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Washington rates for HCPCS L3962

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

Facilitymedian $977 · 10th–90th $617$2,0890%20%10th90th$977Professionalmedian $661 · 10th–90th $372$1,2880%10%20%10th90th$661$1.0$5.0$20.0$100.0$500.0$2.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $1,584.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $489.78 / $870.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $954.99 / $954.99
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,096.48
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,148.15 / $2,754.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $1,122.02 / $1,819.70
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $758.58 / $831.76
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $954.99 / $977.24
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $977.24 / $977.24
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,445.44 / $1,949.84
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $954.99
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $954.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $1,071.52 / $1,288.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $436.52 / $758.58
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $707.95 / $1,513.56