Tori Jones, CNM
Advanced Practice Midwife · Houston, TX 77030 · NPI 1598541104
74%of Medicare
BCBSTX pays Tori Jones, CNM $71.26 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 advanced practice midwifes |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $71.26 | $96.33 | 74% | above 100% of 40 Houston advanced practice midwifes |
| 99214Office visit, established patient, moderate complexity | $104.39 | $137.41 | 76% | above 97% of 40 Houston advanced practice midwifes |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $226.31 | $317.92 | 71% | not typically billed by advanced practice midwifes |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by advanced practice midwifes |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by advanced practice midwifes |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by advanced practice midwifes |
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 Tori Jones, CNM performs these services, and they are kept out of the benchmark above.