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Lumbar Derotation Pad for TLSO (Low Profile)

South Dakota rates for HCPCS L1240

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

Rates data updated July 2026.

How much does Lumbar Derotation Pad for TLSO (Low Profile) cost?

$81.28

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $89.13 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$81.28$60.26 to $115
FacilityA hospital or hospital-owned outpatient department$89.13$72.44 to $100

How much rates vary

Facilitymedian $89 · 10th to 90th $60 to $129Professionalmedian $81 · 10th to 90th $55 to $158
$50$100$200$500facility $89professional $81

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$69.18
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$97.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$158.49
Medica
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$93.33
Typical High
$162.18
Medica
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$63.10
Typical High
$602.56
Midlands
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$95.50
Midlands
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Midlands
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$158.49
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$87.10
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$51.29
Typical High
$72.44
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$66.07
Typical High
$128.82
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10

Where South Dakota sits

The same service costs 3.7 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 10th of 51

$81.28

HI $148DC $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.