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Lumbar Derotation Pad for TLSO (Low Profile)

Pennsylvania rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $120 · 10th–90th $40$4680%20%10th90th$120Professionalmedian $47 · 10th–90th $40$980%50%10th90th$47$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
$39.81
Median
$39.81
Typical High
$154.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$45.71
Typical High
$72.44
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
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
$63.10
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$117.49
Typical High
$169.82
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$64.57
Typical High
$100.00
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$39.81
Typical High
$446.68
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$67.61
Typical High
$72.44
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$70.79
Typical High
$275.42
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$46.77
Typical High
$75.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$346.74
Typical High
$562.34
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$93.33
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$48.98
Typical High
$102.33