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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

California 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 $100 · 10th–90th $79$4570%20%10th90th$100Professionalmedian $98 · 10th–90th $55$8130%10%20%10th90th$98$0.2$1.0$5.0$20.0$100.0$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
$54.95
Median
$54.95
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$89.13
Typical High
$812.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$131.83
Typical High
$141.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$100.00
Typical High
$436.52
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$109.65
Typical High
$234.42
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$295.12
Typical High
$457.09
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$177.83
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$181.97
Typical High
$309.03
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,412.54
Typical High
$1,412.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$169.82
Typical High
$239.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$181.97
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$114.82
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$85.11
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$199.53