CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Astria Toppenish Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $177
Cash Discount Price: $300
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Astria Toppenish Hospital is $177. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $300. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 2.32x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$300

Average discount available for prompt cash payment at this facility.

Insurance Median

$177

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: $300 (394%)

Insurance Median: $177 (232%)

Cash: $300 (394% of Medicare)

Ins. Median: $177 (232% 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 232% of the Medicare baseline (a markup of 132%). 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
Ambetter / Centene	$45	59%
Medicaid / KanCare	$45 - $135	59%
Medicare (plans)	$45 - $388	59%
UnitedHealthcare	$45 - $388	59%
Va	$45	59%
Molina	$46	60%
Molina_Exchange	$58	76%
Li	$76	100%
Aetna	$78 - $414	102%
Cigna	$78	102%
Humana	$78 - $470	102%
Tricare	$78	102%
Zenith	$78	102%
Regence	$153 - $159	201%
Premera	$170 - $177	223%
Premera_Affordable_Care	$170 - $177	223%
Chpw_Cascade_Care	$285 - $296	374%
Kaiser	$299	393%
First_Choice	$312 - $324	410%
Tpsc	$353 - $367	464%
Bcchp	$452 - $470	594%
Great_Rivers	$452 - $470	594%
Healthcomp	$452 - $470	594%
Washington_State_Hca	$452 - $470	594%

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 $300.
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 Astria Toppenish Hospital 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.