healthcosts.net
Total Knee Replacement at indian river hospital
1000 36th Street, Vero Beach, FL · Cleveland Clinic · · NPI 1376512988
$5,096.00
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.
$7,840.00
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.
$992.70 with Value Options vs $29,576.40 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 |
|---|---|---|---|
| Value Options | Managed Medicaid | $992.70 | ↓ -81% |
| Medicaid | Managed Medicaid | $992.70 | ↓ -81% |
| Molina | Managed Medicaid | $992.70 | ↓ -81% |
| Wellcare | Managed Medicaid | $992.70 | ↓ -81% |
| AmeriHealth | Managed Medicaid | $992.70 | ↓ -81% |
| Optum | Managed Medicaid | $1,166.61 | ↓ -77% |
| Avmed | Medicare Advantage | $1,279.21 | ↓ -75% |
| Value Options | Medicare Advantage | $1,279.21 | ↓ -75% |
| Magellan | Medicare Advantage | $1,279.21 | ↓ -75% |
| Careplus | Medicare Advantage | $1,279.21 | ↓ -75% |
| Wellcare | Medicare Advantage | $1,279.21 | ↓ -75% |
| Blue Cross | Medicare Advantage PPO | $1,279.21 | ↓ -75% |
| Blue Cross | Medicare Advantage HMO | $1,279.21 | ↓ -75% |
| Independent Living Systems | Medicare Advantage | $1,343.17 | ↓ -74% |
| Freedom Health | Medicare Advantage | $1,343.17 | ↓ -74% |
| WellMed | Medicare Advantage | $1,343.17 | ↓ -74% |
| United | Medicare Advantage | $1,355.77 | ↓ -73% |
| Clear Spring Health | All Products | $1,381.55 | ↓ -73% |
| Blue Cross | Health Options | $1,452.11 | ↓ -72% |
| Blue Cross | Network Blue | $1,487.82 | ↓ -71% |
| Blue Cross | Traditional (PPS) | $1,523.53 | ↓ -70% |
| Blue Cross | Perferred Patient Care | $1,523.53 | ↓ -70% |
| Aetna | Medicare Advantage Behavioral Health | $1,535.05 | ↓ -70% |
| Aetna | Medicare Advantage PCP | $1,586.22 | ↓ -69% |
| Aetna | Medicare Advantage Specialist | $1,611.80 | ↓ -68% |
| Avmed | Exchange | $1,801.38 | ↓ -65% |
| Avmed | Select | $1,870.67 | ↓ -63% |
| Avmed | Broad | $2,009.24 | ↓ -61% |
| Aetna | PPO First Health | $2,181.77 | ↓ -57% |
| United | All Products | $2,621.85 | ↓ -49% |
| Aetna | POS First Health | $3,528.00 | ↓ -31% |
| Clarity Health | All Products | $5,096.00 | ↑ +0% |
| Three Rivers | All Products | $5,096.00 | ↑ +0% |
| The Legacy Companies | All Products | $5,096.00 | ↑ +0% |
| OPTUM | Managed Medicaid | $5,660.06 | ↑ +11% |
| Consociate Health | ALL PRODUCTS | $5,880.00 | ↑ +15% |
| MOLINA | Florida KidCare | $5,957.96 | ↑ +17% |
| AMERIHEALTH | Managed Medicaid | $5,957.96 | ↑ +17% |
| Molina | Florida Kidcare | $5,957.96 | ↑ +17% |
| SUNSHINE HEALTH | Managed Medicaid | $5,957.96 | ↑ +17% |
| Carelon BH Strategies | Managed Medicaid | $5,957.96 | ↑ +17% |
| MOLINA | Managed Medicaid | $6,255.86 | ↑ +23% |
| AETNA | Managed Medicaid/CHIP | $6,553.76 | ↑ +29% |
| National Provider Network | All Products | $6,664.00 | ↑ +31% |
| Aetna | All Products First Health | $7,056.00 | ↑ +38% |
| Independent Living Systems | Managed Medicaid | $7,149.55 | ↑ +40% |
| Cigna | Individual Family Plan Mid-Level | $7,840.00 | ↑ +54% |
| Cigna | Surefit Physician | $7,840.00 | ↑ +54% |
| Cigna | All Products Physician | $7,840.00 | ↑ +54% |
| Cigna | All Products Mid-Level | $7,840.00 | ↑ +54% |
| Cigna | Individual Family Plan Physician | $7,840.00 | ↑ +54% |
| Cigna | Surefit Mid-Level | $7,840.00 | ↑ +54% |
| AETNA | ALL PRODUCTS | $10,786.00 | ↑ +112% |
| UNITED | MEDICARE ADVANTAGE | $12,915.46 | ↑ +153% |
| Carelon BH Strategies | MEDICARE ADVANTAGE | $12,915.46 | ↑ +153% |
| Careplus | MEDICARE ADVANTAGE | $12,915.46 | ↑ +153% |
| Freedom Health | MEDICARE ADVANTAGE | $12,915.46 | ↑ +153% |
| BLUE CROSS | Medicare Advantage HMO | $12,915.46 | ↑ +153% |
| HUMANA | Medicare Advantage HMO | $12,915.46 | ↑ +153% |
| BLUE CROSS | Medicare Advantage PPO | $12,915.46 | ↑ +153% |
| Wellcare | MEDICARE ADVANTAGE | $13,407.17 | ↑ +163% |
| AETNA | MEDICARE ADVANTAGE | $13,407.17 | ↑ +163% |
| WellMed | MEDICARE ADVANTAGE | $13,407.17 | ↑ +163% |
| AVMED | MEDICARE ADVANTAGE | $13,432.07 | ↑ +164% |
| Independent Living Systems | MEDICARE ADVANTAGE | $13,561.23 | ↑ +166% |
| DEVOTED HEALTH | Medicare Advantage HMO | $14,747.88 | ↑ +189% |
| UNITED | ALL PRODUCTS | $18,361.00 | ↑ +260% |
| AVMED | EXCHANGE | $20,277.27 | ↑ +298% |
| AVMED | Select | $22,731.20 | ↑ +346% |
| AVMED | BROAD | $29,576.40 | ↑ +480% |
| Magellan | Pinnacle | not published by hospital | — |
| Aetna | Medical Rental | not published by hospital | — |
| Aetna | All Products Behavioral Health | not published by hospital | — |
| Magellan | Summit | not published by hospital | — |
| Aetna | All Products Anesthesia | not published by hospital | — |
| Aetna | All Products PCP | not published by hospital | — |
| Aetna | All Products Specialist | not published by hospital | — |
| Value Options | All Products | not published by hospital | — |
Visitor-reported prices
Comments
Total Knee Replacement at other Florida hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic florida weston hospital | Weston | $5,096.00 | $992.70 – $14,747.88 |
| martin north hospital | Stuart | $5,096.00 | $992.70 – $14,747.88 |
| Bethesda Hospital East | BOYNTON BEACH | not published | not published |
| Boca Raton Regional Hospital | BOCA RATON | not published | not published |
| Doctors Hospital | CORAL GABLES | not published | not published |
| Baptist Health Hospital Doral | SOUTH MIAMI | not published | not published |
| Homestead Hospital | HOMESTEAD | not published | not published |
| Mariners Hospital | TAVERNIER | not published | not published |