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SEWHFO, Shoulder Cap, without Joints, Custom Fabricated

Wyoming 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 $912 · 10th–90th $813$1,8200%20%10th90th$912Professionalmedian $1,047 · 10th–90th $708$1,8200%20%10th90th$1,047$1.0K$2.0K

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
Professional
Modifier
Global
Typical Low
$707.95
Median
$1,047.13
Typical High
$1,621.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$1,819.70
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
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$831.76
Typical High
$1,513.56
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$812.83
Typical High
$1,258.93