Kalpana Cadambi, M.D.,
Obstetrics & Gynecology Physician · Houston, TX 77015 · NPI 1629263439
60%of Medicare
BCBSTX pays Kalpana Cadambi, M.D., $57.73 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 obstetrics & gynecology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $57.73 | $96.33 | 60% | above 8% of 470 Houston obstetrics & gynecology physicians |
| 99214Office visit, established patient, moderate complexity | $259.24 | $137.41 | 189% | above 97% of 470 Houston obstetrics & gynecology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $274.49 | $317.92 | 86% | not typically billed by obstetrics & gynecology physicians |
| 72148MRI lumbar spine, without contrast | $177.91 | $192.38 | 92% | not typically billed by obstetrics & gynecology physicians |
| 74177CT abdomen and pelvis, with contrast | $806.53 | $300.72 | 268% | not typically billed by obstetrics & gynecology physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by obstetrics & gynecology 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 Kalpana Cadambi, M.D., performs these services, and they are kept out of the benchmark above.