CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Adventist Health St Helena

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $447
Cash Discount Price: $149
vs. Medicare Baseline: 5.87x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Adventist Health St Helena is $447. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $149. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 5.87x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$149

Average discount available for prompt cash payment at this facility.

Insurance Median

$447

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$76.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $76.15 (100%)

Cash / Self-Pay: $149 (196%)

Insurance Median: $447 (587%)

Cash: $149 (196% of Medicare)

Ins. Median: $447 (587% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $76.15 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 587% of the Medicare baseline (a markup of 487%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Va Medi-Cal	$81	106%
Blue Shield Bh Mcr Adv	$89	117%
Blue Shield Mcr Adv	$89	117%
Kaiser Mcr Adv	$89	117%
Tricare	$89	117%
UnitedHealthcare	$89 - $634	117%
Va Mcr - All Other Plans	$89	117%
Ah Employee Health Plan - All Plans	$160	210%
Blue Shield Epn-All Other Plans	$286	376%
Aetna	$292	383%
Blue Shield Non-Epn	$294	386%
Western Growers-All Plans	$297	390%
Blue Cross Blue Shield	$332 - $447	436%
Blue Shield Behav Hlth	$448	588%
Phcs-All Plans	$547	718%
Healthnet-All Plans	$610	801%
Interplan-All Plans	$647	850%
Choicecare-All Plans	$696	914%
Beech Street-All Plans	$746	980%
Cigna	$796	1045%
Kaiser-All Other Plans	$816	1072%
Health Management Network-All Plans	$846	1111%
Galaxy Network-All Plans	$896	1177%
Three Rivers-All Plans	$896	1177%

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 $149.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 92507.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 92507.
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.