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Lumbar Derotation Pad for TLSO (Low Profile)

Georgia rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $52$4170%10%20%10th90th$112Professionalmedian $63 · 10th–90th $46$1070%20%10th90th$63$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
$257.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$54.95
Typical High
$95.50
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$102.33
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$269.15
Typical High
$416.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$91.20
Typical High
$138.04
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$134.90
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$112.20
Typical High
$169.82
United
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$43.65
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$107.15