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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Florida 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 $977 · 10th–90th $794$3,4670%50%10th90th$977Professionalmedian $933 · 10th–90th $776$1,6220%20%40%10th90th$933$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
$794.33
Median
$891.25
Typical High
$977.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$954.99
Typical High
$1,621.81
AvMed
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$1,905.46
Typical High
$1,905.46
AvMed
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,778.28
Typical High
$1,905.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$3,467.37
Median
$3,467.37
Typical High
$3,467.37
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$1,122.02
Typical High
$1,905.46
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$891.25
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$891.25
Typical High
$1,230.27
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,905.46