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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

North Carolina 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 $170 · 10th–90th $79$3390%20%10th90th$170Professionalmedian $148 · 10th–90th $87$1910%20%10th90th$148$0.2$2.0$20.0$200.0$2.0K

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
$169.82
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$239.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$190.55
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$107.15
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$114.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$97.72
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$169.82
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$158.49
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$134.90
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$1,412.54