Speech therapy (language evaluation)
Facility: Amberwell Atchison Association
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $260
- Cash Discount Price: $508
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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% |
| Superior Select Mcr Adv - All Plans | $168 | 221% |
| UnitedHealthcare | $168 - $911 | 221% |
| Va Ccn - All Plans | $168 | 221% |
| Triwest - All Plans | $168 | 221% |
| Humana | $168 - $229 | 221% |
| Ambetter / Centene | $260 | 341% |
| Aetna | $279 | 366% |
| Cigna | $279 | 366% |
| Oscar - All Plans | $381 | 500% |
| Centrus Health Direct - All Plans | $381 | 500% |
| Multiplan - All Plans | $396 | 520% |
| Wppa Providrs Care - All Plans | $457 | 600% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Amberwell Atchison Association, the cash price is $508.00, which matches the facility's median negotiated rate of $260.00 and the cash median of $508.00. While the facility is a Critical Access Hospital in Atchison, KS, the data does not provide specific county or state average figures for comparison. It is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures; however, in this specific case, the cash price is significantly higher than the median negotiated rate of $260.00. Patients with high-deductible plans or those who have not yet met their out-of-pocket maximum may find paying the cash price of $508.00 more cost-effective than relying on insurance, which could result in higher allowed amounts or deductibles.
Patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, if you are using insurance, be aware of the No Surprises Act, which prohibits balance billing for out-of-network providers at in-network facilities, and always demand a full itemized CPT-coded bill rather than accepting a summary invoice. Since Medicare rates for this service are $76.15, the commercial cash price represents a significant markup compared to the federal benchmark. To ensure you are not overcharged, verify your plan's allowed amount and confirm that the facility has applied any applicable prompt-pay discounts prior to payment.