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

Wisconsin 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 $871 · 10th–90th $603$1,5850%50%10th90th$871Professionalmedian $813 · 10th–90th $427$1,4790%20%10th90th$813$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
$436.52
Median
$501.19
Typical High
$602.56
Aetna
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$794.33
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,445.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$812.83
Typical High
$977.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,995.26
Typical High
$4,466.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$1,258.93
Typical High
$1,659.59
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$741.31
Typical High
$1,071.52
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$2,344.23
Typical High
$2,951.21
Medica
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$851.14
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$478.63
Typical High
$1,047.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$380.19
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Network Health
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$977.24
Typical High
$1,698.24
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$741.31
Typical High
$1,071.52
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$851.14
Typical High
$1,047.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,318.26
Typical High
$2,454.71
Quartz
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$1,778.28
Typical High
$4,365.16
Quartz
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$1,318.26
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$478.63
Typical High
$870.96
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$426.58
Typical High
$977.24