go back

SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Oregon 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 $1,738 · 10th–90th $1,413$1,8200%50%10th90th$1,738Professionalmedian $1,318 · 10th–90th $776$1,9950%10%20%10th90th$1,318$2.0$10.0$50.0$200.0$1.0K$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
Professional
Modifier
Global
Typical Low
$741.31
Median
$977.24
Typical High
$1,288.25
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
$870.96
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$3,630.78
Typical High
$4,466.84
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,380.38
Typical High
$1,819.70
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,445.44
Typical High
$1,949.84
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$1,819.70
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,778.28
Typical High
$1,995.26
Providence
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,479.11
Typical High
$1,995.26
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,584.89
Typical High
$1,905.46
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$1,862.09
Typical High
$7,079.46
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$1,995.26
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$1.32
Median
$812.83
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$812.83
Typical High
$1,548.82