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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Hawaii 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 $107 · 10th–90th $85$1550%20%10th90th$107Professionalmedian $191 · 10th–90th $65$2000%50%10th90th$191$100.0$200.0

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
$64.57
Median
$64.57
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$173.78
Typical High
$234.42
HMSA
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$190.55
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$234.42