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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Connecticut 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 $1,202 · 10th–90th $676$1,8200%10%10th90th$1,202Professionalmedian $871 · 10th–90th $741$1,7380%20%10th90th$871$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$851.14
Typical High
$1,862.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,819.70
Typical High
$2,187.76
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,047.13
Typical High
$2,398.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,288.25
Typical High
$1,949.84
Health New England
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$812.83
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$891.25
Typical High
$1,584.89