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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Illinois 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 $195 · 10th–90th $100$9770%20%10th90th$195Professionalmedian $120 · 10th–90th $89$1950%20%10th90th$120$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$100.00
Median
$100.00
Typical High
$194.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$194.98
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
BCBS
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$371.54
Typical High
$1,318.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$147.91
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$208.93
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$223.87
Typical High
$275.42
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$158.49
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$165.96