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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

South Carolina 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 $115 · 10th–90th $91$2450%20%10th90th$115Professionalmedian $98 · 10th–90th $81$1700%20%10th90th$98$50.0$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
$95.50
Median
$95.50
Typical High
$95.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$95.50
Typical High
$169.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$151.36
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$107.15
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$223.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$112.20
Medcost
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$144.54
Typical High
$302.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95
Molina
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
United
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$107.15
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$128.82