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

New Hampshire 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 $1,047 · 10th–90th $575$1,2590%20%40%10th90th$1,047Professionalmedian $692 · 10th–90th $447$8910%20%10th90th$692$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
$575.44
Median
$575.44
Typical High
$691.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$575.44
Typical High
$691.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,096.48
Typical High
$1,258.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
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
$575.44
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$398.11
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$776.25
Typical High
$891.25
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$1,445.44