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

Illinois 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 $871 · 10th–90th $437$4,4670%20%10th90th$871Professionalmedian $513 · 10th–90th $407$8710%20%40%10th90th$513$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$436.52
Median
$436.52
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$436.52
Typical High
$870.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$5,888.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$660.69
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$891.25
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$977.24
Typical High
$1,202.26
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Molina
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$707.95
Typical High
$891.25
United
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$426.58
Typical High
$891.25