Lyndsey Prather, MD
Pediatrics Physician · Houston, TX 77030 · NPI 1184326241 · 1 payer file
117%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lyndsey Prather, MD $112.50 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 8 contract rows for this clinician and code, from $85.33 to $139.67; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $112.50median of 8 rows · $85.33–$139.67 | $96.33 | 117% | above 93% of 715 Houston pediatrics physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $162.46median of 8 rows · $125.67–$199.24 | $137.41 | 118% | above 93% of 717 Houston pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $108.58median of 8 rows · $97.28–$119.88 | $82.68 | 131% | not typically billed by pediatrics 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 Lyndsey Prather, MD performs these services, and they are kept out of the benchmark above.