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Nonstandard Size or Width

Wisconsin rates for HCPCS L3254

Nonstandard size or width

Rates data updated July 2026.

Facilitymedian $14 · 10th–90th $11$650%50%10th90th$14Professionalmedian $14 · 10th–90th $14$660%50%90th$14$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. 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
$14.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
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
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$25.12
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$53.70
Typical High
$1,202.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$89.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Molina
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$54.95
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$25.12
Quartz
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$20.89
Typical High
$27.54
Quartz
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$64.57
Typical High
$100.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$10.72
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