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Upper Extremity Socket Insert, without Locking Mechanism

Pennsylvania 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 $891 · 10th–90th $316$2,6300%20%10th90th$891Professionalmedian $372 · 10th–90th $288$7080%20%40%10th90th$372$1.0$10.0$100.0$1.0K$10.0K

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
$316.23
Median
$316.23
Typical High
$1,202.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$346.74
Typical High
$562.34
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$1,023.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$562.34
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$891.25
Typical High
$1,288.25
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$501.19
Typical High
$724.44
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$524.81
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,202.26
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$346.74
Typical High
$562.34
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$2,344.23
Typical High
$4,073.80
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$676.08
Typical High
$758.58
United
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$912.01
Typical High
$912.01
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$398.11
Typical High
$758.58