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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

New Hampshire 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 $1,023$2,2390%20%40%10th90th$1,820Professionalmedian $1,202 · 10th–90th $776$1,5850%20%10th90th$1,202$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
$1,023.29
Median
$1,023.29
Typical High
$1,202.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,023.29
Typical High
$1,202.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,949.84
Typical High
$2,238.72
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
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
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$2,884.03
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$812.83
Typical High
$1,071.52
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,071.52
Typical High
$1,584.89
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$2,570.40