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

Oklahoma 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 $417 · 10th–90th $380$1,1220%20%10th90th$417Professionalmedian $398 · 10th–90th $339$6170%10%20%10th90th$398$200.0$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
$380.19
Median
$398.11
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$398.11
Typical High
$489.78
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
$891.25
Medica
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$588.84
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$446.68
Typical High
$1,023.29
United
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$691.83
Typical High
$933.25
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$398.11
Typical High
$602.56