Guliz Erdem, MD
Pediatric Infectious Diseases Physician · Houston, TX 77030 · NPI 1063405413 · 2 payer files
88%of Medicare
Cigna — Houston FlexCare pays Guliz Erdem, MD $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 pediatric infectious diseases 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 56% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $120.41median of 20 rows · $73.56–$176.98 | $96.33 | 125% | above 85% of 35 Houston pediatric infectious diseases 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 59% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $196.79median of 40 rows · $108.33–$266.94 | $137.41 | 143% | above 85% of 35 Houston pediatric infectious diseases physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric infectious diseases 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 pediatric infectious diseases physicians |
| Aetna — Texas (office visit and psychotherapy codes only) | $93.60median of 8 rows · $83.86–$103.35 | $82.68 | 113% | not typically billed by pediatric infectious diseases 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 pediatric infectious diseases physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $548.20 | $317.92 | 172% | not typically billed by pediatric infectious diseases physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $326.65 | $192.38 | 170% | not typically billed by pediatric infectious diseases physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $491.58 | $300.72 | 163% | not typically billed by pediatric infectious diseases physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $205.95 | $126.38 | 163% | not typically billed by pediatric infectious diseases 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 Guliz Erdem, MD performs these services, and they are kept out of the benchmark above.