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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

North Dakota 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 $1,349 · 10th–90th $1,288$2,6300%50%10th90th$1,349Professionalmedian $1,738 · 10th–90th $977$2,2910%20%10th90th$1,738$500.0$1.0K$2.0K$5.0K$10.0K

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
$1,348.96
Typical High
$1,348.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,288.25
Typical High
$6,918.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,041.74
Typical High
$2,238.72
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
$1,202.26
Median
$2,137.96
Typical High
$2,691.53
Medica
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$1,584.89
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$812.83
Typical High
$1,862.09
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,258.93
Typical High
$2,137.96