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Lumbar Derotation Pad for TLSO (Low Profile)

Texas rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $76 · 10th–90th $43$2510%10%20%10th90th$76Professionalmedian $45 · 10th–90th $40$630%50%10th90th$45$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$42.66
Median
$50.12
Typical High
$109.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$45.71
Typical High
$63.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
Baylor Scott & White
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$95.50
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$72.44
Typical High
$95.50
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$95.50
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
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$75.86
Typical High
$125.89
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$91.20
Typical High
$95.50
Molina
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$61.66
Providence
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$72.44
Typical High
$125.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$77.62
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$63.10
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$95.50
Typical High
$128.82