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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

California 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 $955 · 10th–90th $759$4,3650%20%10th90th$955Professionalmedian $977 · 10th–90th $776$7,7620%20%10th90th$977$2.0$10.0$50.0$200.0$1.0K$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
Facility
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$977.24
Typical High
$7,762.47
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$954.99
Typical High
$4,073.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,000.00
Typical High
$2,238.72
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$3,162.28
Typical High
$4,365.16
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$1,698.24
Typical High
$4,677.35
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
$1,202.26
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,148.15
Typical High
$2,187.76
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,659.59
Typical High
$2,818.38
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$8,709.64
Median
$8,709.64
Typical High
$8,709.64
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$9,549.93
Median
$13,489.63
Typical High
$13,489.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$1,862.09
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,819.70
Typical High
$2,344.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,737.80
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,388.44
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,258.93
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$812.83
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$912.01
Typical High
$1,905.46