Arun RAI, M.D.
Urology Physician · Houston, TX 77030 · NPI 1508278995 · 1 payer file
148%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Arun RAI, M.D. $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 urology 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 82% of 121 Houston urology 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 82% of 121 Houston urology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston urology 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 urology 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 urology 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 Arun RAI, M.D. performs these services, and they are kept out of the benchmark above.