CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Adventist Health Clearlake

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $460
Cash Discount Price: $213
vs. Medicare Baseline: 6.04x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Adventist Health Clearlake is $460. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 6.04x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$213

Average discount available for prompt cash payment at this facility.

Insurance Median

$460

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: $213 (280%)

Insurance Median: $460 (604%)

Cash: $213 (280% of Medicare)

Ins. Median: $460 (604% 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 604% of the Medicare baseline (a markup of 504%). 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
Bc Managed Mcal	$81	106%
Medi-Cal	$81	106%
Blue Shield Mcr Adv	$124	163%
Kaiser Mcr Adv	$124	163%
Tricare	$124	163%
Blue Cross Blue Shield	$129 - $543	169%
UnitedHealthcare	$137 - $494	180%
Ah Employee Health Plan - All Plans	$249	327%
Blue Shield Epn - All Other Plans	$326	428%
Blue Shield Non-Epn	$333	437%
Aetna	$442	580%
Western Growers- All Plans	$444	583%
First Health- All Plans	$474	622%
Healthnet- All Plans	$485	637%
Foundation- All Plans	$503	661%
Health Mgmt Network- All Plans	$503	661%
Humana	$503	661%
Phcs- All Plans	$503	661%
Cigna	$533	700%
Interplan- All Plans	$533	700%
Kaiser- All Other Plans	$533	700%
Three Rivers Provider Network- All Plans	$533	700%
Partnership Mcal - All Plans	$977	1283%

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 $213.
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 Clearlake 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.