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Shoulder Orthosis (SO), Vest Type Abduction Restrainer

Wisconsin 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 $195 · 10th–90th $145$3550%20%40%10th90th$195Professionalmedian $182 · 10th–90th $95$3240%20%10th90th$182$0.2$1.0$5.0$20.0$100.0$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
$97.72
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$177.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$323.59
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$181.97
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$457.09
Typical High
$1,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$281.84
Typical High
$371.54
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$245.47
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$234.42
Typical High
$295.12
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$190.55
Typical High
$891.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$102.33
Typical High
$213.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$109.65
Network Health
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Network Health
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$223.87
Typical High
$389.05
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$245.47
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$186.21
Typical High
$190.55
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$295.12
Typical High
$512.86
Quartz
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$398.11
Typical High
$912.01
Quartz
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$295.12
Typical High
$977.24
Security Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$177.83
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$100.00
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$95.50
Typical High
$186.21