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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

New York 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 $1,288 · 10th–90th $776$2,7540%10%10th90th$1,288Professionalmedian $1,000 · 10th–90th $776$2,6920%20%10th90th$1,000$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$870.96
Typical High
$2,041.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$870.96
Typical High
$1,202.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$3,630.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$3,090.30
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,513.56
Typical High
$1,513.56
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$1,513.56
Typical High
$1,513.56
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,288.25
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$3,019.95
Typical High
$7,079.46
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,905.46
Typical High
$3,467.37
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,380.38
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,148.15
Typical High
$1,288.25
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,737.80
Typical High
$2,089.30
United
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$954.99
Typical High
$2,884.03
United
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,202.26
Typical High
$3,019.95
Univera
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,071.52
Typical High
$1,380.38
Univera
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,148.15
Typical High
$1,288.25