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Lumbar Derotation Pad for TLSO (Low Profile)

California rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $51 · 10th–90th $40$2290%20%10th90th$51Professionalmedian $52 · 10th–90th $41$5010%20%10th90th$52$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$501.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$52.48
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$229.09
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$53.70
Typical High
$131.83
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$204.17
Typical High
$288.40
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$112.20
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$60.26
Typical High
$141.25
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$190.55
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$660.69
Typical High
$660.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$95.50
Typical High
$141.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$91.20
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$66.07
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$43.65
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$52.48
Typical High
$123.03