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Lumbar Derotation Pad for TLSO (Low Profile)

Washington rates for HCPCS L1240

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

Rates data updated July 2026.

Facilitymedian $93 · 10th–90th $63$2040%20%10th90th$93Professionalmedian $78 · 10th–90th $46$1740%10%10th90th$78$1.0$5.0$20.0$100.0$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
$63.10
Median
$128.82
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$63.10
Typical High
$501.19
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$91.20
Typical High
$93.33
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$104.71
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$128.82
Typical High
$269.15
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$109.65
Typical High
$204.17
Molina
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$72.44
Typical High
$79.43
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$91.20
Typical High
$93.33
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$93.33
Typical High
$97.72
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$138.04
Typical High
$186.21
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$91.20
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$93.33
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$120.23
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$51.29
Typical High
$83.18
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$81.28
Typical High
$144.54