Cleveland Clinic Indian River Hospital
1000 36Th St, Vero Beach, FL 32960 · 140 Priced Procedures · 58% Patient Recommendation
Typical commercial prices here are 13% below the fair benchmark (0.87×) after accounting for local nurse/doctor wages and patient complexity.
2-Star CMS clinical quality rating paired with 0.87× fair market pricing.
Uniform Value Leader · Low-Cost Across Departments
Cleveland Clinic Indian River Hospital maintains low, disciplined commercial pricing across both routine shoppable procedures (0.8× Medicare, p50 0.91× Fair BaseRate) and emergency/ancillary services (1.0× Medicare, p75 0.98× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 13% below peer Fair BaseRate (0.87×)
- Self-pay cash beats commercial insurance on 28% of shoppable procedures (99/100 Cash Honesty)
- 4-Star CMS clinical rating with 58% patient recommendation (58/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (18.5% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (0.87× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (1.7×) & laboratory (0.8×) services average 1.25× higher multiples than routine shoppable care (0.8×)
- Even at low-cost facilities (0.87× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Consolidated metro market (HHI 6,829) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Cleveland Clinic Indian River Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 140 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Spinal fusion, single level (inpatient stay) MS-DRG Code: 451 | $25,398 | 0.8× |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $19,339 | 1.0× |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $17,656 | 0.9× |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $16,190 | 0.9× |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $7,258 | 0.9× |
| Bunion correction surgery CPT Code: 28296 | $3,686 | 1.1× |
| C-section delivery (full package) CPT Code: 59510 | $2,847 | 1.0× |
| Total hip replacement CPT Code: 27130 | $2,627 | 0.2× |
| Vaginal delivery (full package) CPT Code: 59400 | $2,533 | 0.9× |
| Total knee replacement CPT Code: 27447 | $2,402 | 0.2× |
| Cataract surgery with lens implant CPT Code: 66984 | $2,289 | 0.9× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,831 | 0.3× |
| Inguinal hernia repair CPT Code: 49505 | $1,735 | 0.5× |
| Trauma team activation HCPCS Code: G0390 | $1,387 | 1.0× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $839 | 0.8× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $854 | 0.3× |
| Injection procedure for pain management HCPCS Code: G0260 | $730 | 0.9× |
| Breast lump removal CPT Code: 19120 | $755 | 0.2× |
| Upper endoscopy with biopsy CPT Code: 43239 | $615 | 0.6× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $609 | 0.6× |
| Colonoscopy with biopsy CPT Code: 45380 | $633 | 0.5× |
| Rabies immune globulin HCPCS Code: 90375 | $532 | 1.7× |
| Hospital observation (per hour) HCPCS Code: G0378 | $464 | unverified |
| Residential mental health treatment HCPCS Code: H2036 | $383 | 0.9× |
| Psychological testing by technician CPT Code: 96138 | $394 | unverified |
Audit a Bill or Quote at Cleveland Clinic Indian River Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $11,289
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (18.5% of gross = $11,289).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Cleveland Clinic Indian River Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)
Your bill ($60,955) is $30,180 above the denoised Fair BaseRate ($30,775) and 2.6× the $23,504 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (18.5% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (1,745 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Cleveland Clinic Indian River Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.