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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Kansas 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 $1,445 · 10th–90th $525$1,8620%50%10th90th$1,445Professionalmedian $1,585 · 10th–90th $871$1,5850%50%10th$1,585$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
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$1,000.00
Typical High
$1,513.56
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$1,412.54
Typical High
$1,513.56
BCBS
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
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$2,137.96
Medica
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$1,318.26
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$912.01
Typical High
$9,332.54
United
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,479.11
Typical High
$1,862.09
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$912.01
Typical High
$1,288.25