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

Vermont 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 $537 · 10th–90th $309$5750%20%40%10th90th$537Professionalmedian $513 · 10th–90th $501$6610%20%40%10th90th$513$500.0$1.0K$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$660.69
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
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$398.11
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$758.58
Typical High
$2,041.74