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SEWHO, Abduction Positioning, Erb's Palsy, Prefabricated

Utah 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 $398 · 10th–90th $257$7940%20%40%10th90th$398Professionalmedian $479 · 10th–90th $257$4,5710%20%10th90th$479$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$363.08
Typical High
$4,570.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$489.78
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$575.44
Typical High
$758.58
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$794.33
Typical High
$794.33
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$562.34
Typical High
$1,096.48
Select Health
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
Select Health
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$812.83
Typical High
$1,000.00
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$812.83
Typical High
$1,202.26
United
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$446.68
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$398.11
Typical High
$602.56