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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Georgia 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 $1,905 · 10th–90th $871$6,9180%20%10th90th$1,905Professionalmedian $1,122 · 10th–90th $851$1,7780%20%10th90th$1,122$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$870.96
Median
$870.96
Typical High
$2,290.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$912.01
Typical High
$1,621.81
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$4,466.84
Typical High
$6,918.31
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,548.82
Typical High
$2,238.72
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
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
$2,238.72
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,905.46
Typical High
$2,630.27
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$812.83
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$912.01
Typical High
$1,819.70