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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Maryland 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 $955 · 10th–90th $617$1,8200%10%10th90th$955Professionalmedian $871 · 10th–90th $741$1,5140%20%10th90th$871$1.0K$2.0K$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
$741.31
Median
$776.25
Typical High
$1,479.11
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,258.93
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
$1,202.26
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,819.70
Typical High
$2,754.23
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$812.83
Typical High
$1,819.70
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$933.25
Typical High
$1,445.44
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$1,548.82