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

South Carolina 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 $525 · 10th–90th $437$1,1750%20%10th90th$525Professionalmedian $457 · 10th–90th $417$7590%20%10th90th$457$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
$436.52
Median
$436.52
Typical High
$436.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$446.68
Typical High
$758.58
BCBS
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$812.83
Typical High
$891.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$891.25
Typical High
$1,122.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$645.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$1,000.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Medcost
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$741.31
Typical High
$1,548.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$512.86
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$436.52
Typical High
$891.25