go back

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

Indiana 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 $427$1,0960%50%10th90th$871Professionalmedian $457 · 10th–90th $407$7590%50%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
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$436.52
Typical High
$676.08
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$870.96
Typical High
$1,096.48
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$501.19
Typical High
$891.25
CareSource
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,122.02
Typical High
$1,318.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$758.58
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$616.60
Typical High
$870.96
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$426.58
Typical High
$707.95