CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Fort Memorial Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $233
Cash Discount Price: $107
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Fort Memorial Hospital is $233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 3.06x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$107

Average discount available for prompt cash payment at this facility.

Insurance Median

$233

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: $107 (141%)

Insurance Median: $233 (306%)

Cash: $107 (141% of Medicare)

Ins. Median: $233 (306% 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 306% of the Medicare baseline (a markup of 206%). 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
Humana	$75 - $235	98%
Molina	$76	100%
UnitedHealthcare	$98 - $250	129%
Blue Cross Blue Shield	$116 - $271	152%
Dean Health Plan	$116 - $216	152%
Medicaid / KanCare	$116	152%
Quartz	$116 - $778	152%
Veteran Evaluation Services	$123	162%
Managed Health Services	$126	165%
Aetna	$133 - $247	175%
Group Health Cooperative	$213 - $343	280%
Alliance	$236	310%
Fort Care	$236	310%
Mercycare	$245	322%
Centivo	$288 - $300	378%
Trilogy	$290	381%
Cigna	$313	411%

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 $107.
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 Fort Memorial 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.