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Lumbar Derotation Pad for TLSO (Low Profile)

Vermont rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $56 · 10th–90th $33$630%20%40%10th90th$56Professionalmedian $54 · 10th–90th $47$710%20%40%10th90th$54$50.0$100.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$56.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$58.88
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$66.07
Typical High
$190.55