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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Washington 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 $191 · 10th–90th $126$4170%20%10th90th$191Professionalmedian $155 · 10th–90th $78$3240%10%10th90th$155$2.0$10.0$50.0$200.0$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
$125.89
Median
$125.89
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$125.89
Typical High
$302.00
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$181.97
Typical High
$186.21
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$208.93
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
$107.15
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$223.87
Typical High
$537.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$218.78
Typical High
$398.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$186.21
Typical High
$190.55
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$186.21
Typical High
$190.55
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$275.42
Typical High
$371.54
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$181.97
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$186.21
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$281.84
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$93.33
Typical High
$165.96
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$107.15
Typical High
$162.18