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

Tennessee 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 $692 · 10th–90th $398$5,0120%20%10th90th$692Professionalmedian $427 · 10th–90th $389$7410%20%40%10th90th$427$1.0$5.0$20.0$100.0$500.0$2.0K

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
$389.05
Median
$426.58
Typical High
$691.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$416.87
Typical High
$741.31
BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$707.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$676.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$575.44
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,011.87
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$5,128.61
Median
$7,762.47
Typical High
$7,762.47
United
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$478.63
Typical High
$891.25
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$426.58
Typical High
$645.65