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
Sio flex pelvic/sacr pre ots
Devils Lake, ND
See all hospitals reporting HCPCS L0621 →Price type
Altru Hospital Devils Lake’s median price of $89 is 13% above the median hospital's median price ($79), higher than 62% of the 1,118 hospitals reporting HCPCS L0621. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Medica medicaid managed care plan facility · fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 2 | Medica medicaid managed care plan – hmo facility · fee schedule · outpatient | $25 | $25 | — | — | — | $25 – $25 |
| 3 | Medica medicare managed care plan facility · fee schedule · outpatient | $45 | $45 | — | — | — | $45 – $45 |
| 4 | Medica all commercial plans facility · fee schedule · outpatient | $73 | $73 | — | — | — | $73 – $73 |
| 5 | Aetna medicare managed care plan facility · fee schedule · outpatient | $75 | $75 | — | — | — | $75 – $75 |
| 6 | Blue Cross Blue Shield all commercial plans facility · fee schedule · outpatient | $89 | $89 | — | — | — | $89 – $89 |
| 7 | Blue Cross Blue Shield medicaid managed care plan facility · fee schedule · outpatient | $89 | $89 | — | — | — | $89 – $89 |
| 8 | Sanford Health Plan all commercial plans facility · fee schedule · outpatient | $103 | $103 | $15 | 15% | — | $88 – $118 |
| 9 | Aetna all commercial plans facility · fee schedule · outpatient | $107 | $107 | $28 | 26% | — | $79 – $135 |
| 10 | UnitedHealthcare all commercial plans facility · fee schedule · outpatient | $147 | $147 | — | — | — | $147 – $147 |
Last updated: Mar 1, 2026
See Flexible pelvic and sacral support brace, prefabricated pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.