CMS Price Transparency Data

Ultrasound, pelvis

Facility: Graham Regional Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $200
Cash Discount Price: $273
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Graham Regional Medical Center is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $273. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.87x the Medicare baseline. Located in 1301 Montgomery Road, Graham, TX.

Cash / Self-Pay

$273

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $273 (256%)

Insurance Median: $200 (187%)

Cash: $273 (256% of Medicare)

Ins. Median: $200 (187% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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	$65 - $200	61%
Choicecare Network	$65 - $200	61%
Superior Healthplan	$65 - $200	61%
Wellpoint	$87 - $270	81%
Aetna	$140 - $434	131%
Cigna	$140 - $434	131%
Blue Cross Blue Shield	$147 - $500	138%
Three Rivers Provider Network	$184 - $567	172%
Health Advantage Network	$194 - $600	182%
Healthsmart Preferred Care	$194 - $600	182%
UnitedHealthcare	$208 - $416	195%
Curative	$378 - $1,167	354%

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 $273.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

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 76856.
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.