Oscar
What does Oscar actually pay hospitals? We analyzed 220 negotiated rates from 3 hospitals across 1 states.
$15,147
Avg Negotiated Rate
220
Total Rates
75
Procedures Covered
3
Hospitals in Network
1
States
Is Oscar Expensive or Cheap?
Avg Rate
$15,147
Range: $8 - $205,880
vs All Payers Average
+49%
All-payer avg: $10,146
vs Medicare
1x Medicare
Medicare avg: $15,331
Based on our analysis of 220 negotiated rates, Oscar is significantly more expensive than average compared to other insurance companies in our database. They pay roughly the same or less than Medicare for equivalent services.
Top Procedures with Negotiated Rates
Procedures where Oscar has the most rate data
| Code | Description | Rates | Avg Rate | Min | Max |
|---|---|---|---|---|---|
| 36415 | Collection of venous blood by venipuncture | 6 | $18 | $9 | $27 |
| 293 | HEART FAILURE AND SHOCK WITHOUT CC/MCC | 6 | $6,397 | $5,659 | $6,617 |
| 812 | RED BLOOD CELL DISORDERS WITHOUT MCC | 6 | $9,743 | $8,228 | $10,734 |
| 689 | KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 6 | $12,814 | $9,993 | $15,105 |
| 461 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC | 6 | $53,498 | $41,805 | $64,564 |
| 85025 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | 4 | $15 | $8 | $22 |
| 641 | MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOU | 4 | $8,328 | $7,207 | $9,097 |
| 292 | HEART FAILURE AND SHOCK WITH CC | 4 | $9,037 | $7,723 | $9,925 |
| 561 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC | 4 | $8,788 | $8,105 | $9,398 |
| 897 | ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC | 4 | $9,538 | $8,697 | $10,320 |
| 190 | CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 4 | $11,483 | $9,609 | $12,949 |
| 560 | AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC | 4 | $11,657 | $9,744 | $13,164 |
| 291 | HEART FAILURE AND SHOCK WITH MCC | 4 | $13,148 | $10,894 | $15,008 |
| 811 | RED BLOOD CELL DISORDERS WITH MCC | 4 | $14,287 | $11,772 | $16,416 |
| 064 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 4 | $20,093 | $16,196 | $23,509 |
| 493 | LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC | 4 | $25,104 | $20,025 | $29,647 |
| 462 | BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | 4 | $26,160 | $20,929 | $31,095 |
| 480 | HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC | 4 | $28,546 | $22,768 | $34,045 |
| 471 | CERVICAL SPINAL FUSION WITH MCC | 4 | $34,995 | $32,330 | $38,294 |
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility | 3 | $43 | $25 | $74 |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes | 3 | $32 | $30 | $34 |
| 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 | $88 | $85 | $96 |
| 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 | 3 | $138 | $96 | $220 |
| 62323 | Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, i | 3 | $2,128 | $2,128 | $2,128 |
| 64483 | Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level | 3 | $2,128 | $2,128 | $2,128 |
Hospitals with Oscar Rates
Hospitals where we have negotiated rate data for Oscar
| Hospital | State | Rates | Procedures | Avg Rate | Range |
|---|---|---|---|---|---|
| HCA HOUSTON HEALTHCARE MEDICAL CENTER | TX | 85 | 63 | $16,169 | $8 - $205,880 |
| HCA HOUSTON HEALTHCARE TOMBALL | TX | 75 | 55 | $16,202 | $8 - $202,849 |
| HCA HOUSTON HEALTHCARE CLEAR LAKE | TX | 60 | 45 | $12,378 | $9 - $161,281 |
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.