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

Arizona 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 $933 · 10th–90th $275$1,9950%10%10th90th$933Professionalmedian $457 · 10th–90th $363$1,0960%20%40%10th90th$457$1.0$5.0$20.0$100.0$500.0$2.0K

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
$363.08
Median
$457.09
Typical High
$602.56
BCBS
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$1,174.90
Typical High
$2,238.72
BCBS
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,096.48
Typical High
$2,187.76
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
$575.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$660.69
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$407.38
Typical High
$5,011.87
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$851.14
Typical High
$1,047.13
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$407.38
Typical High
$616.60