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

South Dakota 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 $813 · 10th–90th $575$1,5140%10%10th90th$813Professionalmedian $776 · 10th–90th $513$1,2590%20%10th90th$776$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$575.44
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,258.93
Medica
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$831.76
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$602.56
Typical High
$5,011.87
Midlands
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$891.25
Typical High
$891.25
Midlands
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Midlands
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$1,513.56
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$851.14
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$478.63
Typical High
$676.08
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$616.60
Typical High
$1,000.00
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33