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Nonstandard Size or Width

Michigan rates for HCPCS L3254

Nonstandard size or width

Rates data updated July 2026.

Facilitymedian $87 · 10th–90th $14$2090%20%10th90th$87Professionalmedian $18 · 10th–90th $14$450%20%40%10th90th$18$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
$14.13
Median
$14.13
Typical High
$14.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$28.84
BCBS
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$134.90
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$44.67
Typical High
$46.77
CareSource
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
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
$8.71
Typical High
$10.72
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$87.10
Typical High
$97.72
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$33.11
Typical High
$45.71
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$8.71
Median
$8.71
Typical High
$8.71
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
$51.29
Typical High
$51.29