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Wisconsin rates for HCPCS L3962

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

Facilitymedian $813 · 10th–90th $646–$1,4790%50%10th90th$813Professionalmedian $589 · 10th–90th $380–$1,2020%20%10th90th$589$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
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $426.58 / $660.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,318.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,862.09 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $1,148.15 / $1,513.56
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $645.65 / $1,000.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $758.58 / $954.99
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $794.33 / $4,168.69
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $457.09 / $954.99
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $489.78
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $912.01 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,258.93 / $2,511.89
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,621.81 / $5,011.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $724.44 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $457.09 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $398.11 / $676.08