Flexible pelvic and sacral support brace, prefabricated

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC Sacroiliac Ortho Pelvic-Sacral Sup Prefab Tier1

Tricare pricing summary

Low

$33

Average

$97

Median

$77

High

$251

Tricare rate distribution

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60 hospital rates

#		Plans
1	Ascension Seton Austin, TX fee schedule · outpatient	1	$89	$89	—	—	—	$89 – $89
2	Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient	1	$74	$74	—	—	—	$74 – $74
3	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient	1	$89	$89	—	—	—	$89 – $89
4	CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient	1	$100	$100	—	—	—	$100 – $100
5	CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient	1	$100	$100	—	—	—	$100 – $100
6	Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient	1	$60	$60	—	—	—	$60 – $60
7	Clarion Hospital Clarion, PA facility · fee schedule · outpatient	1	$89	$89	—	—	—	$89 – $89
8	FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient	1	$77	$77	—	—	—	$77 – $77
9	FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient	1	$77	$77	—	—	—	$77 – $77
10	Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges	1	$159	$159	—	—	—	$159 – $159
11	Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges	1	$149	$149	—	—	—	$149 – $149
12	Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges	1	$129	$129	—	—	—	$129 – $129
13	Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges	1	$109	$109	—	—	—	$109 – $109
14	Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges	1	$243	$243	—	—	—	$243 – $243
15	Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges	1	$178	$178	—	—	—	$178 – $178
16	IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient	1	$49	$49	—	—	—	$49 – $49
17	IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient	1	$49	$49	—	—	—	$49 – $49
18	LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient	1	$100	$100	—	—	—	$100 – $100
19	Lancaster General Health Lancaster, PA facility · fee schedule · outpatient	1	$60	$60	—	—	—	$60 – $60
20	Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient	1	$76	$76	—	—	—	$76 – $76
21	MCLAREN BAY REGION CITY, MI fee schedule	1	$62	$62	—	—	—	$62 – $62
22	MCLAREN CARO REGION CARO, MI fee schedule	1	$176	$176	—	—	—	$176 – $176
23	MCLAREN CENTRAL MICHIGAN PLEASANT, MI fee schedule	1	$56	$56	—	—	—	$56 – $56
24	MCLAREN FLINT FLINT, MI fee schedule	1	$60	$60	—	—	—	$60 – $60
25	MCLAREN GREATER LANSING LANSING, MI fee schedule	1	$59	$59	—	—	—	$59 – $59

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HCPCS L0621