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Lumbar Derotation Pad for TLSO (Low Profile)

Rhode Island 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?

$56.23

Typical negotiated rate. In Rhode Island, October 2026.

Insurers have agreed to pay about $56.23 for this service. The price depends on where it is billed: about $56.23 from a physician practice, and about $178 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$56.23$47.86 to $61.66
FacilityA hospital or hospital-owned outpatient department$178$138 to $200

How much rates vary

Facilitymedian $178 · 10th to 90th $120 to $219Professionalmedian $56 · 10th to 90th $44 to $79
$50$100$200facility $178professional $56

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
$56.23
Median
$56.23
Typical High
$56.23
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$28.18
Median
$28.18
Typical High
$28.18
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$11.22
Median
$11.22
Typical High
$11.22
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$8.51
Median
$8.51
Typical High
$8.51
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$5.62
Median
$5.62
Typical High
$5.62
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$190.55
Typical High
$218.78
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$61.66
Typical High
$87.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Professional
Modifier
None
Typical Low
$45.71
Median
$45.71
Typical High
$63.10
United
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
None
Typical Low
$36.31
Median
$51.29
Typical High
$79.43

Where Rhode Island 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.

Rhode Island· 28th of 51

$56.23

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.