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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

North Carolina 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 $1,622 · 10th–90th $776$3,1620%20%10th90th$1,622Professionalmedian $1,413 · 10th–90th $813$1,6220%20%40%10th90th$1,413$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
$1,621.81
Median
$1,621.81
Typical High
$1,621.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,621.81
Typical High
$1,621.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$1,819.70
Typical High
$3,715.35
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,548.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,230.27
Medcost
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$933.25
Typical High
$1,202.26
Medcost
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$1,621.81
Typical High
$2,691.53
United
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,513.56
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$1,288.25
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$8,709.64
Median
$8,709.64
Typical High
$8,709.64
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$9,549.93
Median
$9,549.93
Typical High
$13,489.63