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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

South Dakota 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 $182 · 10th–90th $107$2630%10%10th90th$182Professionalmedian $166 · 10th–90th $120$2820%10%20%10th90th$166$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$134.90
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$281.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$190.55
Typical High
$363.08
Medica
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$128.82
Typical High
$977.24
Midlands
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$208.93
Typical High
$208.93
Midlands
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Midlands
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$346.74
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$194.98
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$100.00
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$131.83
Typical High
$223.87
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21