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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Maine 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 $2,089 · 10th–90th $1,023$2,4550%20%10th90th$2,089Professionalmedian $1,096 · 10th–90th $813$1,5850%20%10th90th$1,096$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$977.24
Typical High
$1,122.02
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$2,137.96
Typical High
$2,454.71
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,318.26
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
$1,202.26
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,905.46
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,047.13
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$812.83
Typical High
$1,047.13
United
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,548.82
Typical High
$1,584.89