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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Arizona 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 October 2026.

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

$871

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $871 for this service. The price depends on where it is billed: about $871 from a physician practice, and about $1,820 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$871$776 to $1,479
FacilityA hospital or hospital-owned outpatient department$1,820$1,023 to $3,020

How much rates vary

Facilitymedian $1,820 · 10th to 90th $513 to $8,511Professionalmedian $871 · 10th to 90th $724 to $9,333
$500$1K$2K$5K$10Kfacility $1,820professional $871

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
Professional
Modifier
None
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$1,995.26
Typical High
$3,019.95
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$1,288.25
Median
$1,479.11
Typical High
$2,691.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Medica
Setting
Facility
Modifier
None
Typical Low
$724.44
Median
$1,905.46
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$977.24
Typical High
$9,332.54
United
Setting
Professional
Modifier
None
Typical Low
$741.31
Median
$812.83
Typical High
$1,230.27

Where Arizona sits

The same service costs 2.2 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.

Arizona· 50th of 51

$871

MT $1,950DE $871

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.