Elmer Santos, MD
Nuclear Medicine Physician · Houston, TX 77030 · NPI 1922193713
80%of Medicare
BCBSTX pays Elmer Santos, MD $110.52 for a 99214 — Office visit, established patient, moderate complexity. Medicare pays $137.41 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 |
|---|---|---|---|---|
| 99214Office visit, established patient, moderate complexity | $110.52 | $137.41 | 80% | above 50% of 15 Houston nuclear medicine physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $134.59 | $317.92 | 42% | not typically billed by nuclear medicine physicians |
| 74177CT abdomen and pelvis, with contrast | $301.90 | $300.72 | 100% | not typically billed by nuclear medicine physicians |
| 77067Screening mammography, bilateral | $44.86 | $126.38 | 35% | 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 Elmer Santos, MD performs these services, and they are kept out of the benchmark above.