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Elbow-Wrist-Hand-Finger Orthosis (EWHFO), Rigid

Montana rates for HCPCS L3765

Elbow-wrist-hand-finger orthosis (EWHFO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Rates data updated July 2026.

Facilitymedian $1,380 · 10th–90th $912$1,7380%20%10th90th$1,380Professionalmedian $1,096 · 10th–90th $407$2,6920%10%20%10th90th$1,096$100.0$200.0$500.0$1.0K$2.0K$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
Professional
Modifier
Global
Typical Low
$407.38
Median
$741.31
Typical High
$6,025.60
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$1,479.11
Typical High
$1,479.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,479.11
Typical High
$1,479.11
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,380.38
Typical High
$2,691.53
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,380.38
Typical High
$2,691.53
Providence
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,318.26
Typical High
$1,698.24
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,122.02
Typical High
$1,479.11
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$776.25
Typical High
$812.83
United
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$630.96
Typical High
$954.99