Karen Zorrilla, M.D.
Primary Care Clinic/Center · Houston, TX 77024 · NPI 1851613863
57%of Medicare
BCBSTX pays Karen Zorrilla, M.D. $54.49 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 primary care clinic/centers |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $54.49 | $96.33 | 57% | above 51% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $115.79 | $137.41 | 84% | above 71% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by primary care clinic/centers |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by primary care clinic/centers |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by primary care clinic/centers |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by primary care clinic/centers |
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 Karen Zorrilla, M.D. performs these services, and they are kept out of the benchmark above.