Marta Gonzalez, CPNP-AC
Pediatric Nurse Practitioner · Houston, TX 77030 · NPI 1376109231
46%of Medicare
BCBSTX pays Marta Gonzalez, CPNP-AC $44.19 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 nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.19 | $96.33 | 46% | above 2% of 234 Houston pediatric nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $94.00 | $137.41 | 68% | above 26% of 233 Houston pediatric nurse practitioners |
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 pediatric nurse practitioners |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by pediatric nurse practitioners |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by pediatric nurse practitioners |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by pediatric nurse practitioners |
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 Marta Gonzalez, CPNP-AC performs these services, and they are kept out of the benchmark above.