Speech therapy (language evaluation)
Facility: Nmc Health
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $159
- Cash Discount Price: $176
- vs. Medicare Baseline: 2.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 209% of the Medicare baseline (a markup of 109%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $58 | 76% |
| Bluestem Pace | $73 | 96% |
| Blue Cross Blue Shield | $78 | 102% |
| Medicaid / KanCare | $117 | 154% |
| Leading Age | $117 | 154% |
| Wppa | $125 - $142 | 164% |
| Occunet | $136 - $155 | 179% |
| Samaritan Ministries International | $148 - $168 | 194% |
| Medincrease Health Plan | $148 - $168 | 194% |
| Prime Health Services | $170 - $194 | 223% |
| UnitedHealthcare | $204 - $233 | 268% |
| Cigna | $216 - $246 | 284% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Nmc Health in Newton, KS, the facility's cash price of $176.00 is notably lower than the state average, which sits at $251.00. While the facility's negotiated rates with major insurers like UnitedHealthcare and Cigna range from $204 to $246, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. To secure this lower amount, patients should request a "self-pay" classification and ask specifically about "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative claim processing fees.
The facility's rate of $176.00 also compares favorably against the Medicare benchmark of $76.15, indicating a markup that is higher than the typical fair pricing range of 120% to 150% of Medicare. However, because the cash price is still significantly lower than the gross charges and many commercial negotiated rates, it remains the most cost-effective option for self-pay patients. If you receive a bill from an out-of-network provider or encounter unexpected charges, remember that the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities; always request a detailed, itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included.