go back

Lumbar Derotation Pad for TLSO (Low Profile)

North Carolina rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $95 · 10th–90th $44$1910%10%20%10th90th$95Professionalmedian $85 · 10th–90th $46$1050%50%10th90th$85$0.1$1.0$10.0$100.0$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
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$95.50
Typical High
$104.71
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$102.33
BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$109.65
Typical High
$218.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$63.10
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$69.18
Medcost
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$47.86
Typical High
$64.57
Medcost
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$95.50
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$66.07
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$74.13
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$660.69