Imelda Diala
Licensed Practical Nurse · Houston, TX 77083 · NPI 1437556313
74%of Medicare
BCBSTX pays Imelda Diala $71.26 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 licensed practical nurses |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $71.26 | $96.33 | 74% | above 68% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $104.39 | $137.41 | 76% | above 68% of 24,759 all Houston clinicians |
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 licensed practical nurses |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by licensed practical nurses |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by licensed practical nurses |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by licensed practical nurses |
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 Imelda Diala performs these services, and they are kept out of the benchmark above.