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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Alaska rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $105 · 10th–90th $55$2000%20%40%10th90th$105Professionalmedian $110 · 10th–90th $55$2570%10%20%10th90th$110$100.0$200.0$500.0

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
$263.03
Median
$263.03
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$100.00
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$208.93
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$125.89
Typical High
$190.55
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$190.55
Typical High
$616.60
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$181.97
Typical High
$190.55
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$181.97
Typical High
$190.55
Providence
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$199.53
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$107.15
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$91.20
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$131.83
Typical High
$467.74