David Berken, MD
Orthopaedic Surgery Physician · Houston, TX 77030 · NPI 1790105153 · 1 payer file
95%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays David Berken, MD $91.83 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 48 contract rows for this clinician and code, from $50.75 to $172.42; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston orthopaedic surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $91.83median of 48 rows · $50.75–$172.42 | $96.33 | 95% | above 57% of 116 Houston orthopaedic surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $138.34median of 48 rows · $77.90–$243.43 | $137.41 | 101% | above 57% of 116 Houston orthopaedic surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston orthopaedic surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $125.01median of 20 rows · $93.76–$145.49 | $82.68 | 151% | not typically billed by orthopaedic surgery 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 David Berken, MD performs these services, and they are kept out of the benchmark above.