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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Pennsylvania 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 $302 · 10th–90th $78$1,0000%10%20%10th90th$302Professionalmedian $91 · 10th–90th $66$1860%20%10th90th$91$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
$77.62
Median
$77.62
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$91.20
Typical High
$134.90
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$112.20
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$363.08
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$134.90
Typical High
$190.55
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$141.25
Typical High
$245.47
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$302.00
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$91.20
Typical High
$154.88
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$676.08
Typical High
$1,096.48
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$234.42
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$93.33
Typical High
$194.98