Tonsillectomy (age 12+) at indian river hospital
1000 36th Street, Vero Beach, FL · Cleveland Clinic · · NPI 1376512988
$897.00
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$1,380.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$193.48 with Optum vs $8,724.00 with AETNA — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Optum | Managed Medicaid | $193.48 | ↓ -78% |
| AmeriHealth | Managed Medicaid | $199.66 | ↓ -78% |
| Value Options | Managed Medicaid | $199.66 | ↓ -78% |
| Wellcare | Managed Medicaid | $199.66 | ↓ -78% |
| Molina | Managed Medicaid | $199.66 | ↓ -78% |
| Medicaid | Managed Medicaid | $199.66 | ↓ -78% |
| Blue Cross | Health Options | $239.19 | ↓ -73% |
| Blue Cross | Network Blue | $245.08 | ↓ -73% |
| Blue Cross | Medicare Advantage HMO | $246.99 | ↓ -72% |
| Wellcare | Medicare Advantage | $246.99 | ↓ -72% |
| Value Options | Medicare Advantage | $246.99 | ↓ -72% |
| Magellan | Medicare Advantage | $246.99 | ↓ -72% |
| Careplus | Medicare Advantage | $246.99 | ↓ -72% |
| Avmed | Medicare Advantage | $246.99 | ↓ -72% |
| Blue Cross | Medicare Advantage PPO | $246.99 | ↓ -72% |
| Blue Cross | Traditional (PPS) | $250.96 | ↓ -72% |
| Blue Cross | Perferred Patient Care | $250.96 | ↓ -72% |
| Independent Living Systems | Medicare Advantage | $259.34 | ↓ -71% |
| Freedom Health | Medicare Advantage | $259.34 | ↓ -71% |
| WellMed | Medicare Advantage | $259.34 | ↓ -71% |
| United | Medicare Advantage | $265.15 | ↓ -70% |
| Clear Spring Health | All Products | $266.75 | ↓ -70% |
| Aetna | Medicare Advantage Behavioral Health | $296.39 | ↓ -67% |
| Aetna | Medicare Advantage PCP | $306.27 | ↓ -66% |
| Aetna | Medicare Advantage Specialist | $311.21 | ↓ -65% |
| Avmed | Exchange | $353.00 | ↓ -61% |
| Avmed | Select | $366.58 | ↓ -59% |
| Aetna | PPO First Health | $392.62 | ↓ -56% |
| Avmed | Broad | $393.73 | ↓ -56% |
| United | All Products | $513.78 | ↓ -43% |
| Aetna | POS First Health | $621.00 | ↓ -31% |
| Clarity Health | All Products | $897.00 | ↑ +0% |
| Three Rivers | All Products | $897.00 | ↑ +0% |
| The Legacy Companies | All Products | $897.00 | ↑ +0% |
| Consociate Health | ALL PRODUCTS | $1,035.00 | ↑ +15% |
| National Provider Network | All Products | $1,173.00 | ↑ +31% |
| Aetna | All Products First Health | $1,242.00 | ↑ +38% |
| OPTUM | Managed Medicaid | $1,292.16 | ↑ +44% |
| MOLINA | Florida KidCare | $1,360.17 | ↑ +52% |
| AMERIHEALTH | Managed Medicaid | $1,360.17 | ↑ +52% |
| Carelon BH Strategies | Managed Medicaid | $1,360.17 | ↑ +52% |
| Molina | Florida Kidcare | $1,360.17 | ↑ +52% |
| SUNSHINE HEALTH | Managed Medicaid | $1,360.17 | ↑ +52% |
| Cigna | Individual Family Plan Physician | $1,380.00 | ↑ +54% |
| Cigna | Individual Family Plan Mid-Level | $1,380.00 | ↑ +54% |
| Cigna | All Products Physician | $1,380.00 | ↑ +54% |
| Cigna | All Products Mid-Level | $1,380.00 | ↑ +54% |
| Cigna | Surefit Physician | $1,380.00 | ↑ +54% |
| Cigna | Surefit Mid-Level | $1,380.00 | ↑ +54% |
| MOLINA | Managed Medicaid | $1,428.18 | ↑ +59% |
| AETNA | Managed Medicaid/CHIP | $1,496.19 | ↑ +67% |
| Independent Living Systems | Managed Medicaid | $1,632.20 | ↑ +82% |
| HUMANA | Medicare Advantage HMO | $3,255.33 | ↑ +263% |
| Careplus | MEDICARE ADVANTAGE | $3,255.33 | ↑ +263% |
| Carelon BH Strategies | MEDICARE ADVANTAGE | $3,255.33 | ↑ +263% |
| BLUE CROSS | Medicare Advantage PPO | $3,255.33 | ↑ +263% |
| BLUE CROSS | Medicare Advantage HMO | $3,255.33 | ↑ +263% |
| UNITED | MEDICARE ADVANTAGE | $3,255.33 | ↑ +263% |
| Freedom Health | MEDICARE ADVANTAGE | $3,255.33 | ↑ +263% |
| AVMED | MEDICARE ADVANTAGE | $3,385.54 | ↑ +277% |
| Independent Living Systems | MEDICARE ADVANTAGE | $3,418.10 | ↑ +281% |
| AETNA | MEDICARE ADVANTAGE | $3,462.26 | ↑ +286% |
| WellMed | MEDICARE ADVANTAGE | $3,462.26 | ↑ +286% |
| Wellcare | MEDICARE ADVANTAGE | $3,462.26 | ↑ +286% |
| DEVOTED HEALTH | Medicare Advantage HMO | $3,808.49 | ↑ +325% |
| AVMED | EXCHANGE | $5,110.87 | ↑ +470% |
| AVMED | Select | $5,729.38 | ↑ +539% |
| AVMED | BROAD | $7,454.70 | ↑ +731% |
| AETNA | ALL PRODUCTS | $8,724.00 | ↑ +873% |
| Aetna | All Products Anesthesia | not published by hospital | — |
| Aetna | All Products PCP | not published by hospital | — |
| Value Options | All Products | not published by hospital | — |
| Aetna | Medical Rental | not published by hospital | — |
| Magellan | Summit | not published by hospital | — |
| Aetna | All Products Specialist | not published by hospital | — |
| Aetna | All Products Behavioral Health | not published by hospital | — |
| Magellan | Pinnacle | not published by hospital | — |
Visitor-reported prices
Comments
Tonsillectomy (age 12+) at other Florida hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Adventhealth Tampa | Tampa | $33,427.05 | $758.00 – $7,686.23 |
| cleveland clinic florida weston hospital | Weston | $897.00 | $193.48 – $3,808.49 |
| martin north hospital | Stuart | $897.00 | $199.66 – $3,808.49 |
| AdventHealth Orlando | Orlando | $11,581.00 | $3,462.26 – $9,175.00 |
| Adventhealth Riverview | Riverview | $33,427.05 | not published |
| Adventhealth Wesley Chapel | Wesley Chapel | $33,427.05 | $3,462.26 – $7,686.23 |
| Adventhealth Zephyrhills | Zephyrhills | $33,427.05 | not published |
| Adventhealth Carrollwood | Tampa | $33,427.05 | $758.00 – $7,686.23 |