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

Iowa 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 $708 · 10th–90th $417$2,2910%20%10th90th$708Professionalmedian $525 · 10th–90th $398$1,0000%20%10th90th$525$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
Facility
Modifier
Global
Typical Low
$398.11
Median
$602.56
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$512.86
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$1,000.00
Typical High
$1,258.93
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$912.01
Typical High
$1,023.29
Medica
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,047.13
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$562.34
Typical High
$1,348.96
Midlands
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$954.99
Typical High
$1,258.93
Midlands
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Midlands
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,348.96
Typical High
$1,348.96
United
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$831.76
Typical High
$1,778.28
United
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$436.52
Typical High
$891.25
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$794.33