ProCare Advantage Knee Replacement Rates in Houston

Published ProCare Advantage negotiated rates for Knee Replacement at 22 hospitals in Houston, TX. Data from CMS-mandated hospital transparency files.

Lowest Rate

$12,000

HCA Houston Healthcare Clear Lake

all plan types

Highest Rate

$14,831.76

Memorial Hermann The Woodlands Medical Center

all plan types

Rate Spread

across all plan types

Hospitals

with ProCare Advantage data

Knee replacement rates across Houston's 22 hospitals range from $12,000 at HCA Clear Lake to $14,832 at Memorial Hermann Woodlands, with a median of $13,093. The lowest rates often reflect Medicaid/Medicare pricing rather than commercial plans. This narrow 1.2x spread indicates relatively consistent pricing across the market.

Why the range is so wide: ProCare Advantage negotiates different rates for different plan types. Medicaid-managed and Medicare Advantage plans typically have the lowest negotiated rates. Commercial PPO and HMO plans are higher. The "lowest rate" at each hospital may be a Medicaid or Medicare plan rate, not a commercial plan rate. The plan type is shown in the table where available.

ProCare Advantage Knee Replacement Rates by Hospital

Hospital	Lowest ProCare Advantage Rate	Plan Type	Highest Rate	Plans
HCA Houston Healthcare Clear Lake	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Conroe	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Kingwood	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Mainland	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Medical Center	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare North Cypress	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Northwest	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Pearland	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Southeast	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare Tomball	$12,000	MGMCR	$12,000	1
HCA Houston Healthcare West	$12,000	MGMCR	$12,000	1
Houston Methodist Hospital	$14,186.9	Medicare Managed Care - Hmo	$14,186.9	1
Memorial Hermann, Texas Medical Center	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Cypress Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Greater Heights Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Katy Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Memorial City Medical Center	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Pearland Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Southeast Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Southwest Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann Sugar Land Hospital	$14,831.76	Medicare Managed Care Plan	$14,831.76	1
Memorial Hermann The Woodlands Medical Center	$14,831.76	Medicare Managed Care Plan	$14,831.76	1

Rates shown are ProCare Advantage's published negotiated rates from each hospital's CMS transparency file. "Lowest rate" is the lowest rate across all ProCare Advantage plan types (including Medicaid-managed and Medicare Advantage) at that hospital. Commercial plan rates are typically higher. Your actual cost depends on your specific plan's deductible, copay, and coinsurance.

Understanding ProCare Advantage Negotiated Rates

A negotiated rate is the price ProCare Advantage has agreed to pay a hospital for a specific service. This is not necessarily what you pay out of pocket. If you have met your annual deductible, you typically pay a copay or coinsurance percentage of the negotiated rate. If you have not met your deductible, you may owe the full negotiated rate.

The same insurer often negotiates different rates at different hospitals, and different plan types (HMO, PPO, high-deductible) within the same insurer can have different rates at the same hospital. The table above shows the range across all ProCare Advantage plan types at each facility.

Prices shown are facility fees only. You will also receive separate bills from the physician performing the procedure.

Compare Other Insurers for Knee Replacement in Houston

Aetna $1,997 - $19,990.64 31 hospitals Blue Cross Blue Shield of Texas $5,418.56 - $45,698.73 20 hospitals Cigna $3,309 - $62,486 20 hospitals Community Health Choice $13,532.04 - $19,331.49 20 hospitals UnitedHealthcare $4,175 - $30,000 20 hospitals Superior Health Plan $948 - $19,331.49 19 hospitals

View all Knee Replacement prices in Houston (cash + insured) →

Frequently Asked Questions

Where is the lowest-cost ProCare Advantage Knee Replacement in Houston?

The lowest ProCare Advantage negotiated rate for Knee Replacement in Houston is $12,000 at HCA Houston Healthcare Clear Lake, across all plan types including Medicaid-managed and Medicare Advantage. The highest is $14,831.76 at Memorial Hermann The Woodlands Medical Center. Commercial plan rates typically fall between these extremes.

Is the ProCare Advantage negotiated rate what I'll pay?

Not necessarily. The negotiated rate is what ProCare Advantage has agreed to pay the hospital. Your out-of-pocket cost depends on your deductible, copay, and coinsurance. If you have not met your annual deductible, you may owe the full negotiated rate. Contact ProCare Advantage for a pre-service cost estimate specific to your plan.

How many Houston hospitals have published ProCare Advantage rates?

22 hospitals in the Houston area have published ProCare Advantage negotiated rates for Knee Replacement in their CMS transparency files. Having a published rate does not necessarily confirm current network participation. Verify your network status with ProCare Advantage directly.

Does ProCare Advantage require prior authorization for knee replacement?

Almost all ProCare Advantage plans require prior authorization for knee replacement surgery. Without authorization, ProCare Advantage can deny the claim entirely. Start the approval process well before your planned surgery date and confirm what documentation your plan requires.

We are not affiliated with ProCare Advantage or any hospital listed on this page. Negotiated rates are sourced from hospital-published CMS transparency files and represent the amounts agreed between the insurer and hospital. Your actual out-of-pocket cost depends on your deductible, copay, and coinsurance. Contact ProCare Advantage or the hospital billing department for a cost estimate specific to your plan. All insurer and hospital names are trademarks of their respective owners.

Visit the official ProCare Advantage website: www.procareadv.com