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Lumbar Derotation Pad for TLSO (Low Profile)

Hawaii rates for HCPCS L1240

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

Rates data updated October 2026.

How much does Lumbar Derotation Pad for TLSO (Low Profile) cost?

$148

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $148 for this service. Most negotiated rates run $100 to $155.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $115 · 10th to 90th $63 to $115Professionalmedian $148 · 10th to 90th $91 to $158
$100facility $115professional $148

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$114.82
Typical High
$114.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
HMSA
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$147.91
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$147.91
Typical High
$190.55
United
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$158.49
Typical High
$158.49
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20

Where Hawaii sits

The same service costs 3.2 times more in Hawaii than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 1st of 51

$148

HI $148NJ $45.71

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.