Avinash Bapat, M.D.
Cardiovascular Disease Physician · Houston, TX 77089 · NPI 1427098235 · 1 payer file
88%of Medicare
Cigna — Houston FlexCare pays Avinash Bapat, M.D. $85.07 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 $69.28 to $100.86; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $85.07median of 2 rows · $69.28–$100.86 | $96.33 | 88% | above 61% of 34 Houston cardiovascular disease physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $126.47median of 2 rows · $106.61–$146.33 | $137.41 | 92% | above 61% of 34 Houston cardiovascular disease physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $92.50median of 2 rows · $88.19–$96.80 | $82.68 | 112% | not typically billed by cardiovascular disease physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $153.89median of 2 rows · $146.71–$161.07 | $138.62 | 111% | not typically billed by cardiovascular disease physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $548.20 | $317.92 | 172% | not typically billed by cardiovascular disease physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $326.65 | $192.38 | 170% | not typically billed by cardiovascular disease physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $491.58 | $300.72 | 163% | not typically billed by cardiovascular disease physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $205.95 | $126.38 | 163% | not typically billed by cardiovascular disease 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 Avinash Bapat, M.D. performs these services, and they are kept out of the benchmark above.