go back

Lumbar Derotation Pad for TLSO (Low Profile)

South Carolina rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $63 · 10th–90th $49$1350%20%10th90th$63Professionalmedian $55 · 10th–90th $40$950%20%10th90th$55$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$54.95
Typical High
$95.50
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$102.33
Typical High
$112.20
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$102.33
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$63.10
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$125.89
Medcost
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$58.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$75.86
Typical High
$169.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$27.54
Typical High
$28.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$54.95
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$69.18