Fallon Bernard
Audiologist · Houston, TX 77021 · NPI 1437938719 · 1 payer file
79%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Fallon Bernard $75.67 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 56 contract rows for this clinician and code, from $53.88 to $104.74; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston audiologists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $75.67median of 56 rows · $53.88–$104.74 | $96.33 | 79% | above 91% of 59 Houston audiologists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $110.35median of 56 rows · $82.71–$154.68 | $137.41 | 80% | above 91% of 58 Houston audiologists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston audiologists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $97.30median of 28 rows · $53.57–$98.26 | $82.68 | 118% | not typically billed by audiologists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $163.77median of 28 rows · $89.04–$164.72 | $138.62 | 118% | not typically billed by audiologists |
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 Fallon Bernard performs these services, and they are kept out of the benchmark above.