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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Vermont 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 $107 · 10th–90th $71$1550%20%10th90th$107Professionalmedian $62 · 10th–90th $51$1510%20%40%10th90th$62$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$117.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$114.82
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$131.83
Typical High
$380.19