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Lumbar Derotation Pad for TLSO (Low Profile)

Montana rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $59$1100%20%10th90th$85Professionalmedian $76 · 10th–90th $34$1660%10%20%10th90th$76$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$57.54
Typical High
$501.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$91.20
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$91.20
Typical High
$91.20
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$85.11
Typical High
$165.96
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$85.11
Typical High
$165.96
Providence
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$81.28
Typical High
$120.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$79.43
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$54.95
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$43.65
Typical High
$66.07