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

Texas 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 $372$3,0900%10%20%10th90th$692Professionalmedian $407 · 10th–90th $363$6170%50%10th90th$407$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
$173.78
Median
$389.05
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$407.38
Typical High
$616.60
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$851.14
Typical High
$851.14
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
$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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$812.83
Typical High
$1,318.26
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$812.83
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$416.87
Typical High
$416.87
Providence
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$776.25
Typical High
$1,288.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$575.44
United
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$691.83
Typical High
$933.25
United
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$501.19
Typical High
$616.60
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$851.14
Typical High
$1,148.15