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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Washington 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 $1,778 · 10th–90th $1,202$3,8900%10%20%10th90th$1,778Professionalmedian $1,479 · 10th–90th $871$3,2360%10%10th90th$1,479$20.0$100.0$500.0$2.0K$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
$1,202.26
Median
$1,202.26
Typical High
$2,884.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,202.26
Typical High
$7,762.47
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,737.80
Typical High
$1,778.28
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,995.26
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
$1,202.26
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$2,454.71
Typical High
$5,128.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$2,089.30
Typical High
$3,801.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$1,230.27
Typical High
$1,513.56
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$1,778.28
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$1,778.28
Typical High
$2,818.38
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$2,630.27
Typical High
$3,630.78
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$1,737.80
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,778.28
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$2,691.53
Typical High
$2,691.53
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$954.99
Typical High
$1,584.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,288.25
Typical High
$2,754.23