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Lumbar Derotation Pad for TLSO (Low Profile)

Nebraska 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?

$57.54

Typical negotiated rate. In Nebraska, October 2026.

Insurers have agreed to pay about $57.54 for this service. The price depends on where it is billed: about $52.48 from a physician practice, and about $97.72 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$52.48$43.65 to $95.50
FacilityA hospital or hospital-owned outpatient department$97.72$95.50 to $97.72

How much rates vary

Facilitymedian $98 · 10th to 90th $59 to $468Professionalmedian $52 · 10th to 90th $33 to $132
$50$100$200$500facility $98professional $52

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
Facility
Modifier
None
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
Aetna
Setting
Professional
Modifier
None
Typical Low
$52.48
Median
$56.23
Typical High
$75.86
Cigna
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$97.72
Typical High
$97.72
Cigna
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$109.65
Typical High
$186.21
Medica
Setting
Facility
Modifier
None
Typical Low
$56.23
Median
$97.72
Typical High
$467.74
Medica
Setting
Professional
Modifier
None
Typical Low
$33.11
Median
$43.65
Typical High
$69.18
Midlands
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$186.21
Midlands
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Midlands
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$186.21
Typical High
$239.88
United
Setting
Facility
Modifier
None
Typical Low
$56.23
Median
$100.00
Typical High
$100.00
United
Setting
Professional
Modifier
None
Typical Low
$31.62
Median
$43.65
Typical High
$66.07
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$26.30
Median
$28.18
Typical High
$38.02
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$10.47
Median
$11.48
Typical High
$15.14
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$7.94
Median
$8.51
Typical High
$11.22
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$5.25
Median
$5.75
Typical High
$7.59

Where Nebraska 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.

Nebraska· 27th of 51

$57.54

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.