Daniel LEE, M.D.
Nuclear Medicine Physician · Houston, TX 77030 · NPI 1780839183
139%of Medicare
BCBSTX pays Daniel LEE, M.D. $134.22 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 nuclear medicine physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $134.22 | $96.33 | 139% | above 93% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $196.63 | $137.41 | 143% | above 93% of 15 Houston nuclear medicine physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $190.74 | $317.92 | 60% | not typically billed by nuclear medicine physicians |
| 72148MRI lumbar spine, without contrast | $123.04 | $192.38 | 64% | not typically billed by nuclear medicine physicians |
| 74177CT abdomen and pelvis, with contrast | $151.88 | $300.72 | 51% | not typically billed by nuclear medicine physicians |
| 77067Screening mammography, bilateral | $123.38 | $126.38 | 98% | not typically billed by nuclear medicine 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 Daniel LEE, M.D. performs these services, and they are kept out of the benchmark above.