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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Nebraska 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 $195 · 10th–90th $85$8910%20%10th90th$195Professionalmedian $89 · 10th–90th $55$1780%20%40%10th90th$89$100.0$200.0$500.0$1.0K

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
$123.03
Median
$123.03
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$89.13
Typical High
$123.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$295.12
BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$186.21
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$154.88
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$223.87
Typical High
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$891.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$95.50
Typical High
$204.17
Midlands
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$512.86
Midlands
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$478.63
Typical High
$512.86
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$194.98
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$95.50
Typical High
$151.36