HCPCS L0621

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

Current code32 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Unknown: The source file doesn't say which population this rate applies to.

Prices for HCPCS L0621 by hospital
HospitalUnknown rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$17.20 – $241$43.00 – $603
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$17.20 – $241$43.00 – $603
Harborview Medical CenterSeattleFile dated 2026-04-01—$29.28$41.83
Island HospitalAnacortes$115 – $1212 plans——
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$98.70$141
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$17.20 – $241$43.00 – $603
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$17.20 – $241$43.00 – $603
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$17.20 – $241$43.00 – $603
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$17.20 – $241$43.00 – $603
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$17.20 – $241$43.00 – $603
Olympic Medical CenterPort AngelesFile dated 2026-06-24———
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01———
PeaceHealth St Joseph Medical CenterBellingham—$170$262
PeaceHealth United General Medical CenterSedro Woolley—$148$228
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$212$303
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$125$240
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$212$303
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$200$285
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$133$255
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$200$285
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$126$180
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$125$240
Seattle Children's HospitalSeattle$42.01 – $1505 plans$167$167
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$82.08 – $92.75$171 – $193
Swedish IssaquahIssaquahFile dated 2026-04-01—$82.08 – $92.75$171 – $193
Swedish Medical CenterSeattleFile dated 2026-04-01—$82.08 – $92.75$171 – $193
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$82.08 – $92.75$171 – $193
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$17.20 – $241$43.00 – $603
University of Washington Medical CtrSeattleFile dated 2026-04-01—$209$298
Virginia Mason Medical CenterSeattle———
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27———
Yakima Valley MemorialYakimaFile dated 2026-08-27—$17.20 – $156$43.00 – $391

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Equipment fee, Washington
$33.70 (fee)