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Tonsillectomy (child under 12) at indian river hospital
1000 36th Street, Vero Beach, FL · Cleveland Clinic · · NPI 1376512988
not published by hospital
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.
not published by hospital
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.
$1,292.16 with OPTUM vs $13,598.07 with AVMED — 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 | $1,292.16 | — |
| AMERIHEALTH | Managed Medicaid | $1,360.17 | — |
| Carelon BH Strategies | Managed Medicaid | $1,360.17 | — |
| MOLINA | Florida KidCare | $1,360.17 | — |
| Medicaid | Managed Medicaid | $1,360.17 | — |
| Molina | Florida Kidcare | $1,360.17 | — |
| SUNSHINE HEALTH | Managed Medicaid | $1,360.17 | — |
| Wellcare | Managed Medicaid | $1,360.17 | — |
| MOLINA | Managed Medicaid | $1,428.18 | — |
| AETNA | Managed Medicaid/CHIP | $1,496.19 | — |
| Independent Living Systems | Managed Medicaid | $1,632.20 | — |
| BLUE CROSS | Medicare Advantage HMO | $5,938.02 | — |
| BLUE CROSS | Medicare Advantage PPO | $5,938.02 | — |
| Carelon BH Strategies | MEDICARE ADVANTAGE | $5,938.02 | — |
| Careplus | MEDICARE ADVANTAGE | $5,938.02 | — |
| Freedom Health | MEDICARE ADVANTAGE | $5,938.02 | — |
| HUMANA | Medicare Advantage HMO | $5,938.02 | — |
| UNITED | MEDICARE ADVANTAGE | $5,938.02 | — |
| AVMED | MEDICARE ADVANTAGE | $6,175.54 | — |
| AETNA | MEDICARE ADVANTAGE | $6,181.95 | — |
| WellMed | MEDICARE ADVANTAGE | $6,181.95 | — |
| Wellcare | MEDICARE ADVANTAGE | $6,181.95 | — |
| Independent Living Systems | MEDICARE ADVANTAGE | $6,234.92 | — |
| DEVOTED HEALTH | Medicare Advantage HMO | $6,800.15 | — |
| AVMED | EXCHANGE | $9,322.69 | — |
| AVMED | Select | $10,450.92 | — |
| AVMED | BROAD | $13,598.07 | — |
Visitor-reported prices
Comments
Tonsillectomy (child under 12) at other Florida hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic florida weston hospital | Weston | $912.60 | $170.32 – $6,800.15 |
| martin north hospital | Stuart | $912.60 | $192.51 – $6,800.15 |
| Baptist Hospital | MIAMI | not published | not published |