CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Tomah Memorial Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $343
Cash Discount Price: $232
vs. Medicare Baseline: 4.50x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Tomah Memorial Hospital is $343. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $232. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 4.50x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$232

Average discount available for prompt cash payment at this facility.

Insurance Median

$343

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: $232 (305%)

Insurance Median: $343 (450%)

Cash: $232 (305% of Medicare)

Ins. Median: $343 (450% 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 450% of the Medicare baseline (a markup of 350%). 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
Blue Cross Blue Shield	$137 - $474	180%
Group Hlth Mcr Adv - All Plans	$137	180%
Humana	$137 - $373	180%
Independent Care Mcr - All Other Plans	$137	180%
Quartz Mcr Adv	$137	180%
Security Hp Mcr Adv	$137	180%
UnitedHealthcare	$137 - $380	180%
Va Ccn - All Plans	$137	180%
Aetna	$262 - $343	344%
Cigna	$307 - $391	403%
Security Hp Comm - All Other Plans	$343	450%
Quartz Comm - All Other Plans	$363	477%
The Alliance - All Plans	$375	492%
Independent Care Mcaid	$474	622%
Managed Hlth Mcaid - All Plans	$474	622%
Quartz Mcaid	$474	622%
Security Hp Mcaid	$474	622%

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 $232.
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 Tomah 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.