Daniel Rodriguez
Ophthalmology Physician · Houston, TX 77030 · NPI 1306588470 · 1 payer file
148%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Daniel Rodriguez $142.97 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 32 contract rows for this clinician and code, from $105.18 to $194.26; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston ophthalmology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $142.97median of 32 rows · $105.18–$194.26 | $96.33 | 148% | above 99% of 170 Houston ophthalmology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $214.97median of 32 rows · $161.73–$285.77 | $137.41 | 156% | above 99% of 169 Houston ophthalmology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston ophthalmology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $136.88median of 24 rows · $113.66–$170.52 | $82.68 | 166% | not typically billed by ophthalmology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $230.24median of 24 rows · $191.50–$286.42 | $138.62 | 166% | not typically billed by ophthalmology 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 Daniel Rodriguez performs these services, and they are kept out of the benchmark above.