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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Kentucky 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 $102 · 10th–90th $78$2690%20%40%10th90th$102Professionalmedian $95 · 10th–90th $87$1510%20%40%10th90th$95$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
$100.00
Median
$100.00
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$102.33
Typical High
$154.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$199.53
Typical High
$208.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$93.33
Typical High
$109.65
CareSource
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$263.03
Typical High
$338.84
CareSource
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$239.88
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$269.15
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$151.36
Typical High
$954.99
Molina
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$85.11
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$93.33
Typical High
$131.83