Flexible pelvic and sacral support brace, prefabricated at Methodist Hospital

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
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Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

SAN ANTONIO, TX

See all hospitals reporting HCPCS L0621 →

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How this price compares nationally

Methodist Hospital’s median price of $76 is 4% below the median hospital's median price ($79), higher than 39% of the 1,116 hospitals reporting HCPCS L0621. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS L0621 at Methodist Hospital

Negotiated rates from the hospital’s own file: 11 payers, 36 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	First Health chip percent of total billed charges · outpatientfrom % of charges	$49	$49	—	—	—	$49 – $49
2	First Health chipperinate percent of total billed charges · outpatientfrom % of charges	$49	$49	—	—	—	$49 – $49
3	First Health mcdstar percent of total billed charges · outpatientfrom % of charges	$49	$49	—	—	—	$49 – $49
4	Blue Cross Blue Shield mgmcrhmo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
5	Blue Cross Blue Shield mgmcrpos fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
6	Blue Cross Blue Shield mgmcrppo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
7	Devoted dualeligible fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
8	Devoted mcrhmo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
9	Devoted mcrpffs fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
10	Devoted mcrpos fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
11	Devoted mcrppo fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
12	Devoted mcrsnp fee schedule · outpatient	$72	$72	—	—	—	$72 – $72
13	Aetna mcr fee schedule · outpatient	$73	$73	—	—	—	$73 – $73
14	UnitedHealthcare mcr fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
15	WellCare mcrhmo fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
16	WellCare mcrpos fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
17	WellCare mcrppo fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
18	WellCare mcrsnp fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
19	WellCare pffs fee schedule · outpatient	$74	$74	—	—	—	$74 – $74
20	Clover mcr fee schedule · outpatient	$76	$76	—	—	—	$76 – $76
21	UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges	$102	$102	—	—	—	$102 – $102
22	Molina mcr fee schedule · outpatient	$115	$115	—	—	—	$115 – $115
23	Molina mme-mmp fee schedule · outpatient	$115	$115	—	—	—	$115 – $115
24	Blue Cross Blue Shield mybluehealth percent of total billed charges · outpatientfrom % of charges	$118	$118	—	—	—	$118 – $118
25	Cigna comm percent of total billed charges · outpatientfrom % of charges	$118	$118	—	—	—	$118 – $118

Page 1 of 2 · 36 rates

Last updated: May 1, 2026

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