JOY Sostak, APN/CNP
Critical Care Pediatric Nurse Practitioner · Houston, TX 77027 · NPI 1922284645 · 1 payer file
159%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays JOY Sostak, APN/CNP $153.26 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 $117.23 to $189.29; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston critical care pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $153.26median of 8 rows · $117.23–$189.29 | $96.33 | 159% | above 100% of 40 Houston critical care pediatric nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $221.86median of 8 rows · $173.07–$270.65 | $137.41 | 161% | above 98% of 41 Houston critical care pediatric nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston critical care pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $131.59median of 12 rows · $86.73–$161.57 | $82.68 | 159% | not typically billed by critical care pediatric nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $245.84median of 8 rows · $220.66–$271.03 | $138.62 | 177% | not typically billed by critical care pediatric nurse practitioners |
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 JOY Sostak, APN/CNP performs these services, and they are kept out of the benchmark above.