Speech therapy (language evaluation)
Facility: Scott County Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $185
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.43x 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 243% of the Medicare baseline (a markup of 143%). 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 |
|---|---|---|
| UnitedHealthcare | $77 - $196 | 101% |
| Blue Cross Blue Shield | $78 | 102% |
| Humana | $87 | 114% |
| Wppa | $124 - $1,200 | 163% |
| Aetna | $185 | 243% |
Consumer Guidance & Cost Commentary
For the speech therapy language evaluation (CPT 92507) at Scott County Hospital in Scott City, KS, the facility's negotiated rates range from $77 to $1,200 depending on the insurance plan, with a median negotiated amount of $185. This commercial rate is significantly higher than the Medicare benchmark of $76.15, reflecting the typical markup found in private insurance contracts where administrative costs and provider work are bundled into a single payment. While the facility is a voluntary non-profit Critical Access Hospital, patients should be aware that their specific plan's negotiated rate may vary widely; for instance, UnitedHealthcare plans pay a median of $77 to $196, whereas WPPA plans can reach up to $1,200. Because commercial rates often exceed cash prices due to these administrative layers, individuals with high-deductible plans might find it financially advantageous to pay the cash price directly, provided they confirm the availability of a self-pay or prompt-pay discount before scheduling.
To ensure you are receiving the most accurate pricing, it is essential to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital charges contain errors such as unbundled codes or services not rendered. Before finalizing any payment, verify your deductible status, as paying the full negotiated rate without meeting your out-of-pocket threshold can result in unexpected financial strain. If you choose to pay out-of-network or self-pay, remember that the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities, but you must proactively sign a waiver of insurance submission to secure prompt-pay discounts that bypass costly claims processing