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Shoulder Orthosis (SO), Airplane Design, Custom Fabricated

Pennsylvania rates for HCPCS L3674

Shoulder orthosis (SO), abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Rates data updated July 2026.

How much does Shoulder Orthosis (SO), Airplane Design, Custom Fabricated cost?

$631

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $631 for this service. The price depends on where it is billed: about $631 from a physician practice, and about $1,585 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$631$537 to $832
FacilityA hospital or hospital-owned outpatient department$1,585$525 to $2,512

How much rates vary

Facilitymedian $1,585 · 10th to 90th $525 to $6,166Professionalmedian $631 · 10th to 90th $513 to $1,259
$500$1K$2K$5K$10K$20K$50Kfacility $1,585professional $631

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$1,995.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$602.56
Typical High
$891.25
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,258.93
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$1,819.70
Cigna
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$724.44
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,698.24
Typical High
$2,454.71
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$912.01
Typical High
$1,288.25
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$1,995.26
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$616.60
Typical High
$1,071.52
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$4,570.88
Typical High
$8,128.31
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,202.26
Typical High
$1,230.27
United
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$1,584.89
Typical High
$1,584.89
United
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$630.96
Typical High
$1,318.26

Where Pennsylvania sits

The same service costs 2.6 times more in Kansas than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 43rd of 51

$631

KS $1,349DC $513

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.