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Lumbar Derotation Pad for TLSO (Low Profile)

New Jersey rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $33 · 10th–90th $30$890%20%40%10th90th$33Professionalmedian $52 · 10th–90th $35$890%10%10th90th$52$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
$30.20
Median
$30.20
Typical High
$30.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$45.71
Typical High
$58.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$63.10
Typical High
$89.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$117.49
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$58.88
Typical High
$89.13
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$50.12
Typical High
$89.13