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Lumbar Derotation Pad for TLSO (Low Profile)

Ohio rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $59$1740%20%40%10th90th$112Professionalmedian $59 · 10th–90th $46$1150%20%40%10th90th$59$0.1$0.5$2.0$10.0$50.0$200.0

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
$58.88
Median
$67.61
Typical High
$104.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$58.88
Typical High
$63.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$117.49
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$64.57
Typical High
$144.54
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$100.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$93.33
Typical High
$131.83
CareSource
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$100.00
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$69.18
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$66.07
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$64.57
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$66.07
Typical High
$95.50
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$125.89
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$89.13
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$51.29
Typical High
$70.79