PayerParity

Heather Machen, M.D.

Pediatric Emergency Medicine (Pediatrics) Physician · Houston, TX 77030 · NPI 1023143369 · 1 payer file

96%of Medicare

Aetna — Texas (office visit and psychotherapy codes only) pays Heather Machen, M.D. $92.33 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 4 contract rows for this clinician and code, from $92.33 to $92.33; the median is shown.

Negotiated rates vs Medicare

ServicePayer · planNegotiatedMedicare% of MedicareAmong Houston pediatric emergency medicine (pediatrics) physicians, same plan
99213Office visit, established patient, low complexityAetna — Texas (office visit and psychotherapy codes only)$92.33median of 4 rows · $92.33–$92.33$96.3396%

above 20% of 76 Houston pediatric emergency medicine (pediatrics) physicians on this plan

99214Office visit, established patient, moderate complexityAetna — Texas (office visit and psychotherapy codes only)$136.89median of 4 rows · $136.89–$136.89$137.41100%

above 19% of 76 Houston pediatric emergency medicine (pediatrics) physicians on this plan

Sources. Aetna — Texas (office visit and psychotherapy codes only) (August 2026 extract). Each payer’s machine-readable file, joined to the national provider registry by NPI. Rates are the negotiated professional amounts — not billed charges, and not what a member owes after cost sharing. Where a file carries several contract rows for one clinician and code, the median is shown with the range and row count beneath it.

Medicare. Non-facility allowed amount, HOUSTON, Texas, Locality 18, CY2026 non-QP conversion factor, computed from RVUs and the locality’s geographic indices — not looked up from a table.

Position. Percentile of this rate among Houston clinicians in the same specialty holding a rate for the same code on the same plan; falls back to all Houston clinicians on that plan where the specialty cohort is under ten. Payers are never pooled.

Built 2026-09-03 · PayerParity