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Lumbar Derotation Pad for TLSO (Low Profile)

Tennessee 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 $44$5620%20%10th90th$87Professionalmedian $52 · 10th–90th $44$930%20%40%10th90th$52$0.1$0.5$2.0$10.0$50.0$200.0

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
$50.12
Median
$53.70
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$50.12
Typical High
$93.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$87.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$72.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$660.69
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$51.29
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$51.29
Typical High
$66.07