CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Saint Michael's Medical Center

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $123
Cash Discount Price: $84
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Saint Michael's Medical Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 1.62x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$84

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$76.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $76.15 (100%)

Cash / Self-Pay: $84 (110%)

Insurance Median: $123 (162%)

Cash: $84 (110% of Medicare)

Ins. Median: $123 (162% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Tricare	$67	88%
Horizon	$82 - $247	108%
Aetna	$84 - $178	110%
Amerihealth	$84	110%
Humana	$84	110%
Medicare (plans)	$84	110%
New Jersey Out of State	$84	110%
UnitedHealthcare	$84 - $499	110%
Wellpoint Amerigroup	$84	110%
Clover Health	$87	114%
Wellcare	$87 - $114	114%
Curana	$88	116%
Fairprice Healthcare Holdings - Fphh	$101	133%
Employer Direct Healthcare	$118	155%
Naphcare	$130	171%
Cigna	$158	207%
Coventry	$168	221%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $84.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 92507.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Saint Michael's Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 92507.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.