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Washington rates for HCPCS 52300

Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $6,309.57 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,890.45
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $645.65 / $9,549.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $537.03 / $549.54
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $380.19 / $380.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $9,772.37 / $19,054.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $12,302.69 / $20,892.96