Czarina Sanchez, M.D.
Emergency Medicine Physician · Houston, TX 77030 · NPI 1629362934 · 1 payer file
126%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Czarina Sanchez, M.D. $121.69 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 56 contract rows for this clinician and code, from $60.93 to $175.46; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston emergency medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $121.69median of 56 rows · $60.93–$175.46 | $96.33 | 126% | above 91% of 402 Houston emergency medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $186.13median of 56 rows · $93.57–$263.18 | $137.41 | 135% | above 70% of 415 Houston emergency medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston emergency medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.25median of 20 rows · $97.28–$135.60 | $82.68 | 139% | not typically billed by emergency medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $203.90median of 12 rows · $179.91–$239.89 | $138.62 | 147% | not typically billed by emergency medicine 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 Czarina Sanchez, M.D. performs these services, and they are kept out of the benchmark above.