CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $97
Cash Discount Price: $375
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Cleveland Clinic Indian River Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $375. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.83x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$375

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $375 (319%)

Insurance Median: $97 (83%)

Cash: $375 (319% of Medicare)

Ins. Median: $97 (83% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$38 - $619	32%
Avmed	$39 - $124	33%
Cigna	$39 - $113	33%
Magellan	$54 - $123	46%
Blue Cross Blue Shield	$69 - $83	59%
UnitedHealthcare	$82	70%
Careplus	$83	71%
United	$83 - $116	71%
Value Options	$83 - $86	71%
Wellcare	$83 - $86	71%
Amerihealth	$86	73%
Medicaid / KanCare	$86	73%
Molina	$86	73%
Freedom Health	$87	74%
Independent Living Systems	$87	74%
Wellmed	$87	74%
Bmi	$89	76%
Clear Spring Health	$90 - $113	77%
Clarity Health	$105 - $447	89%
The Legacy Companies	$105 - $447	89%
Multiplan	$130	111%
National Provider Network	$404 - $482	344%
Three Rivers	$404 - $482	344%
Consociate Health	$433 - $516	368%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $375.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Cleveland Clinic Indian River Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.