Jerry Estep, M.D.
Cardiovascular Disease Physician · Houston, TX 77030 · NPI 1336343847 · 1 payer file
111%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Jerry Estep, M.D. $107.39 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 80 contract rows for this clinician and code, from $79.57 to $144.97; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $107.39median of 80 rows · $79.57–$144.97 | $96.33 | 111% | above 81% of 233 Houston cardiovascular disease physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $155.02median of 64 rows · $117.29–$204.87 | $137.41 | 113% | above 82% of 233 Houston cardiovascular disease physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $119.35median of 64 rows · $98.00–$145.74 | $82.68 | 144% | not typically billed by cardiovascular disease 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 Jerry Estep, M.D. performs these services, and they are kept out of the benchmark above.