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Lumbar Derotation Pad for TLSO (Low Profile)

Maine rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $55$1200%20%10th90th$100Professionalmedian $56 · 10th–90th $42$830%20%10th90th$56$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$52.48
Typical High
$57.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$128.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$70.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$100.00
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$53.70
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$27.54
Median
$54.95
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$83.18
Typical High
$83.18