Mary Paul, MD
Pediatric Allergy/Immunology Physician · Houston, TX 77030 · NPI 1710067137
64%of Medicare
BCBSTX pays Mary Paul, MD $61.45 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 allergy/immunology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $61.45 | $96.33 | 64% | above 17% of 13 Houston pediatric allergy/immunology physicians |
| 99214Office visit, established patient, moderate complexity | $130.73 | $137.41 | 95% | above 67% of 13 Houston pediatric allergy/immunology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by pediatric allergy/immunology 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 Mary Paul, MD performs these services, and they are kept out of the benchmark above.