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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Texas 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 $145 · 10th–90th $85$3800%10%10th90th$145Professionalmedian $91 · 10th–90th $78$1260%50%10th90th$91$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$87.10
Median
$89.13
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$89.13
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$147.91
Typical High
$186.21
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$199.53
Typical High
$199.53
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
$107.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,412.54
Typical High
$1,412.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$147.91
Typical High
$245.47
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$181.97
Typical High
$199.53
Molina
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$123.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$144.54
Typical High
$245.47
Providence
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$158.49
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$102.33
Typical High
$123.03
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$199.53
Typical High
$269.15