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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 October 2026.

How much does Lumbar Derotation Pad for TLSO (Low Profile) cost?

$89.13

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $89.13 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $91.20 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$85.11$69.18 to $91.20
FacilityA hospital or hospital-owned outpatient department$91.20$89.13 to $5,129

How much rates vary

Facilitymedian $91 · 10th to 90th $68 to $5,129Professionalmedian $85 · 10th to 90th $44 to $98
$50$100$200$500$1K$2K$5Kfacility $91professional $85

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$28.18
Median
$57.54
Typical High
$104.71
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$91.20
Typical High
$91.20
Cigna
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$91.20
Typical High
$91.20
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$112.20
Typical High
$5,248.07
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$97.72
Typical High
$5,495.41
Providence
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$91.20
Typical High
$91.20
Providence
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$79.43
Typical High
$91.20
United
Setting
Professional
Modifier
None
Typical Low
$40.74
Median
$43.65
Typical High
$72.44

Where Montana sits

The same service costs 3.2 times more in Hawaii than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 6th of 51

$89.13

HI $148NJ $45.71

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.