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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Montana 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 $1,820 · 10th–90th $1,202$2,2910%20%40%10th90th$1,820Professionalmedian $1,445 · 10th–90th $525$3,5480%10%10th90th$1,445$100.0$200.0$500.0$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
Professional
Modifier
Global
Typical Low
$524.81
Median
$954.99
Typical High
$7,762.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,949.84
Typical High
$1,949.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,949.84
Typical High
$1,949.84
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,819.70
Typical High
$3,548.13
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,819.70
Typical High
$3,548.13
Providence
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,737.80
Typical High
$2,238.72
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,479.11
Typical High
$1,949.84
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$1,023.29
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$812.83
Typical High
$1,258.93