Speech therapy (language evaluation)
Facility: Girard Medical Center
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $52
- Cash Discount Price: $89
- vs. Medicare Baseline: 0.68x 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 |
|---|---|---|
| Kansas Superior Select-All Plans | $52 | 68% |
| UnitedHealthcare | $52 - $142 | 68% |
| Humana | $52 | 68% |
| Aetna | $52 - $261 | 68% |
| Medicare (plans) | $52 | 68% |
| Ambetter / Centene | $52 | 68% |
| Blue Cross Blue Shield | $52 - $78 | 68% |
| Multiplan-All Plans | $138 | 181% |
| Uhhis-All Plans | $142 | 186% |
Consumer Guidance & Cost Commentary
For the speech therapy language evaluation service (CPT 92507) at Girard Medical Center in Girard, KS, the facility's cash median rate is $89.00, which is lower than the negotiated rates paid by most insurance plans. While the facility is a Critical Access Hospital with government ownership, commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $52 to $261, often exceeding the cash price. This pricing structure highlights a common billing dynamic where cash-pay can be more cost-effective for patients with high-deductible plans, as the insurance negotiated rate may surpass the cash price. Patients should verify their specific plan's deductible status before scheduling, as paying out-of-pocket might result in lower out-of-pocket costs if their insurance does not cover the full negotiated amount.
To ensure you are not overcharged, it is important to distinguish between the facility's gross charges and the actual amounts billed. The facility's gross charge for this service is $149.00, but the median amount paid by insurers is $52.00, and the Medicare benchmark is $76.15. Since the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should never sign consent waivers that allow providers to bill the full chargemaster rate for emergency or mandatory services. If you receive a bill that exceeds the negotiated or cash rates, request a formal itemized billing audit to identify errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain discrepancies. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20%