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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 October 2026.

How much does Shoulder Orthosis (SO), Vest Type Abduction Restrainer cost?

$191

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $204 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$191$102 to $204
FacilityA hospital or hospital-owned outpatient department$204$200 to $11,220

How much rates vary

Facilitymedian $204 · 10th to 90th $126 to $11,482Professionalmedian $191 · 10th to 90th $79 to $219
$100$200$500$1K$2K$5K$10Kfacility $204professional $191

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$54.95
Median
$100.00
Typical High
$181.97
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$204.17
Typical High
$204.17
Cigna
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$204.17
Typical High
$204.17
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$147.91
Median
$245.47
Typical High
$11,748.98
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$218.78
Typical High
$12,022.64
Providence
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$204.17
Typical High
$204.17
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$154.88
Typical High
$204.17
United
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$85.11
Typical High
$144.54

Where Montana sits

The same service costs 2.6 times more in Kansas than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 4th of 51

$191

KS $204DE $77.62

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.