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

Massachusetts 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 $1,259 · 10th–90th $447$2,0420%20%10th90th$1,259Professionalmedian $851 · 10th–90th $437$1,3490%20%10th90th$851$1.0$10.0$100.0$1.0K$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
$426.58
Median
$446.68
Typical High
$446.68
Aetna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$457.09
Typical High
$1,412.54
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,000.00
Typical High
$5,011.87
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$851.14
Typical High
$1,230.27
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,318.26
Typical High
$1,737.80
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
$1,000.00
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$1,348.96
Health New England
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,000.00
Typical High
$5,011.87
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$851.14
Typical High
$1,230.27
United
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$537.03
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$870.96
Typical High
$977.24