Aakash Sheth
Student in an Organized Health Care Education/Training Program · Houston, TX 77030 · NPI 1184243487 · 1 payer file
104%of Medicare
Cigna — Texas Connect (individual & family) pays Aakash Sheth $100.60 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 $85.44 to $115.77; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston student in an organized health care education/training programs, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $100.60median of 2 rows · $85.44–$115.77 | $96.33 | 104% | above 79% of 1,164 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $145.38median of 2 rows · $126.32–$164.45 | $137.41 | 106% | above 81% of 1,164 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston student in an organized health care education/training programs, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $92.43median of 2 rows · $87.30–$97.56 | $82.68 | 112% | not typically billed by student in an organized health care education/training programs |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $154.83median of 2 rows · $146.44–$163.23 | $138.62 | 112% | not typically billed by student in an organized health care education/training programs |
| 70553MRI brain, with and without contrast | Cigna — Texas Connect (individual & family) | $487.39 | $317.92 | 153% | not typically billed by student in an organized health care education/training programs |
| 72148MRI lumbar spine, without contrast | Cigna — Texas Connect (individual & family) | $290.76 | $192.38 | 151% | not typically billed by student in an organized health care education/training programs |
| 74177CT abdomen and pelvis, with contrast | Cigna — Texas Connect (individual & family) | $455.47 | $300.72 | 151% | not typically billed by student in an organized health care education/training programs |
| 77067Screening mammography, bilateral | Cigna — Texas Connect (individual & family) | $180.37 | $126.38 | 143% | not typically billed by student in an organized health care education/training programs |
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 Aakash Sheth performs these services, and they are kept out of the benchmark above.