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Lumbar Derotation Pad for TLSO (Low Profile)

Minnesota rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $191 · 10th–90th $87$8910%20%10th90th$191Professionalmedian $110 · 10th–90th $59$1260%20%40%10th90th$110$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
$75.86
Median
$75.86
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$58.88
Typical High
$75.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$109.65
Typical High
$162.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$109.65
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$416.87
Typical High
$1,148.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$162.18
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$457.09
Typical High
$891.25
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$173.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$109.65
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$45.71
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$0.71
Median
$43.65
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$54.95
Typical High
$151.36