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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Mississippi 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 $1,445 · 10th–90th $912$2,2390%20%40%10th90th$1,445Professionalmedian $1,047 · 10th–90th $832$1,7380%20%10th90th$1,047$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
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,698.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,096.48
Typical High
$1,737.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
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
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,513.56
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$870.96
Typical High
$1,258.93