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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

New Hampshire 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 $62$2340%20%10th90th$191Professionalmedian $112 · 10th–90th $74$1660%20%10th90th$112$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
$61.66
Median
$61.66
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$77.62
Typical High
$114.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$204.17
Typical High
$234.42
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$85.11
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$112.20
Typical High
$165.96
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$269.15