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Utah rates for HCPCS L3962

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

Facilitymedian $479 · 10th–90th $251–$7940%20%40%10th90th$479Professionalmedian $550 · 10th–90th $251–$4,5710%10%10th90th$550$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $478.63 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $489.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $575.44 / $758.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $794.33 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $891.25
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $1,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $812.83 / $1,202.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $398.11 / $524.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $398.11 / $630.96