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Lumbar Derotation Pad for TLSO (Low Profile)

North Dakota rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $63 · 10th–90th $63$1320%50%90th$63Professionalmedian $81 · 10th–90th $52$1070%20%10th90th$81$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
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$63.10
Typical High
$446.68
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$125.89
Typical High
$158.49
Medica
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$87.10
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$43.65
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$66.07
Typical High
$128.82