Elizabeth Peguese, OD
Optometrist · Houston, TX 77204 · NPI 1740689975 · 1 payer file
64%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Elizabeth Peguese, OD $61.20 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 86 contract rows for this clinician and code, from $41.92 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston optometrists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $61.20median of 86 rows · $41.92–$81.60 | $96.33 | 64% | above 67% of 575 Houston optometrists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $93.40median of 74 rows · $61.68–$118.37 | $137.41 | 68% | above 73% of 575 Houston optometrists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston optometrists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $65.66median of 30 rows · $57.94–$78.30 | $82.68 | 79% | not typically billed by optometrists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.79median of 30 rows · $102.01–$136.22 | $138.62 | 84% | not typically billed by optometrists |
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 Elizabeth Peguese, OD performs these services, and they are kept out of the benchmark above.