12300102 (CDM) — raw rate rows

CDM · raw rates

12300102 — Bundle Scs Intellissensor MRI

Per-row negotiated rates, exactly as filed by each hospital. Aggregated views below summarize across hospitals; the bottom table shows the underlying rows.

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Typical negotiated price $62,086

Usually $10,950–$82,125 (25th–75th percentile) across 3 hospitals · 7 payers.

“Negotiated” is the hospital’s negotiated facility rate for this CDM 12300102 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.

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This estimate runs on the hospital’s facility charge only. The surgeon’s and anesthesiologist’s fees are billed separately and aren’t in this number — your EOB shows your complete total.

Uninsured estimates use the cash / self-pay median for this code: $109,500.

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Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.

Hospital rates (per row)

Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.

Hospital	Payer	Plan	Negotiated rate	Gross	Cash	Observed	Source
ANDERSON HOSPITAL InpatientFacility	—	—	—	$35.90	$17.95	2026-02-06	MRF ↗
COMMUNITY HOSPITAL OF STAUNTON InpatientFacility	—	—	—	$35.90	$17.95	2026-02-09	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	Great-West Healthcare	HMO	$10,950.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	The First Health Network	Commercial	$16,425.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	United Healthcare of Texas	Commercial	$62,086.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	Managed Care	PPO	$76,650.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	Cigna	PPO	$82,125.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	USA Managed Care Organization	PPO	$93,075.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗
HILL REGIONAL HOSPITAL Outpatient	Aetna	Commercial	$93,075.00	$109,500.00	$109,500.00	2025-11-06	MRF ↗