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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Virginia 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 $1,820 · 10th–90th $891$2,2910%20%40%10th90th$1,820Professionalmedian $977 · 10th–90th $741$1,7380%20%10th90th$977$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
Facility
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$891.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$1,000.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,949.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$2,089.30
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$776.25
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
$1,819.70
Typical High
$2,570.40
Medcost
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,202.26
Typical High
$1,202.26
Medcost
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$1,174.90
Typical High
$2,137.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,122.02
Typical High
$2,290.87
Sentara
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,548.82
Typical High
$4,073.80
Sentara
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,548.82
Typical High
$4,073.80
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$812.83
Typical High
$2,238.72
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$891.25
Typical High
$1,445.44