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Lumbar Derotation Pad for TLSO (Low Profile)

Missouri rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $71 · 10th–90th $46$1480%20%10th90th$71Professionalmedian $52 · 10th–90th $43$1050%20%10th90th$52$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
$45.71
Median
$45.71
Typical High
$52.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$48.98
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$67.61
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$309.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$53.70
Typical High
$83.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Medica
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$70.79
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$43.65
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$89.13
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$43.65
Typical High
$79.43