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Upper Extremity Socket Insert, without Locking Mechanism

Montana rates for HCPCS L6695

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

Rates data updated July 2026.

Facilitymedian $741 · 10th–90th $525$9330%20%10th90th$741Professionalmedian $603 · 10th–90th $214$1,4450%10%10th90th$603$100.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$602.56
Typical High
$3,388.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$794.33
Typical High
$794.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$794.33
Typical High
$794.33
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$741.31
Typical High
$1,445.44
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$741.31
Typical High
$1,445.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$707.95
Typical High
$1,023.29
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$602.56
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$501.19
Typical High
$524.81
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$512.86