go back

Lumbar Derotation Pad for TLSO (Low Profile)

Michigan rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $295 · 10th–90th $63$3630%20%10th90th$295Professionalmedian $63 · 10th–90th $46$1100%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
$63.10
Median
$295.12
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$53.70
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$331.13
Typical High
$630.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$109.65
Typical High
$114.82
CareSource
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$63.10
Typical High
$107.15
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$208.93
Typical High
$234.42
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$87.10
Typical High
$134.90
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$91.20
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$89.13
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$51.29
Typical High
$74.13