Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
SO FLEXIBLE PREFAB
Low
$0
Average
$292
Median
$99
High
$2.0k
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 58 hospitals; the 90th percentile is 80891.4× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Northwest Sahurita Hospital LLC Tucson, AZ | $88 | $104 | $35 | 34% | — | $41 – $201 |
| 2 | Northwest Sahurita Hospital LLC Sahuarita, AZ | $88 | $104 | $35 | 34% | — | $41 – $201 |
| 3 | Oro Valley Hospital LLC Tucson, AZ | $88 | $95 | $38 | 39% | — | $31 – $275 |
| 4 | Northwest Hospital LLC Tucson, AZ | $88 | $98 | $34 | 35% | — | $46 – $275 |
| 5 | Roswell Hospital Corporation Roswell, NM | $128 | $102 | $43 | 43% | — | $20 – $261 |
| 6 | Spring Valley Hospital Medical Center Las Vegas, NV | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 7 | Valley Health Speciality Hospital Las Vegas, NV | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 8 | Summerlin Hospital Medical Center Las Vegas, NV | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 9 | West Henderson Hospital Henderson, NV | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 10 | Henderson Hospital Henderson, NV | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
Ask Claude or any MCP client for HCPCS L0621 pricing at a specific hospital — see how to connect.