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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Alaska rates for HCPCS L3975

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

Rates data updated July 2026.

Facilitymedian $525 · 10th–90th $525$1,8200%50%90th$525Professionalmedian $1,047 · 10th–90th $912$2,4550%20%10th90th$1,047$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
Professional
Modifier
Global
Typical Low
$912.01
Median
$977.24
Typical High
$1,548.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,995.26
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$1,096.48
Typical High
$1,819.70
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,819.70
Typical High
$5,888.44
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,737.80
Typical High
$1,819.70
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,737.80
Typical High
$1,819.70
Providence
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$1,819.70
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$1,202.26
Typical High
$1,698.24
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$1,023.29
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,348.96
Typical High
$4,466.84