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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Minnesota 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 $3,162 · 10th–90th $1,585$15,1360%20%10th90th$3,162Professionalmedian $1,862 · 10th–90th $1,148$2,1380%50%10th90th$1,862$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
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,148.15
Typical High
$1,348.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,862.09
Typical High
$2,691.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,862.09
Typical High
$1,862.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$4,168.69
Median
$6,918.31
Typical High
$19,054.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,454.71
Typical High
$2,691.53
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$7,585.78
Typical High
$15,135.61
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$2,137.96
Median
$2,137.96
Typical High
$2,884.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,862.09
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$812.83
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$812.83
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$954.99
Typical High
$2,630.27