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Lumbar Derotation Pad for TLSO (Low Profile)

Indiana 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$1170%50%10th90th$112Professionalmedian $54 · 10th–90th $46$810%50%10th90th$54$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
$53.70
Median
$53.70
Typical High
$53.70
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$53.70
Typical High
$72.44
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$112.20
Typical High
$141.25
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$53.70
Typical High
$100.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$144.54
Typical High
$165.96
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
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$58.88
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$52.48
Typical High
$77.62