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Lumbar Derotation Pad for TLSO (Low Profile)

Illinois 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 $56$5620%20%10th90th$112Professionalmedian $63 · 10th–90th $46$1120%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
$56.23
Median
$56.23
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$56.23
Typical High
$112.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$213.80
Typical High
$758.58
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$85.11
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$74.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$112.20
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$154.88
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$141.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$83.18
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$89.13
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$54.95
Typical High
$91.20