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

Kansas 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 $724 · 10th–90th $263$1,0000%20%10th90th$724Professionalmedian $955 · 10th–90th $398$9550%50%10th$955$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
$630.96
Median
$630.96
Typical High
$724.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$446.68
Typical High
$676.08
BCBS
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$954.99
Typical High
$1,000.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$954.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$602.56
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$1,000.00
Medica
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$616.60
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$407.38
Typical High
$5,011.87
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$660.69
Typical High
$831.76
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$407.38
Typical High
$1,000.00