CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Harlem Hospital Center

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $217
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.85x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Harlem Hospital Center is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 2.85x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$217

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%)

Insurance Median: $217 (285%)

Ins. Median: $217 (285% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 285% of the Medicare baseline (a markup of 185%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$53 - $192	70%
Healthfirst	$67 - $391	88%
Wellcare	$90	118%
Fidelis	$121 - $391	159%
Metroplus	$161 - $391	211%
Amidacare	$174	228%
Blue Cross Blue Shield	$174 - $391	228%
Carelon	$174 - $308	228%
Senior Whole Health	$174	228%
United	$174 - $284	228%
United Behavioral Health	$174 - $191	228%
Affinity	$177 - $391	232%
Carelon (Amida Care)	$177	232%
Vnsny	$177 - $403	232%
Villagecare Max	$209	274%
Emblem	$213 - $235	280%
Oxford	$236 - $265	310%
Centerlight	$237	311%
Cigna	$241	316%
Oscar	$251	330%
Elderplan	$308	404%
Magnacare	$356	467%
Multiplan	$379	498%
Local 1199	$403	529%

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 $X.
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 Harlem Hospital 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.