ProCare Advantage
What does ProCare Advantage actually pay hospitals? We analyzed 99 negotiated rates from 3 hospitals across 1 states.
$16,318
Avg Negotiated Rate
99
Total Rates
45
Procedures Covered
3
Hospitals in Network
1
States
Is ProCare Advantage Expensive or Cheap?
Avg Rate
$16,318
Range: $8 - $220,586
vs All Payers Average
+61%
All-payer avg: $10,146
vs Medicare
1.1x Medicare
Medicare avg: $15,331
Based on our analysis of 99 negotiated rates, ProCare Advantage is significantly more expensive than average compared to other insurance companies in our database. They pay roughly 1.1x what Medicare pays for equivalent services.
Top Procedures with Negotiated Rates
Procedures where ProCare Advantage has the most rate data
| Code | Description | Rates | Avg Rate | Min | Max |
|---|---|---|---|---|---|
| 36415 | Collection of venous blood by venipuncture | 3 | $10 | $10 | $10 |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | 3 | $34 | $33 | $37 |
| 97162 | Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination o | 3 | $95 | $91 | $103 |
| 471 | CERVICAL SPINAL FUSION WITH MCC | 3 | $13,886 | $995 | $39,669 |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | 3 | $3,773 | $995 | $9,318 |
| 066 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 3 | $3,238 | $995 | $7,723 |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | 3 | $15,018 | $995 | $22,605 |
| 003 | ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH | 3 | $113,755 | $995 | $172,801 |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | 3 | $30,799 | $995 | $46,609 |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | 3 | $6,618 | $6,064 | $7,018 |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | 3 | $9,378 | $8,815 | $9,716 |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 3 | $11,275 | $10,707 | $11,570 |
| 85025 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | 2 | $8 | $8 | $8 |
| 97140 | Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | 2 | $28 | $26 | $29 |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | 2 | $29 | $27 | $31 |
| 97112 | Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing act | 2 | $32 | $30 | $35 |
| 97161 | Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using st | 2 | $97 | $91 | $103 |
| 97163 | Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination | 2 | $103 | $103 | $103 |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | 2 | $995 | $995 | $995 |
| 472 | CERVICAL SPINAL FUSION WITH CC | 2 | $12,827 | $995 | $24,659 |
| 470 | MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT | 2 | $9,226 | $995 | $17,458 |
| 602 | CELLULITIS WITH MCC | 2 | $6,870 | $995 | $12,746 |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 2 | $9,174 | $995 | $17,353 |
| 192 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC | 2 | $4,189 | $995 | $7,383 |
| 640 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH M | 2 | $6,954 | $995 | $12,913 |
Hospitals with ProCare Advantage Rates
Hospitals where we have negotiated rate data for ProCare Advantage
| Hospital | State | Rates | Procedures | Avg Rate | Range |
|---|---|---|---|---|---|
| HCA HOUSTON HEALTHCARE MEDICAL CENTER | TX | 40 | 40 | $18,761 | $8 - $220,586 |
| HCA HOUSTON HEALTHCARE TOMBALL | TX | 35 | 35 | $15,617 | $8 - $217,338 |
| HCA HOUSTON HEALTHCARE CLEAR LAKE | TX | 24 | 24 | $13,268 | $10 - $172,801 |
About This Data
These rates are from hospital Machine-Readable Files (MRFs) required by the CMS Hospital Price Transparency Rule. They reflect specific hospital-payer contracts and may not represent your actual cost, which depends on your specific plan, deductible, copay, coinsurance, and network status. Data sources include CommonSpirit Health, HCA Healthcare, and Kaiser Permanente filings.