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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Missouri 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 $1,479 · 10th–90th $955$3,4670%20%10th90th$1,479Professionalmedian $1,000 · 10th–90th $832$2,1880%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
$954.99
Median
$954.99
Typical High
$1,096.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,000.00
Typical High
$7,762.47
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$6,606.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,000.00
Typical High
$1,737.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,862.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,778.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$1,479.11
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$9,332.54
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$1,479.11
Typical High
$1,862.09
United
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$912.01
Typical High
$1,584.89