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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

West 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 $933 · 10th–90th $933$2,5120%50%90th$933Professionalmedian $891 · 10th–90th $741$1,2020%20%40%10th90th$891$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$933.25
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$2,511.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$2,238.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$2,570.40
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$8,912.51
United
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$812.83
Typical High
$1,905.46
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,023.29
Typical High
$1,479.11