CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Virginia Gay Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $160
Cash Discount Price: $192
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Virginia Gay Hospital is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $192. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 2.10x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$192

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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: $192 (252%)

Insurance Median: $160 (210%)

Cash: $192 (252% of Medicare)

Ins. Median: $160 (210% 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 210% of the Medicare baseline (a markup of 110%). 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
Medicaid / KanCare	$73 - $105	96%
UnitedHealthcare	$81 - $116	106%
Va Ccn-All Plans	$88 - $90	116%
Health Alliance Mcr Adv	$92 - $95	121%
Aetna	$100	131%
Wellmark Hmo	$129	169%
Wellmark Ppo-All Other Plans	$142	186%
Medical Associates-All Plans	$178 - $183	234%
Cedar Valley Community Healthcare-All Plans	$187 - $192	246%
Humana	$190 - $195	250%
Health Partners-All Plans	$201 - $207	264%
Healthsmart-All Plans	$201 - $207	264%
Corvel-All Plans	$220 - $227	289%
Health Alliance-All Other Plans	$225 - $232	295%

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 $192.
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 Virginia Gay Hospital 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.