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
Current code24 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $630 – $4,886 | — | — |
| Deaconess Medical Center | $875 – $3,041 | — | — |
| Harborview Medical Center | $1,169 – $1,462 | $895 | $1,279 |
| Kadlec Regional Medical Center | $1,102 – $2,053 | — | — |
| Mary Bridge Children's Hospital | $630 – $5,363 | — | — |
| MultiCare Auburn Medical Center | $612 – $3,157 | — | — |
| MultiCare Covington Medical Center | $612 – $3,157 | — | — |
| MultiCare Good Samaritan Hospital | $710 – $3,157 | — | — |
| MultiCare Valley Hospital | $700 – $3,035 | — | — |
| Overlake Hospital Medical Center & Clinics | $670 – $2,011 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1,132 – $2,424 | — | — |
| Providence Centralia Hospital | $1,235 – $2,732 | — | — |
| Providence Regional Medical Center Everett | $877 – $1,695 | — | — |
| Providence St Peter Hospital | $621 – $2,386 | — | — |
| Seattle Children's Hospital | $1,219 – $2,168 | $2,258 | $2,258 |
| Swedish Edmonds Hospital | $1,096 – $2,681 | — | — |
| Swedish Issaquah | $1,096 – $1,622 | — | — |
| Swedish Medical Center | $1,096 – $2,610 | — | — |
| Swedish Medical Center / Cherry Hill | $1,096 – $2,610 | — | — |
| Tacoma General Allenmore Hospital | $612 – $3,157 | — | — |
| University of Washington Medical Ctr | $1,169 – $2,292 | $1,130 | $1,615 |
| Virginia Mason Medical Center | $700 – $2,541 | — | — |
| Wellfound Behavioral Health Hospital | $1,844 | — | — |
| Yakima Valley Memorial | $630 – $1,896 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $731 (fee)