 · NPI 1578524286
80%of Medicare
BCBSTX pays John Miller, M.D. $76.70 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 retina specialist (ophthalmology) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $76.70 | $96.33 | 80% | above 62% of 17 Houston retina specialist (ophthalmology) physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 0% of 17 Houston retina specialist (ophthalmology) physicians |
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 retina specialist (ophthalmology) physicians |
| 74177CT abdomen and pelvis, with contrast | $258.15 | $300.72 | 86% | not typically billed by retina specialist (ophthalmology) 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 John Miller, M.D. performs these services, and they are kept out of the benchmark above.