CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Graham Regional Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $64
Cash Discount Price: $95
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Graham Regional Medical Center is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.47x the Medicare baseline. Located in 1301 Montgomery Road, Graham, TX.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $95 (70%)

Insurance Median: $64 (47%)

Cash: $95 (70% of Medicare)

Ins. Median: $64 (47% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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.

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
Amerigroup	$15 - $103	11%
Choicecare Network	$15 - $103	11%
Superior Healthplan	$15 - $103	11%
Wellpoint	$20 - $139	15%
Curative	$30 - $206	22%
Aetna	$33 - $224	24%
Cigna	$33 - $224	24%
Blue Cross Blue Shield	$34 - $258	25%
Three Rivers Provider Network	$43 - $292	32%
Health Advantage Network	$45 - $310	33%
Healthsmart Preferred Care	$45 - $310	33%
UnitedHealthcare	$1,910	1409%

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 $95.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Graham Regional Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.