Speech therapy (language evaluation)
Facility: Susan B Allen Memorial Hospital
Billing Code: 92507 (CPT)
- CPT Billing Code: 92507
- Insurance Median: $554
- Cash Discount Price: $156
- vs. Medicare Baseline: 7.28x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 728% of the Medicare baseline (a markup of 628%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 460% |
| Providrs Care | $757 | 994% |
Consumer Guidance & Cost Commentary
For this speech therapy evaluation at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash price of $156 is notably lower than the state average, which sits at $240. While commercial insurance plans like UnitedHealthcare and Providrs Care have negotiated rates of $350 and $757 respectively, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rates can be significantly higher than the self-pay amount. To maximize savings, it is recommended to verify the facility's "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
When evaluating the facility's pricing against federal benchmarks, the Medicare amount for this service is $76.15, which serves as a reliable baseline for assessing fair value. The facility's cash rate of $156 represents approximately 103% of the Medicare amount, aligning closely with the typical range of 120% to 150% considered fair for commercial pricing. It is important to note that the median negotiated rate of $554 provided in the data reflects a broader average across payers and may not apply to every individual plan. Consumers should avoid comparing these rates to the hospital's full chargemaster list, as those figures are inflated to make discounts appear larger; instead, focusing on the Medicare benchmark provides a clearer picture of the actual cost of care.