Provider Partners Health Plan of Texas
What does Provider Partners Health Plan of Texas actually pay hospitals? We analyzed 395 negotiated rates from 3 hospitals across 1 states.
Is Provider Partners Health Plan of Texas Expensive or Cheap?
Based on our analysis of 395 negotiated rates, Provider Partners Health Plan of Texas is significantly more expensive than average compared to other insurance companies in our database. They pay roughly 1.5x what Medicare pays for equivalent services.
Top Procedures with Negotiated Rates
Procedures where Provider Partners Health Plan of Texas has the most rate data
| Code | Description | Rates | Avg Rate | Min | Max |
|---|---|---|---|---|---|
| 36415 | Collection of venous blood by venipuncture | 15 | $10 | $10 | $10 |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | 15 | $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 | 15 | $96 | $91 | $104 |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | 15 | $6,429 | $5,890 | $6,818 |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | 15 | $9,110 | $8,563 | $9,438 |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 15 | $10,953 | $10,401 | $11,240 |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | 15 | $44,164 | $43,512 | $45,278 |
| 003 | ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH | 15 | $163,696 | $160,540 | $167,864 |
| 85025 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | 10 | $8 | $8 | $8 |
| 97140 | Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | 10 | $28 | $26 | $30 |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | 10 | $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 | 10 | $33 | $31 | $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 | 10 | $98 | $91 | $104 |
| 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 | 10 | $104 | $104 | $104 |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC IPF | 10 | $5,043 | $1,034 | $9,052 |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOU | 10 | $7,868 | $7,501 | $8,235 |
| 292 | HEART FAILURE AND SHOCK WITH CC | 10 | $8,481 | $8,038 | $8,923 |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | 10 | $8,512 | $8,436 | $8,588 |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 10 | $10,425 | $10,002 | $10,848 |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | 10 | $10,563 | $10,141 | $10,985 |
| 291 | HEART FAILURE AND SHOCK WITH MCC | 10 | $11,748 | $11,338 | $12,159 |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | 10 | $12,654 | $12,253 | $13,055 |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 10 | $17,358 | $16,857 | $17,860 |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | 10 | $21,401 | $20,843 | $21,959 |
| 462 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | 10 | $22,091 | $21,783 | $22,399 |
Hospitals with Provider Partners Health Plan of Texas Rates
Hospitals where we have negotiated rate data for Provider Partners Health Plan of Texas
| Hospital | State | Rates | Procedures | Avg Rate | Range |
|---|---|---|---|---|---|
| HCA HOUSTON HEALTHCARE MEDICAL CENTER | TX | 155 | 31 | $24,491 | $8 - $214,284 |
| HCA HOUSTON HEALTHCARE TOMBALL | TX | 135 | 27 | $27,176 | $8 - $211,129 |
| HCA HOUSTON HEALTHCARE CLEAR LAKE | TX | 105 | 21 | $17,605 | $10 - $167,864 |
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.