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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Montana 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 $191 · 10th–90th $120$2400%20%10th90th$191Professionalmedian $166 · 10th–90th $65$2400%20%10th90th$166$100.0$200.0$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
Professional
Modifier
Global
Typical Low
$54.95
Median
$100.00
Typical High
$812.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$204.17
Typical High
$204.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$204.17
Typical High
$204.17
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$371.54
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$371.54
Providence
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$151.36
Typical High
$234.42
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$154.88
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$91.20
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$131.83