Speech therapy (language evaluation)
Facility: Hiawatha Community Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $396
- Cash Discount Price: $508
- vs. Medicare Baseline: 5.20x 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 520% of the Medicare baseline (a markup of 420%). 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 | $74 - $78 | 97% |
| Aetna | $188 - $410 | 247% |
| UnitedHealthcare | $188 - $436 | 247% |
| Humana | $190 | 250% |
| Ambetter / Centene | $226 | 297% |
| Oscar - All Plans | $381 | 500% |
| Centrus Health Direct - All Plans | $381 | 500% |
| Preferred Hlth - All Plans | $457 | 600% |
| Cigna | $483 | 634% |
| Wppa Providrs Care - All Plans | $483 | 634% |
| Multiplan - All Plans | $493 | 647% |
| Midlands Choice - All Plans | $493 | 647% |
| Healthy Blue Mcaid - All Plans | $508 | 667% |
Consumer Guidance & Cost Commentary
For the speech therapy language evaluation (CPT 92507) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $508.00, which matches the facility's gross charge and the cash median. This rate is significantly higher than the state average, reflecting the facility's status as a Critical Access Hospital with a voluntary non-profit ownership structure. While commercial payers negotiate rates ranging from $74 to $508, the cash price remains the baseline for self-pay patients. It is important to note that for patients with high-deductible plans, paying the cash price of $508.00 upfront may be more cost-effective than relying on insurance, as many commercial negotiated rates exceed the cash amount due to administrative overhead and contract structures.
To ensure you are receiving the best possible rate, we recommend requesting an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, patients should inquire about prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full within 30 days, bypassing the costly insurance claims cycle. While the Medicare benchmark for this service is $76.15, commercial rates often average 200% to 300% of this amount; however, fair pricing is typically defined as 120% to 150% of Medicare, suggesting that the negotiated rates for some payers may be higher than necessary. Always verify your deductible status and ask for self-pay or prompt-pay classification prior to scheduling to avoid unexpected balance billing or inflated charges.