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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 July 2026.

Facilitymedian $56 · 10th–90th $44$1150%20%10th90th$56Professionalmedian $148 · 10th–90th $30$1550%50%10th90th$148$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
$30.20
Median
$30.20
Typical High
$56.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$114.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$134.90
Typical High
$181.97
HMSA
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$154.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$147.91
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$72.44
Typical High
$181.97