go back

SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Hawaii 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 $1,072 · 10th–90th $813$1,4130%20%10th90th$1,072Professionalmedian $1,820 · 10th–90th $617$1,9050%50%10th90th$1,820$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
Professional
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$954.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,412.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,698.24
Typical High
$2,238.72
HMSA
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,905.46
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,819.70
Typical High
$2,570.40
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$831.76
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,258.93
Typical High
$2,238.72