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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Louisiana 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 $1,514 · 10th–90th $977$3,3110%20%10th90th$1,514Professionalmedian $1,000 · 10th–90th $776$1,3490%20%10th90th$1,000$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
$1,071.52
Median
$1,071.52
Typical High
$1,071.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,000.00
Typical High
$1,445.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$2,754.23
Typical High
$3,801.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$1,318.26
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,778.28
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,513.56
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$870.96
Typical High
$1,230.27