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Lumbar Derotation Pad for TLSO (Low Profile)

Virginia rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $48$1260%20%40%10th90th$100Professionalmedian $52 · 10th–90th $40$950%20%40%10th90th$52$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$39.81
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$47.86
Typical High
$58.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$104.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$109.65
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$67.61
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$60.26
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$100.00
Typical High
$138.04
Medcost
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$64.57
Typical High
$97.72
Medcost
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$64.57
Typical High
$117.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$53.70
Typical High
$123.03
Sentara
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$81.28
Typical High
$288.40
Sentara
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$81.28
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$45.71
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$77.62