Speech therapy (language evaluation)
Facility: Decatur Health
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $191
- Cash Discount Price: $225
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $100 | 131% |
| Wppa/Providrs Care- All Plans | $150 | 197% |
| UnitedHealthcare | $152 - $191 | 200% |
| Humana | $154 | 202% |
| Midlands Choice- All Plans | $225 | 295% |
| Aetna | $225 - $250 | 295% |
| Medicaid / KanCare | $252 | 331% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Decatur Health in Oberlin, KS, the facility's cash price of $225 is lower than the negotiated rates paid by most major insurers, ranging from $150 to $250. While the state average for this service is not explicitly listed, the facility's cash rate aligns closely with the cash median of $225 and sits below the highest negotiated rates, such as the $250 cap for Aetna. Patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated amounts often exceed the cash rate. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill if settled upfront.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare benchmark of $76.15 for this code. The facility's cash price of $225 represents a significant discount compared to the gross charge of $250 and the median negotiated rate of $191 across payers. If you receive a bill from an out-of-network provider at this facility, the No Surprises Act generally protects you from balance billing for emergency care and non-emergency services, though you should dispute any unexpected charges in writing rather than paying immediately. Always request a detailed, itemized bill to ensure no unbundled codes or services not rendered are included before finalizing payment.