Speech therapy (language evaluation)
Facility: Rawlins County Health Center
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $204
- Cash Discount Price: $200
- vs. Medicare Baseline: 2.68x 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 268% of the Medicare baseline (a markup of 168%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $78 | 102% |
| UnitedHealthcare | $204 | 268% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Rawlins County Health Center in Atwood, Kansas, the cash price of $200 is lower than the facility's negotiated rate of $204 and the state average of $204. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the $200 cash price upfront may result in immediate savings compared to having your insurance negotiate a rate that could exceed the cash amount. We recommend asking the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final cost by bypassing the standard insurance claims cycle.
It is important to understand that the $235 gross charge listed represents the full list price before any discounts or insurance negotiations. Under the No Surprises Act, balance billing for out-of-network services at in-network facilities is prohibited, but patients should still verify their network status to avoid unexpected charges. If you receive an itemized bill, ensure it breaks down the specific CPT code 92507 to confirm no unbundled fees or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit. For context, the Medicare benchmark for this service is $76.15, which serves as a baseline for evaluating the facility's pricing markup; the negotiated rate of $204 reflects the commercial pricing structure agreed upon with payers like Blue Cross Blue Shield and UnitedHealthcare, rather than the federal government's fixed reimbursement rate.