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Lumbar Derotation Pad for TLSO (Low Profile)

Alaska rates for HCPCS L1240

Addition to thoracic-lumbar-sacral orthosis (TLSO), (low profile), lumbar derotation pad

Rates data updated July 2026.

Facilitymedian $52 · 10th–90th $28$1320%20%40%10th90th$52Professionalmedian $66 · 10th–90th $46$1860%10%20%10th90th$66$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$52.48
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$158.49
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$79.43
Typical High
$131.83
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$138.04
Typical High
$288.40
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$131.83
Typical High
$138.04
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$131.83
Typical High
$138.04
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$28.18
Typical High
$120.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$63.10
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$54.95
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$67.61
Typical High
$338.84