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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Washington, DC 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 $741 · 10th–90th $741$2,6920%50%90th$741Professionalmedian $741 · 10th–90th $741$1,1480%50%90th$741$1.0K$2.0K

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
Facility
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$870.96
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,258.93
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
$1,230.27
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,548.82
Typical High
$3,548.13
United
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$1,737.80