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Lumbar Derotation Pad for TLSO (Low Profile)

Utah rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $44 · 10th–90th $28$870%20%40%10th90th$44Professionalmedian $54 · 10th–90th $28$5010%10%20%10th90th$54$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
$28.18
Median
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$42.66
Typical High
$501.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$64.57
Typical High
$83.18
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$87.10
Typical High
$87.10
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$63.10
Typical High
$104.71
Select Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Select Health
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$89.13
Typical High
$95.50
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$89.13
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$48.98
Typical High
$79.43
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$43.65
Typical High
$66.07