Gumaro Granados, M.D.
Family Medicine Physician · Houston, TX 77015 · NPI 1902244452 · 1 payer file
85%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Gumaro Granados, M.D. $81.47 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 8 contract rows for this clinician and code, from $61.79 to $101.14; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $81.47median of 8 rows · $61.79–$101.14 | $96.33 | 85% | above 48% of 623 Houston family medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $117.64median of 8 rows · $91.00–$144.28 | $137.41 | 86% | above 47% of 632 Houston family medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $78.62median of 8 rows · $70.44–$86.81 | $82.68 | 95% | not typically billed by family 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 Gumaro Granados, M.D. performs these services, and they are kept out of the benchmark above.