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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

New York 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 $141 · 10th–90th $81$2880%10%10th90th$141Professionalmedian $110 · 10th–90th $74$2880%20%10th90th$110$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$64.57
Median
$91.20
Typical High
$213.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$91.20
Typical High
$147.91
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$323.59
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$154.88
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$109.65
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$138.04
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$316.23
Typical High
$741.31
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$363.08
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$151.36
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$114.82
Typical High
$141.25
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$181.97
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$125.89
Typical High
$309.03
Univera
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$109.65
Typical High
$151.36
Univera
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$114.82
Typical High
$141.25