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Wisconsin 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
$281.84 / $562.34 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $831.76 / $1,318.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $3,019.95 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $5,495.41 / $8,709.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $630.96 / $1,071.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11