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Lumbar Derotation Pad for TLSO (Low Profile)

Iowa rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $76 · 10th–90th $44$2450%10%20%10th90th$76Professionalmedian $59 · 10th–90th $40$1150%20%10th90th$59$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
Facility
Modifier
Global
Typical Low
$43.65
Median
$63.10
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$56.23
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$97.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$125.89
Typical High
$158.49
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$114.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$114.82
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$56.23
Typical High
$147.91
Midlands
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$102.33
Typical High
$134.90
Midlands
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Midlands
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$147.91
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$72.44
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$46.77
Typical High
$107.15
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$87.10