Ronald Vilela, M.D.
Pediatric Otolaryngology Physician · Houston, TX 77030 · NPI 1700088739
121%of Medicare
BCBSTX pays Ronald Vilela, M.D. $116.53 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 pediatric otolaryngology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 19% of 33 Houston pediatric otolaryngology physicians |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 12% of 33 Houston pediatric otolaryngology 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 pediatric otolaryngology physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by pediatric otolaryngology 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 Ronald Vilela, M.D. performs these services, and they are kept out of the benchmark above.