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Lumbar Derotation Pad for TLSO (Low Profile)

Rhode Island rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $158 · 10th–90th $55$2190%10%20%10th90th$158Professionalmedian $52 · 10th–90th $42$660%20%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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$45.71
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$190.55
Typical High
$218.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$61.66
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$45.71
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$53.70
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$79.43