12480_SUP — Plate Custom Infant Lcb 30mm 18 Hole
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). PLATE CUSTOM INFANT LCB 30MM 18 HOLE (CDM 12480_SUP) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/12480_SUP?code_type=CDM
MLA (9th ed.)
“PLATE CUSTOM INFANT LCB 30MM 18 HOLE (CDM 12480_SUP) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/12480_SUP?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“PLATE CUSTOM INFANT LCB 30MM 18 HOLE (CDM 12480_SUP) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/12480_SUP?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $7,940–$12,452 (25th–75th percentile) across 1 hospital · 34 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 12480_SUP — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
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 |
|---|---|---|---|---|---|---|---|
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | PARKLAND COMM MCAID - ALL PLANS | PARKLAND COMM MCAID - ALL PLANS | $4,511.50 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | PARKLAND COMM MEDICAID-ALL PLANS | PARKLAND COMM MEDICAID-ALL PLANS | $4,511.50 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC MCAID | UHC MCAID | $5,919.09 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC MCAID | UHC MCAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COMMUNITY FIRST HEALTH PLAN-ALL PLANS | COMMUNITY FIRST HEALTH PLAN-ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA MEDICAID | MOLINA MEDICAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS MEDICAID | BCBS MEDICAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AMERIGROUP MEDICAID-ALL PLANS | AMERIGROUP MEDICAID-ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SOONERCARE-ALL PLANS | SOONERCARE-ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CHILDREN MED CENTER HEALTH PLAN - ALL PLANS | CHILDREN MED CENTER HEALTH PLAN - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COOK CHILDRENS HP-ALL PLANS | COOK CHILDRENS HP-ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | DRISCOLL CHILDRENS-ALL PLANS | DRISCOLL CHILDRENS-ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA COMMERCIAL - ALL OTHER PLANS | MOLINA COMMERCIAL - ALL OTHER PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT & WHITE MEDICAID | SCOTT & WHITE MEDICAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA MCAID - ALL PLANS | MOLINA MCAID - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS MCAID | BCBS MCAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AMERIGROUP MCAID - ALL PLANS | AMERIGROUP MCAID - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA MCAID | AETNA MCAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CHILDRENS MED CENTER HP - ALL PLANS | CHILDRENS MED CENTER HP - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COMMUNITY FIRST HP - ALL PLANS | COMMUNITY FIRST HP - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SOONERCARE MCAID - ALL PLANS | SOONERCARE MCAID - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COOK CHILDRENS HP CHIP/STAR - ALL PLANS | COOK CHILDRENS HP CHIP/STAR - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT & WHITE MCAID | SCOTT & WHITE MCAID | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | DIRSCOLL CHILDRENS STAR - ALL PLANS | DIRSCOLL CHILDRENS STAR - ALL PLANS | $7,940.24 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA MEDICAID | AETNA MEDICAID | $8,178.45 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TX CHILDRENS HLTH MCAID - ALL PLANS | TX CHILDRENS HLTH MCAID - ALL PLANS | $9,023.00 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TX CHILDRENS HLTH MCAID-ALL PLANS | TX CHILDRENS HLTH MCAID-ALL PLANS | $9,023.00 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM FRISCO OP ONLY | AETNA COMM FRISCO OP ONLY | $10,466.68 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM OP ONLY - ALL OTHER PLANS | AETNA COMM OP ONLY - ALL OTHER PLANS | $10,466.68 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS BAV | BCBS BAV | $10,466.68 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS BAV | BCBS BAV | $10,466.68 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM - ALL OTHER PLANS | AETNA COMM - ALL OTHER PLANS | $11,729.90 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH MCAID | FIRSTCARE HEALTH MCAID | $11,729.90 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC COMM - ALL OTHER PLANS | UHC COMM - ALL OTHER PLANS | $11,729.90 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC COMM - ALL OTHER PLANS | UHC COMM - ALL OTHER PLANS | $11,729.90 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH MCAID | FIRSTCARE HEALTH MCAID | $11,729.90 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS HMO | BCBS HMO | $12,451.74 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS HMO | BCBS HMO | $12,451.74 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TRICARE - ALL PLANS | TRICARE - ALL PLANS | $12,632.20 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | $12,632.20 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | TRICARE OP ONLY - ALL PLANS | TRICARE OP ONLY - ALL PLANS | $12,632.20 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | FIRSTCARE HEALTH COMM - ALL OTHER PLANS | $12,632.20 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS PPO AND TRAD - ALL OTHER PLANS | BCBS PPO AND TRAD - ALL OTHER PLANS | $13,173.58 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | BCBS PPO/TRAD - ALL OTHER PLANS | BCBS PPO/TRAD - ALL OTHER PLANS | $13,173.58 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | HEALTHSCOPE - ALL PLANS | HEALTHSCOPE - ALL PLANS | $13,534.50 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT AND WHITE HP - ALL OTHER PLANS | SCOTT AND WHITE HP - ALL OTHER PLANS | $13,534.50 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SCOTT & WHITE COMM- ALL OTHER PLANS | SCOTT & WHITE COMM- ALL OTHER PLANS | $13,534.50 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | HEALTHSCOPE - ALL PLANS | HEALTHSCOPE - ALL PLANS | $13,534.50 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $14,436.80 | $18,046.00 | $18,046.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $14,436.80 | $18,046.00 | $18,046.00 | 2026-04-23 | MRF ↗ |