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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

New Mexico 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 $1,175 · 10th–90th $525$1,9050%10%10th90th$1,175Professionalmedian $977 · 10th–90th $724$2,7540%20%10th90th$977$100.0$200.0$500.0$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
$912.01
Median
$912.01
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$977.24
Typical High
$7,762.47
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
$2,691.53
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,862.09
Typical High
$2,754.23
Providence
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$1,258.93
Typical High
$1,905.46
Providence
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,862.09
United
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$812.83
Typical High
$1,230.27