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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

South Carolina 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 $1,122 · 10th–90th $891$2,3440%20%10th90th$1,122Professionalmedian $912 · 10th–90th $776$1,6220%20%10th90th$912$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
$912.01
Median
$912.01
Typical High
$912.01
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$912.01
Typical High
$1,621.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$1,905.46
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$1,995.26
Typical High
$2,630.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,318.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$2,137.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Medcost
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$1,348.96
Typical High
$2,951.21
Medcost
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,258.93
Typical High
$1,258.93
United
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,047.13
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$1,230.27