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Lower Extremity Addition

		
Details: Below Knee/Above Knee, Custom Fabricated From Existing Mold, Socket Insert, Silicone Gel, Elastomeric or Equal, For Use With Locking Mechanism. L5673 is the Healthcare Commom Procedure Code System (HCPCS) code used to bill for this item.



Note: The estimates below are based on Medica Choice network contract rates. How were these costs calculated?




               

               


                    

                    

                    
                 
                    

                         

                    

               

               

          

          
          
          

               

               

               

               

                    

                         

                              

                                   
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                                   		 Facility     
                                   City/State                                 
                                   
                                        Average Cost Range     
                                     
                                   
                                                                                                                                                                
                              

                         
                        
                         

                         

                         

                         
                                                                 

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                                        Actra Rehabilitation Associates (9)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                               
                                   

                                         
                                        Arise Orthotics & Prosthetics, Inc.
                                        Blaine, MN
                                        $600.00 - $800.00
                                         
                   
                                   

                                                               

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                                        Fairview Home Medical Equipment (4)
                                        
                                        
                                        $1,000.00 - $1,200.00

								
                                        
                                   

                                   
                                   
                               
                                   

                                         
                                        Fairview Ortho and Prosth- University
                                        Minneapolis, MN
                                        $1,000.00 - $1,200.00
                                         
                   
                                   

                                                               

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                                        Fairview Orthotics and Prosthetics (7)
                                        
                                        
                                        $1,000.00 - $1,200.00

								
                                        
                                   

                                   
                                   
                               
                                   

                                         
                                        Fairview Riverside Pharmacy
                                        Minneapolis, MN
                                        $1,000.00 - $1,200.00
                                         
                   
                                   

                             
                                   

                                         
                                        Fairview Univ Med Ctr Dept of Pharmaceutical Serv
                                        Minneapolis, MN
                                        $1,000.00 - $1,200.00
                                         
                   
                                   

                             
                                   

                                         
                                        Great Steps Orthotic and Prosthetic Solutions
                                        Sartell, MN
                                        $600.00 - $800.00
                                         
                   
                                   

                                                               

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                                        Hanger Prosthetics & Orthotics (40)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Land of Lakes Orthotics & Prosthetics (6)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Orthotic Care Services (2)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Park Nicollet Health Care Products (20)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Prosthetic Laboratories of Rochester (12)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Tillges Certified Orthotic Prosthetic Inc (9)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 

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                                        Winkley Orthotics & Prosthetics (8)
                                        
                                        
                                        $600.00 - $800.00

								
                                        
                                   

                                   
                                   
                                                                 
                              


                         

                    

                    
                    
                    
                    
                    

               


               

                    
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