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SEWHO, Shoulder Cap, without Joints, Custom Fabricated

Texas rates for HCPCS L3961

Shoulder-elbow-wrist-hand orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Rates data updated October 2026.

How much does SEWHO, Shoulder Cap, without Joints, Custom Fabricated cost?

$977

Typical negotiated rate. In Texas, October 2026.

Insurers have agreed to pay about $977 for this service. The price depends on where it is billed: about $933 from a physician practice, and about $1,023 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 10 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$933$759 to $9,550
FacilityA hospital or hospital-owned outpatient department$1,023$1,000 to $1,380

How much rates vary

Facilitymedian $1,023 · 10th to 90th $776 to $1,905Professionalmedian $933 · 10th to 90th $759 to $13,804
$1K$2K$5K$10Kfacility $1,023professional $933

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$831.76
Median
$831.76
Typical High
$851.14
Aetna
Setting
Professional
Modifier
None
Typical Low
$812.83
Median
$851.14
Typical High
$1,071.52
BCBS Texas
Setting
Professional
Modifier
None
Typical Low
$891.25
Median
$891.25
Typical High
$1,096.48
Christus
Setting
Facility
Modifier
None
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$1,905.46
Cigna
Setting
Facility
Modifier
None
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
Cigna
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$1,023.29
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$9,549.93
Median
$13,803.84
Typical High
$13,803.84
Moda Health
Setting
Facility
Modifier
None
Typical Low
$524.81
Median
$1,047.13
Typical High
$1,905.46
Moda Health
Setting
Professional
Modifier
None
Typical Low
$812.83
Median
$851.14
Typical High
$1,202.26
Molina
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$933.25
Typical High
$933.25
Providence
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$1,023.29
Typical High
$1,905.46
Providence
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$1,023.29
United
Setting
Facility
Modifier
None
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$2,238.72
United
Setting
Professional
Modifier
None
Typical Low
$630.96
Median
$912.01
Typical High
$1,174.90
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29

Where Texas sits

The same service costs 2.6 times more in Montana than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Texas· 39th of 51

$977

MT $1,950DE $759

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.