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Tonsillectomy (child under 12) at fairview hospital
18101 Lorain Avenue, Cleveland, OH · Cleveland Clinic · · NPI 1215989611
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.
$1,175.43 with OPTUM vs $16,154.41 with ANTHEM — 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 Transplant | $1,175.43 | — |
| Paramount | Managed Medicaid | $1,274.41 | — |
| ANTHEM | Managed Medicaid | $1,299.15 | — |
| Buckeye | Managed Medicaid | $1,299.15 | — |
| MOLINA | Managed Medicaid | $1,299.15 | — |
| United BH | Managed Medicaid | $1,311.53 | — |
| CARESOURCE | Managed Medicaid | $1,323.90 | — |
| UNITED | Managed Medicaid | $1,323.90 | — |
| AMERIHEALTH | Managed Medicaid | $1,361.02 | — |
| HUMANA | Medicare Advantage HMO | $5,080.55 | — |
| MMO | Medicare Advantage HMO | $5,484.05 | — |
| OPTUM | All Products VA | $5,484.05 | — |
| OPTUM | Medicare Advantage Transplant | $5,484.05 | — |
| The Health Plan | MEDICARE ADVANTAGE | $5,484.05 | — |
| UNITED | MEDICARE ADVANTAGE | $5,484.05 | — |
| AETNA | MEDICARE ADVANTAGE | $5,600.62 | — |
| ANTHEM | MEDICARE ADVANTAGE | $5,600.62 | — |
| DEVOTED HEALTH | MEDICARE ADVANTAGE | $5,600.62 | — |
| Summacare | MEDICARE ADVANTAGE | $5,600.62 | — |
| UPMC | MEDICARE ADVANTAGE | $5,600.62 | — |
| Valor | HMO & PPO | $5,600.62 | — |
| MMO | Medicare Advantage PPO | $5,648.58 | — |
| CIGNA | MEDICARE ADVANTAGE | $5,768.63 | — |
| CommuniCare | MEDICARE ADVANTAGE | $5,880.65 | — |
| Perennial Health | MEDICARE ADVANTAGE | $5,922.78 | — |
| Perennial Health | HMO I-SNP and HMO C-SNP | $6,048.66 | — |
| PPHP | ALL PRODUCTS | $6,160.68 | — |
| Zing Health | Medicare Advantage | $6,160.68 | — |
| ANTHEM | HPN | $13,731.03 | — |
| MMO | ALL PRODUCTS | $15,401.69 | — |
| ANTHEM | PPO/HMO | $16,154.41 | — |
Visitor-reported prices
Comments
Tonsillectomy (child under 12) at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $912.60 | $1.10 – $5,600.62 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland | not published | $1,993.83 – $2,308.65 |
| lutheran hospital | Cleveland | not published | $1,119.04 – $6,160.68 |
| akron general | Akron | $912.60 | $1.10 – $5,903.23 |
| mercy hospital | Canton | $912.60 | $1.10 – $5,768.63 |
| avon hospital | Avon | not published | $1,221.23 – $6,160.68 |
| euclid hospital | Euclid | not published | $1,251.18 – $6,160.68 |
| hillcrest hospital | Mayfield Heights | not published | $1,224.61 – $6,160.68 |