Leon Sanchez, MD
Emergency Medicine Physician · Houston, TX 77030 · NPI 1790728731 · 2 payer files
115%of Medicare
Cigna — Houston FlexCare pays Leon Sanchez, MD $110.38 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 4 contract rows for this clinician and code, from $93.32 to $127.45; 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 | Cigna — Houston FlexCare | $110.38median of 4 rows · $93.32–$127.45 | $96.33 | 115% | above 9% of 33 Houston emergency medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $106.62median of 36 rows · $60.93–$142.16 | $96.33 | 111% | above 74% of 402 Houston emergency medicine physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $158.43median of 4 rows · $137.04–$179.82 | $137.41 | 115% | above 9% of 33 Houston emergency medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $154.56median of 36 rows · $93.57–$206.08 | $137.41 | 112% | above 52% 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 | Cigna — Houston FlexCare | $93.53median of 4 rows · $88.24–$98.82 | $82.68 | 113% | not typically billed by emergency medicine physicians |
| 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 | Cigna — Houston FlexCare | $155.75median of 4 rows · $147.33–$164.16 | $138.62 | 112% | not typically billed by emergency medicine physicians |
| 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 | |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $480.63median of 2 rows · $480.63–$480.63 | $317.92 | 151% | not typically billed by emergency medicine physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $288.04median of 2 rows · $288.04–$288.04 | $192.38 | 150% | not typically billed by emergency medicine physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $462.54median of 2 rows · $462.54–$462.54 | $300.72 | 154% | not typically billed by emergency medicine physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $115.80median of 2 rows · $115.80–$115.80 | $126.38 | 92% | 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 Leon Sanchez, MD performs these services, and they are kept out of the benchmark above.