CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $104
  • Cash Discount Price: $450
  • vs. Medicare Baseline: 0.77x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Cleveland Clinic Indian River Hospital is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $450. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.77x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.
Cash / Self-Pay
$450

Average discount available for prompt cash payment at this facility.

Insurance Median
$104

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $450 (332%)
Insurance Median: $104 (77%)
Cash: $450 (332% of Medicare)
Ins. Median: $104 (77% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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.

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 $51 - $743 38%
UnitedHealthcare $51 38%
Avmed $52 - $145 38%
Amerihealth $53 39%
Cigna $53 - $113 39%
Medicaid / KanCare $53 39%
Molina $53 39%
Value Options $53 - $97 39%
Wellcare $53 - $97 39%
Magellan $54 - $130 40%
Blue Cross Blue Shield $70 - $97 52%
Careplus $97 72%
United $97 - $119 72%
Freedom Health $102 75%
Independent Living Systems $102 75%
Wellmed $102 75%
Clear Spring Health $105 - $135 77%
Bmi $119 88%
Clarity Health $141 - $537 104%
The Legacy Companies $141 - $537 104%
Multiplan $174 128%
National Provider Network $484 - $578 357%
Three Rivers $484 - $578 357%
Consociate Health $519 - $620 383%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 36Th St, Vero Beach, FL 32960
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals