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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Idaho 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 $1,738 · 10th–90th $955$2,2390%50%10th90th$1,738Professionalmedian $1,288 · 10th–90th $741$1,9950%10%20%10th90th$1,288$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
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,071.52
Typical High
$1,584.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$2,884.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,905.46
Median
$1,995.26
Typical High
$1,995.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,202.26
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$1,698.24
Typical High
$1,995.26
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$1,737.80
Typical High
$1,819.70
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$1,548.82
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,737.80
Typical High
$1,737.80
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,995.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,862.09
Typical High
$2,754.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,737.80
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$1.32
Median
$954.99
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$812.83
Typical High
$1,174.90