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Lumbar Derotation Pad for TLSO (Low Profile)

Idaho rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $89 · 10th–90th $50$1200%20%40%10th90th$89Professionalmedian $63 · 10th–90th $40$1050%10%20%10th90th$63$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
$56.23
Typical High
$81.28
BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$151.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$72.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.18
Median
$81.28
Typical High
$112.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$95.50
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$81.28
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$91.20
Typical High
$91.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$104.71
Select Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$95.50
Typical High
$144.54
Select Health
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$91.20
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$50.12
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$43.65
Typical High
$63.10