Justin Broyles, M.D.
Plastic and Reconstructive Surgery Physician · Houston, TX 77030 · NPI 1295034940 · 1 payer file
86%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Justin Broyles, M.D. $82.75 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 20 contract rows for this clinician and code, from $48.97 to $110.33; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston plastic and reconstructive surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $82.75median of 20 rows · $48.97–$110.33 | $96.33 | 86% | above 26% of 66 Houston plastic and reconstructive surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $120.76median of 20 rows · $75.55–$161.01 | $137.41 | 88% | above 25% of 66 Houston plastic and reconstructive surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston plastic and reconstructive surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $84.92median of 12 rows · $74.93–$99.91 | $82.68 | 103% | not typically billed by plastic and reconstructive surgery physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $141.88median of 12 rows · $125.19–$166.92 | $138.62 | 102% | not typically billed by plastic and reconstructive surgery 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 Justin Broyles, M.D. performs these services, and they are kept out of the benchmark above.