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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Nebraska 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 $1,862 · 10th–90th $832$8,5110%20%10th90th$1,862Professionalmedian $851 · 10th–90th $708$1,5140%20%40%10th90th$851$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
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$851.14
Typical High
$1,174.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,778.28
Typical High
$1,778.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$2,137.96
Typical High
$3,890.45
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,995.26
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$912.01
Typical High
$1,819.70
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$4,897.79
Midlands
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$4,570.88
Typical High
$4,897.79
United
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,862.09
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$912.01
Typical High
$1,445.44