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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

New Jersey 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 $617 · 10th–90th $617$1,8200%50%90th$617Professionalmedian $891 · 10th–90th $708$1,7780%10%20%10th90th$891$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
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$812.83
Typical High
$1,148.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,202.26
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,737.80
Typical High
$2,398.83
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,778.28
Median
$1,778.28
Typical High
$1,778.28
United
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,819.70
Typical High
$1,819.70
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$977.24
Typical High
$1,778.28