Wellcare
What does Wellcare actually pay hospitals? We analyzed 857 negotiated rates from 8 hospitals across 4 states.
$16,656
Avg Negotiated Rate
857
Total Rates
120
Procedures Covered
8
Hospitals in Network
4
States
Is Wellcare Expensive or Cheap?
Avg Rate
$16,656
Range: $8 - $242,594
vs All Payers Average
+64%
All-payer avg: $10,146
vs Medicare
1.1x Medicare
Medicare avg: $15,331
Based on our analysis of 857 negotiated rates, Wellcare 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 Wellcare has the most rate data
| Code | Description | Rates | Avg Rate | Min | Max |
|---|---|---|---|---|---|
| 36415 | HC VENIPUNCTURE | 21 | $10 | $9 | $12 |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | 20 | $6,236 | $4,868 | $6,751 |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | 20 | $8,971 | $7,677 | $9,346 |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | 20 | $45,080 | $43,274 | $48,821 |
| 003 | ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE MOUTH AND NECK WITH MAJOR O.R. PROCEDURES | 20 | $165,412 | $158,478 | $184,045 |
| 97530 | HC PT FUNCTIONAL ACTIV 15 MIN | 19 | $34 | $31 | $53 |
| 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 | 19 | $97 | $89 | $171 |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 19 | $10,817 | $9,534 | $11,130 |
| 85025 | HC LAB CBC W/AUTO DIFF | 16 | $8 | $8 | $11 |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC IPF | 15 | $5,173 | $958 | $8,963 |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION METABOLISM FLUIDS AND ELECTROLYTES WITHOUT MCC | 15 | $7,751 | $6,615 | $8,216 |
| 561 | AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | 15 | $8,186 | $6,886 | $8,504 |
| 292 | HEART FAILURE AND SHOCK WITH CC | 15 | $8,362 | $7,214 | $8,836 |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 15 | $10,353 | $9,179 | $10,798 |
| 560 | AFTERCARE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | 15 | $10,490 | $9,297 | $10,956 |
| 291 | HEART FAILURE AND SHOCK WITH MCC | 15 | $11,714 | $10,544 | $12,314 |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | 15 | $12,612 | $11,310 | $13,352 |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 15 | $17,330 | $15,681 | $18,577 |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP FOOT AND FEMUR WITH CC | 15 | $21,257 | $18,773 | $23,099 |
| 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | 15 | $24,233 | $22,826 | $26,339 |
| 471 | CERVICAL SPINAL FUSION WITH MCC | 15 | $39,109 | $37,212 | $42,842 |
| 002 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC | 15 | $88,383 | $82,715 | $98,846 |
| 001 | HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC | 15 | $217,265 | $207,497 | $242,594 |
| 97140 | Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes | 14 | $29 | $25 | $56 |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | 14 | $31 | $26 | $61 |
Hospitals with Wellcare Rates
Hospitals where we have negotiated rate data for Wellcare
| Hospital | State | Rates | Procedures | Avg Rate | Range |
|---|---|---|---|---|---|
| CHI Saint Joseph Health - Saint Joseph Mount Sterling | KY | 206 | 117 | $9,345 | $8 - $218,991 |
| HCA HOUSTON HEALTHCARE MEDICAL CENTER | TX | 155 | 31 | $24,971 | $8 - $218,485 |
| HCA HOUSTON HEALTHCARE TOMBALL | TX | 135 | 27 | $26,909 | $8 - $209,059 |
| HCA HOUSTON HEALTHCARE CLEAR LAKE | TX | 105 | 21 | $17,432 | $10 - $166,218 |
| CHI St. Luke's Health Brazosport | TX | 101 | 101 | $10,342 | $8 - $207,497 |
| CHI Memorial Hospital - Georgia | GA | 72 | 72 | $431 | $11 - $1,676 |
| HCA HEALTHONE PRESBYTERIAN ST LUKES | CO | 44 | 44 | $22,731 | $8 - $239,962 |
| HCA HEALTHONE AURORA | CO | 39 | 39 | $24,107 | $8 - $242,594 |
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.