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Lumbar Derotation Pad for TLSO (Low Profile)

Washington, DC rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $40 · 10th–90th $40$1410%50%90th$40Professionalmedian $40 · 10th–90th $40$520%50%90th$40$50.0$100.0

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$45.71
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$67.61
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
$67.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$48.98
Typical High
$93.33