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SEWHO, Abduction Positioning, Erb's Palsy, Prefabricated

Montana rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $776 · 10th–90th $513$9550%20%10th90th$776Professionalmedian $631 · 10th–90th $257$1,5140%10%20%10th90th$631$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Global
Typical Low
$257.04
Median
$416.87
Typical High
$4,570.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$831.76
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$831.76
Typical High
$831.76
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$1,513.56
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$1,513.56
Providence
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$776.25
Typical High
$1,071.52
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$616.60
Typical High
$933.25
United
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$446.68
Typical High
$489.78
United
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$398.11
Typical High
$602.56