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Upper Extremity Socket Insert, without Locking Mechanism

North Dakota 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 $550 · 10th–90th $550$9330%50%90th$550Professionalmedian $708 · 10th–90th $398$9330%20%10th90th$708$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
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$660.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$549.54
Typical High
$3,019.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$831.76
Typical High
$912.01
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Cigna
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$912.01
Typical High
$1,148.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$660.69
Typical High
$1,659.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$758.58
United
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$1,096.48
United
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$512.86
Typical High
$933.25