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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Idaho 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 $178 · 10th–90th $93$2340%50%10th90th$178Professionalmedian $135 · 10th–90th $55$2090%10%20%10th90th$135$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
Professional
Modifier
Global
Typical Low
$54.95
Median
$112.20
Typical High
$165.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$177.83
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$208.93
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$169.82
Typical High
$199.53
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$181.97
Typical High
$190.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$162.18
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$181.97
Typical High
$181.97
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$208.93
Select Health
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$194.98
Typical High
$288.40
Select Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$0.14
Median
$93.33
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$123.03