Alberto Colomer, M.D.
Pulmonary Disease Physician · Houston, TX 77030 · NPI 1821265513
69%of Medicare
BCBSTX pays Alberto Colomer, M.D. $66.02 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 pulmonary disease physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $66.02 | $96.33 | 69% | above 55% of 159 Houston pulmonary disease physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 4% of 159 Houston pulmonary disease physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $136.24 | $317.92 | 43% | not typically billed by pulmonary disease physicians |
| 72148MRI lumbar spine, without contrast | $87.88 | $192.38 | 46% | not typically billed by pulmonary disease physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by pulmonary disease physicians |
| 77067Screening mammography, bilateral | $161.89 | $126.38 | 128% | not typically billed by pulmonary 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 Alberto Colomer, M.D. performs these services, and they are kept out of the benchmark above.