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SEWHO, Abduction Positioning, Erb's Palsy, Prefabricated

Wisconsin 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 $813 · 10th–90th $617$1,6220%50%10th90th$813Professionalmedian $759 · 10th–90th $398$1,3490%10%20%10th90th$759$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
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$870.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,318.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$758.58
Typical High
$891.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$1,862.09
Typical High
$4,073.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$1,174.90
Typical High
$1,513.56
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$645.65
Typical High
$1,000.00
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$758.58
Typical High
$954.99
Medica
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$794.33
Typical High
$4,168.69
Medica
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$457.09
Typical High
$954.99
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$489.78
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Network Health
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$912.01
Typical High
$1,584.89
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$645.65
Typical High
$1,000.00
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$794.33
Typical High
$1,047.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,230.27
Typical High
$2,344.23
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$1,621.81
Typical High
$4,265.80
Quartz
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$1,202.26
Typical High
$5,128.61
Security Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$724.44
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$457.09
Typical High
$812.83
United
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$398.11
Typical High
$758.58