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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Iowa 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 $1,413 · 10th–90th $851$4,5710%10%20%10th90th$1,413Professionalmedian $1,175 · 10th–90th $741$2,1380%10%20%10th90th$1,175$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
$851.14
Median
$1,288.25
Typical High
$1,348.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,148.15
Typical High
$1,737.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$2,137.96
Typical High
$2,691.53
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,862.09
Typical High
$1,995.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$2,187.76
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,122.02
Typical High
$3,090.30
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,137.96
Typical High
$2,570.40
Midlands
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$3,090.30
Typical High
$3,090.30
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$1,862.09
Typical High
$3,548.13
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$912.01
Typical High
$1,862.09
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,412.54
Median
$1,778.28
Typical High
$1,778.28