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Elbow-Wrist-Hand Orthosis (EWHO), Nontorsion Joints

Alaska rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $398 · 10th–90th $263$1,0230%20%40%10th90th$398Professionalmedian $589 · 10th–90th $427$1,4450%20%10th90th$589$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Global
Typical Low
$426.58
Median
$489.78
Typical High
$891.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$1,202.26
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$602.56
Typical High
$1,023.29
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,071.52
Typical High
$2,691.53
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,023.29
Typical High
$1,071.52
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,023.29
Typical High
$1,071.52
Providence
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$1,047.13
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$575.44
Typical High
$851.14
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$512.86
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$776.25
Typical High
$2,570.40