CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: Stoughton Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $248
Cash Discount Price: $221
vs. Medicare Baseline: 3.26x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at Stoughton Hospital is $248. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 3.26x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$248

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: $221 (290%)

Insurance Median: $248 (326%)

Cash: $221 (290% of Medicare)

Ins. Median: $248 (326% 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 326% of the Medicare baseline (a markup of 226%). 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
Tricare	$96	126%
Healthnet Mcr Adv - All Plans	$107	141%
Dean Health Insurance Med Adv	$113	148%
Humana	$113 - $362	148%
Quartz Mcr Adv	$113	148%
Security Health/First Health - All Plans	$113	148%
Aetna	$121 - $342	159%
UnitedHealthcare	$177 - $322	232%
Quartz Health Solutions - All Other Lans	$199	261%
Alliance - All Plans	$233	306%
Dean Health Insurance Epo	$248	326%
Dean Health Insurance Comm - All Other Plans	$301	395%
Geha - All Plans	$302	397%
Cigna	$322	423%
Wisconsin Ppo Ppa Direct - All Plans	$322	423%
Blue Cross Blue Shield	$350	460%
Medicaid / KanCare	$357	469%
Wps - All Plans	$362	475%

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 $221.
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 Stoughton 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.