Marion Woerner, M.D.
Pediatrics Physician · Houston, TX 77030 · NPI 1376812404 · 2 payer files
87%of Medicare
Cigna — Houston FlexCare pays Marion Woerner, M.D. $84.10 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. The file lists 2 contract rows for this clinician and code, from $68.49 to $99.72; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $84.10median of 2 rows · $68.49–$99.72 | $96.33 | 87% | above 10% of 49 Houston pediatrics physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $223.00median of 4 rows · $223.00–$223.00 | $96.33 | 231% | above 100% of 715 Houston pediatrics physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $125.03median of 2 rows · $105.40–$144.67 | $137.41 | 91% | above 10% of 49 Houston pediatrics physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $253.00median of 4 rows · $253.00–$253.00 | $137.41 | 184% | above 99% of 717 Houston pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $91.44median of 2 rows · $87.18–$95.70 | $82.68 | 111% | not typically billed by pediatrics physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $152.13median of 2 rows · $145.04–$159.23 | $138.62 | 110% | not typically billed by pediatrics physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $347.07 | $317.92 | 109% | not typically billed by pediatrics physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $206.80 | $192.38 | 107% | not typically billed by pediatrics physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $311.22 | $300.72 | 103% | not typically billed by pediatrics physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $130.39 | $126.38 | 103% | not typically billed by pediatrics 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 Marion Woerner, M.D. performs these services, and they are kept out of the benchmark above.