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Nonstandard Size or Width

South Dakota rates for HCPCS L3254

Nonstandard size or width

Rates data updated October 2026.

How much does Nonstandard Size or Width cost?

$46.77

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $46.77 for this service. The price depends on where it is billed: about $46.77 from a physician practice, and about $30.20 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$46.77$17.78 to $46.77
FacilityA hospital or hospital-owned outpatient department$30.20$25.70 to $30.20

How much rates vary

Facilitymedian $30 · 10th to 90th $14 to $49Professionalmedian $47 · 10th to 90th $18 to $47
$10$20$50facility $30professional $47

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$14.45
Median
$14.45
Typical High
$14.45
Aetna
Setting
Professional
Modifier
None
Typical Low
$14.45
Median
$17.78
Typical High
$17.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Cigna
Setting
Professional
Modifier
None
Typical Low
$7.76
Median
$7.76
Typical High
$53.70
Medica
Setting
Facility
Modifier
None
Typical Low
$25.12
Median
$30.20
Typical High
$48.98
Medica
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$56.23
Midlands
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
Midlands
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
United
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Wellmark
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$46.77
Typical High
$46.77

Where South Dakota sits

The same service costs 27.5 times more in Kansas than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 12th of 51

$46.77

KS $138SC $5.01

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.