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Upper Extremity Socket Insert, without Locking Mechanism

Wisconsin 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 $813 · 10th–90th $646$1,4790%50%10th90th$813Professionalmedian $759 · 10th–90th $398$1,3490%10%20%10th90th$759$1.0$5.0$20.0$100.0$500.0$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
$398.11
Median
$398.11
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$707.95
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,318.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$758.58
Typical High
$912.01
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,862.09
Typical High
$4,073.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$1,174.90
Typical High
$1,513.56
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$645.65
Typical High
$1,000.00
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$776.25
Typical High
$954.99
Medica
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$794.33
Typical High
$3,467.37
Medica
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$478.63
Typical High
$891.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$501.19
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Network Health
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$912.01
Typical High
$1,584.89
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$645.65
Typical High
$1,000.00
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$776.25
Typical High
$794.33
Quartz
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,202.26
Typical High
$1,995.26
Quartz
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$1,621.81
Typical High
$3,548.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$1,202.26
Typical High
$3,890.45
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$501.19
Typical High
$812.83
United
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$398.11
Typical High
$724.44