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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Indiana 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 $1,862 · 10th–90th $912$2,2910%50%10th90th$1,862Professionalmedian $955 · 10th–90th $794$1,5140%20%40%10th90th$955$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
$912.01
Median
$912.01
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$912.01
Typical High
$1,513.56
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,862.09
Typical High
$2,344.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,000.00
Typical High
$1,819.70
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$2,398.83
Typical High
$2,754.23
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
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,148.15
Typical High
$1,862.09
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$912.01
Typical High
$1,288.25