Gloria Lalezari, FNP
Family Nurse Practitioner · Houston, TX 77035 · NPI 1861033904
78%of Medicare
BCBSTX pays Gloria Lalezari, FNP $75.38 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 family nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $75.38 | $96.33 | 78% | above 73% of 1,635 Houston family nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $80.01 | $137.41 | 58% | above 11% of 1,612 Houston family nurse practitioners |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $294.89 | $317.92 | 93% | not typically billed by family nurse practitioners |
| 72148MRI lumbar spine, without contrast | $176.75 | $192.38 | 92% | not typically billed by family nurse practitioners |
| 74177CT abdomen and pelvis, with contrast | $78.35 | $300.72 | 26% | not typically billed by family nurse practitioners |
| 77067Screening mammography, bilateral | $116.92 | $126.38 | 93% | not typically billed by family 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 Gloria Lalezari, FNP performs these services, and they are kept out of the benchmark above.