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

Pennsylvania 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 $1,096 · 10th–90th $407$4,7860%20%10th90th$1,096Professionalmedian $457 · 10th–90th $398$9770%50%10th90th$457$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
$407.38
Median
$407.38
Typical High
$1,548.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$446.68
Typical High
$660.69
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$1,258.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$575.44
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,380.38
Typical High
$1,995.26
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,000.00
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$707.95
Typical High
$1,000.00
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$1,548.82
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$467.74
Typical High
$1,230.27
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$3,548.13
Typical High
$5,754.40
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$812.83
Typical High
$954.99
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,096.48
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$489.78
Typical High
$1,023.29