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

Nebraska 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 $832 · 10th–90th $407$4,2660%20%10th90th$832Professionalmedian $407 · 10th–90th $389$6760%20%40%10th90th$407$500.0$1.0K$2.0K$5.0K

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
$524.81
Median
$524.81
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$407.38
Typical High
$524.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$794.33
Typical High
$794.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$1,000.00
Typical High
$1,698.24
Medica
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$933.25
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$407.38
Typical High
$812.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$2,187.76
Midlands
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$2,041.74
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$831.76
Typical High
$933.25
United
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$407.38
Typical High
$676.08