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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Missouri 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 $155 · 10th–90th $100$3390%20%10th90th$155Professionalmedian $107 · 10th–90th $85$2140%20%40%10th90th$107$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
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$812.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$676.08
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$107.15
Typical High
$177.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$154.88
Typical High
$891.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$95.50
Typical High
$977.24
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$154.88
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$165.96