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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Utah 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 $85 · 10th–90th $55$1950%20%40%10th90th$85Professionalmedian $107 · 10th–90th $55$8130%10%10th90th$107$50.0$100.0$200.0$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
$54.95
Median
$54.95
Typical High
$54.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$87.10
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$107.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$141.25
Typical High
$186.21
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$194.98
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$138.04
Typical High
$208.93
Select Health
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Select Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$199.53
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$177.83
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$85.11
Typical High
$131.83