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

Washington 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 $891 · 10th–90th $603$1,9050%10%20%10th90th$891Professionalmedian $741 · 10th–90th $427$1,6220%10%20%10th90th$741$10.0$50.0$200.0$1.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,174.90
Typical High
$1,412.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$602.56
Typical High
$4,466.84
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$851.14
Median
$870.96
Typical High
$891.25
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$575.44
Typical High
$575.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$575.44
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,202.26
Typical High
$2,511.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$1,047.13
Typical High
$1,905.46
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$676.08
Typical High
$741.31
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$870.96
Typical High
$891.25
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,288.25
Typical High
$1,778.28
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$870.96
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$891.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$1,318.26
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$478.63
Typical High
$794.33
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$501.19
Typical High
$776.25