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Nonstandard Size or Width

California rates for HCPCS L3254

Nonstandard size or width

Rates data updated July 2026.

Facilitymedian $62 · 10th–90th $49$1550%20%10th90th$62Professionalmedian $14 · 10th–90th $11$660%20%10th90th$14$10.0$20.0$50.0$100.0$200.0$500.0

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
$28.84
Median
$102.33
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$28.84
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$61.66
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Cigna
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$10.72
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$21.38
Typical High
$25.70
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$34.67
Typical High
$630.96
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$17.78
Typical High
$46.77
Providence
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$10.72
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$23.44
Typical High
$36.31
United
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$52.48