Caitlin Thornley, MD
Surgery Physician · Houston, TX 77030 · NPI 1316397003 · 1 payer file
101%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Caitlin Thornley, MD $96.98 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 $73.56 to $120.41; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $96.98median of 8 rows · $73.56–$120.41 | $96.33 | 101% | above 29% of 230 Houston surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $140.04median of 8 rows · $108.33–$171.76 | $137.41 | 102% | above 28% of 230 Houston surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $93.60median of 8 rows · $83.86–$103.35 | $82.68 | 113% | not typically billed by 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 Caitlin Thornley, MD performs these services, and they are kept out of the benchmark above.