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

Utah 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 $617 · 10th–90th $407$1,4130%20%40%10th90th$617Professionalmedian $794 · 10th–90th $407$6,0260%10%10th90th$794$50.0$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
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$630.96
Typical High
$6,025.60
Cigna
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$1,047.13
Typical High
$1,318.26
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$1,412.54
Typical High
$1,412.54
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$1,023.29
Typical High
$1,548.82
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
Select Health
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,412.54
Typical High
$1,445.44
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,445.44
Typical High
$1,698.24
United
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$630.96
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$630.96
Typical High
$954.99