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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Indiana 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 $95$2090%50%10th90th$195Professionalmedian $100 · 10th–90th $78$1580%20%10th90th$100$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
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$95.50
Typical High
$158.49
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$194.98
Typical High
$245.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$190.55
CareSource
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$251.19
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$107.15
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$169.82
United
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$120.23
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$95.50
Typical High
$134.90