Speech therapy (language evaluation)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $97
- Cash Discount Price: $86
- vs. Medicare Baseline: 1.27x 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.
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 | $73 - $77 | 96% |
| UnitedHealthcare | $97 - $108 | 127% |
| Providers Care (Wppa)-All Plans | $189 | 248% |
Consumer Guidance & Cost Commentary
For the CPT code 92507, representing a speech therapy language evaluation, the facility's cash median rate is $86.00, while the median negotiated rate for in-network insurance is $97.00. This suggests that for patients with high-deductible plans or those without insurance, paying cash directly may result in a lower out-of-pocket cost compared to using an in-network plan, as the insurance negotiated rate exceeds the cash price. The facility, a Critical Access Hospital in Anthony, KS, lists a gross charge of $108.00, but commercial payers like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $73.00 to $108.00 depending on the specific plan.
To ensure you receive the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills often obscure individual charges and potential errors. Additionally, you should inquire about prompt-pay discounts, which can reduce the total bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. While the data provided does not include specific county or state average comparisons for this procedure, understanding that Medicare benchmarks this service at $76.15 provides a baseline for evaluating the facility's pricing structure and ensuring fair rates are applied.