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

Virginia 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 $1,000 · 10th–90th $490$1,2880%20%40%10th90th$1,000Professionalmedian $490 · 10th–90th $398$9120%20%40%10th90th$490$1.0$5.0$20.0$100.0$500.0$2.0K$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
$398.11
Median
$489.78
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$489.78
Typical High
$489.78
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,000.00
Typical High
$1,071.52
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$1,047.13
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$691.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$575.44
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,000.00
Typical High
$1,412.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$660.69
Typical High
$660.69
Medcost
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$645.65
Typical High
$1,174.90
Medcost
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$645.65
Typical High
$1,258.93
Sentara
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$891.25
Typical High
$2,187.76
Sentara
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$891.25
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$426.58
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$489.78
Typical High
$870.96