Speech therapy (language evaluation)
Facility: Holton Community Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $168
- Cash Discount Price: $152
- vs. Medicare Baseline: 2.21x 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 221% of the Medicare baseline (a markup of 121%). 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 | $77 | 101% |
| UnitedHealthcare | $100 - $203 | 131% |
| Aetna | $108 - $203 | 142% |
| Humana | $109 | 143% |
| Kansas Superior Select - All Plans | $110 | 144% |
| Preferred Health Freedom | $168 | 221% |
| Preferred Health Fn Select - All Other Plans | $168 | 221% |
| Preferred Health Professionals | $168 | 221% |
| Wppa Providers - All Plans | $193 | 253% |
| Medicaid / KanCare | $203 | 267% |
Consumer Guidance & Cost Commentary
For the speech therapy language evaluation (CPT 92507) at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $152.00, which is notably lower than the negotiated rates commercial insurers typically pay. While the facility's negotiated rate of $168.00 aligns with the state average for this service, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $152.00. It is important to note that insurance plans often pay higher amounts due to administrative costs and contract structures, meaning the cash price can sometimes represent a better financial option for those who have not yet met their deductible or are paying out-of-pocket.
The facility's negotiated rate of $168.00 is consistent with the median negotiated amount across payers, though it remains below the gross charge of $203.00. This service is provided by a Critical Access Hospital, a facility type often subject to specific federal pricing rules that can influence rates. To ensure you are receiving the most favorable pricing, we recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, since over 80% of hospital bills contain errors, we strongly advise requesting a detailed, itemized bill before making any payment to verify that all charges are accurate and that no services were unbundled or double-billed.