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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Michigan 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 $2,239 · 10th–90th $977$7,4130%20%10th90th$2,239Professionalmedian $1,047 · 10th–90th $871$1,8620%20%10th90th$1,047$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
$1,047.13
Median
$1,047.13
Typical High
$1,047.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$977.24
Typical High
$1,047.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$5,495.41
Typical High
$10,715.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,862.09
Typical High
$1,949.84
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
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
$1,230.27
Typical High
$2,041.74
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$3,467.37
Typical High
$3,890.45
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,479.11
Typical High
$2,238.72
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,862.09
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,513.56
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$870.96
Typical High
$1,318.26