Winifred King, MD
General Practice Physician · Houston, TX 77068 · NPI 1114931847 · 1 payer file
72%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Winifred King, MD $69.35 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 38 contract rows for this clinician and code, from $55.29 to $81.59; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston general practice physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $69.35median of 38 rows · $55.29–$81.59 | $96.33 | 72% | above 27% of 42 Houston general practice physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.60median of 40 rows · $81.20–$118.37 | $137.41 | 73% | above 29% of 43 Houston general practice physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston general practice physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 18 rows · $58.72–$78.29 | $82.68 | 81% | not typically billed by general practice 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 Winifred King, MD performs these services, and they are kept out of the benchmark above.