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Lumbar Derotation Pad for TLSO (Low Profile)

Arizona rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $31$2450%10%10th90th$100Professionalmedian $49 · 10th–90th $40$1230%20%40%10th90th$49$0.1$0.5$2.0$10.0$50.0$200.0

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
$39.81
Median
$48.98
Typical High
$67.61
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$91.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$131.83
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$117.49
Typical High
$245.47
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
$63.10
Medica
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$77.62
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$43.65
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$95.50
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$43.65
Typical High
$66.07