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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Ohio 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 $204 · 10th–90th $102$3720%20%10th90th$204Professionalmedian $102 · 10th–90th $78$2140%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0

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
$102.33
Median
$147.91
Typical High
$436.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$102.33
Typical High
$154.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$208.93
Typical High
$416.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$114.82
Typical High
$257.04
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
CareSource
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$165.96
Typical High
$234.42
CareSource
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$263.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$138.04
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$138.04
Typical High
$194.98
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$218.78
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$158.49
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$93.33
Typical High
$138.04