Speech therapy (language evaluation)
Facility: Clara Barton Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $299
- Cash Discount Price: $235
- vs. Medicare Baseline: 3.93x 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 393% of the Medicare baseline (a markup of 293%). 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% |
| 6 Degrees Health - All Plans | $232 - $238 | 305% |
| Wppa-All Plans | $266 - $272 | 349% |
| Phcs - All Plans | $299 - $306 | 393% |
| Aetna | $299 - $306 | 393% |
| UnitedHealthcare | $299 - $306 | 393% |
| Hlth Partners Of Ks-All Plans | $305 - $313 | 401% |
Consumer Guidance & Cost Commentary
For the speech therapy language evaluation service (CPT 92507) at Clara Barton Hospital in Hoisington, KS, the cash price of $235.00 is lower than the facility's negotiated rates, which range from $232.00 to $313.00 depending on the insurance plan. While the median negotiated amount paid by insurers is $299.00, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is significantly below the insurer's allowed amount. It is important to note that this facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated rate by their insurance carrier.
When evaluating this cost, it is essential to compare the facility's pricing against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this service is $76.15, and the facility's cash price of $235.00 represents a markup of 3.9 times the Medicare rate. Although the facility's rating is 2, the pricing data indicates that the cash price is the most transparent figure for consumers, as commercial negotiated rates often include administrative overhead that inflates the baseline price. To avoid unexpected balance billing or errors, patients should request a full itemized CPT-coded bill before paying, ensuring that no unbundled codes or services not rendered are included in the final invoice.