Roberto Alvarez, M.D.
Family Medicine Physician · Houston, TX 77095 · NPI 1427065283 · 2 payer files
88%of Medicare
Cigna — Houston FlexCare pays Roberto Alvarez, M.D. $84.75 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 $68.75 to $100.74; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $84.75median of 2 rows · $68.75–$100.74 | $96.33 | 88% | above 59% of 64 Houston family medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $89.22median of 12 rows · $67.67–$110.77 | $96.33 | 93% | above 50% of 623 Houston family medicine physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $126.91median of 2 rows · $105.97–$147.85 | $137.41 | 92% | above 63% of 64 Houston family medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $128.84median of 8 rows · $99.67–$158.02 | $137.41 | 94% | above 49% of 632 Houston family medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $57.34median of 2 rows · $57.10–$57.57 | $82.68 | 69% | not typically billed by family medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $150.55median of 2 rows · $150.08–$151.02 | $138.62 | 109% | not typically billed by family medicine physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $645.46 | $317.92 | 203% | not typically billed by family medicine physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $431.14 | $192.38 | 224% | not typically billed by family medicine physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $394.77 | $300.72 | 131% | not typically billed by family medicine physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $147.84 | $126.38 | 117% | not typically billed by family medicine 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 Roberto Alvarez, M.D. performs these services, and they are kept out of the benchmark above.