Arlene Reuley Balinao
Nurse Practitioner · Houston, TX 77074 · NPI 1013705979 · 1 payer file
71%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Arlene Reuley Balinao $68.42 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 40 contract rows for this clinician and code, from $53.95 to $80.50; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $68.42median of 40 rows · $53.95–$80.50 | $96.33 | 71% | above 23% of 462 Houston nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $99.31median of 30 rows · $79.48–$116.82 | $137.41 | 72% | above 23% of 458 Houston nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $65.67median of 24 rows · $57.93–$77.26 | $82.68 | 79% | not typically billed by nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.60median of 18 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by nurse practitioners |
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 Arlene Reuley Balinao performs these services, and they are kept out of the benchmark above.