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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Michigan 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 $282 · 10th–90th $107$7590%10%20%10th90th$282Professionalmedian $110 · 10th–90th $65$1910%20%10th90th$110$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
$109.65
Median
$109.65
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$102.33
Typical High
$109.65
BCBS
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$575.44
Typical High
$1,096.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
CareSource
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
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
$107.15
Typical High
$213.80
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$363.08
Typical High
$407.38
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$154.88
Typical High
$234.42
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$162.18
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$158.49
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$138.04