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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Oklahoma 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 $891 · 10th–90th $851$2,2390%20%40%10th90th$891Professionalmedian $871 · 10th–90th $692$1,2020%20%40%10th90th$871$500.0$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
$851.14
Median
$870.96
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$870.96
Typical High
$977.24
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
$1,995.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$1,174.90
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$891.25
Typical High
$2,238.72
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$1,513.56
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$812.83
Typical High
$1,174.90