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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Kentucky 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 $977 · 10th–90th $794$2,5700%20%40%10th90th$977Professionalmedian $955 · 10th–90th $832$1,1480%50%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
$954.99
Median
$954.99
Typical High
$977.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$954.99
Typical High
$1,096.48
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,905.46
Typical High
$1,995.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$954.99
Typical High
$1,000.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$2,511.89
Typical High
$3,235.94
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,290.87
Typical High
$2,951.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$2,570.40
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,479.11
Typical High
$8,912.51
Molina
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$812.83
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$891.25
Typical High
$1,230.27