William Kowalski, DC FACO
Orthopedic Chiropractor · Houston, TX 77015 · NPI 1457403172
29%of Medicare
BCBSTX pays William Kowalski, DC FACO $28.20 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 orthopedic chiropractors |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $28.20 | $96.33 | 29% | above 0% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $59.99 | $137.41 | 44% | above 11% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $252.85 | $317.92 | 80% | not typically billed by orthopedic chiropractors |
| 72148MRI lumbar spine, without contrast | $151.55 | $192.38 | 79% | not typically billed by orthopedic chiropractors |
| 77067Screening mammography, bilateral | $28.12 | $126.38 | 22% | not typically billed by orthopedic chiropractors |
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 William Kowalski, DC FACO performs these services, and they are kept out of the benchmark above.