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Lumbar Derotation Pad for TLSO (Low Profile)

New York rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $56 · 10th–90th $38$1740%10%20%10th90th$56Professionalmedian $54 · 10th–90th $38$1320%20%40%10th90th$54$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$30.20
Median
$56.23
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$46.77
Typical High
$63.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$181.97
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$151.36
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$74.13
Typical High
$74.13
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$69.18
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$147.91
Typical High
$346.74
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$89.13
Typical High
$169.82
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$47.86
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$52.48
Typical High
$56.23
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$87.10
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$58.88
Typical High
$147.91
Univera
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$52.48
Typical High
$54.95
Univera
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$52.48
Typical High
$56.23