ALI Sambursky, DNP, AGACNP-BC
Acute Care Nurse Practitioner · Houston, TX 77030 · NPI 1508455635 · 1 payer file
69%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays ALI Sambursky, DNP, AGACNP-BC $66.01 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 128 contract rows for this clinician and code, from $42.41 to $108.84; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acute care nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $66.01median of 128 rows · $42.41–$108.84 | $96.33 | 69% | above 26% of 469 Houston acute care nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $94.28median of 128 rows · $62.74–$153.18 | $137.41 | 69% | above 25% of 468 Houston acute care nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acute care nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $61.97median of 64 rows · $46.47–$85.59 | $82.68 | 75% | not typically billed by acute care nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $93.52median of 24 rows · $78.04–$115.99 | $138.62 | 67% | not typically billed by acute care nurse practitioners |
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 ALI Sambursky, DNP, AGACNP-BC performs these services, and they are kept out of the benchmark above.