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Lumbar Derotation Pad for TLSO (Low Profile)

Oregon rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $87 · 10th–90th $71$930%50%10th90th$87Professionalmedian $71 · 10th–90th $44$1050%10%20%10th90th$71$0.1$1.0$10.0$100.0$1.0K

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
Professional
Modifier
Global
Typical Low
$39.81
Median
$52.48
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$45.71
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$194.98
Typical High
$234.42
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$95.50
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$75.86
Typical High
$104.71
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$91.20
Typical High
$93.33
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$93.33
Typical High
$102.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$79.43
Typical High
$117.49
Providence
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$81.28
Typical High
$100.00
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$97.72
Typical High
$363.08
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$104.71
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$48.98
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$43.65
Typical High
$83.18