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Upper Extremity Socket Insert, without Locking Mechanism

South 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 $741 · 10th–90th $537$1,4790%10%10th90th$741Professionalmedian $741 · 10th–90th $589$1,1480%10%20%10th90th$741$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$660.69
Typical High
$741.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$1,148.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$776.25
Typical High
$2,041.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$512.86
Typical High
$3,801.89
Midlands
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$812.83
Typical High
$831.76
Midlands
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$1,348.96
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$758.58
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$501.19
Typical High
$549.54
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$512.86
Typical High
$933.25
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31