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Scope Treatment of a Ureterocele in the Bladder

Hawaii rates for HCPCS 52301

A thin telescope is passed along the urine channel into the bladder, and a ureterocele — a balloon-like swelling at the end of the tube bringing urine down from the kidney — is cut open or destroyed so urine can drain freely. It is done entirely through the natural opening, with no external incision.

Rates data updated July 2026.

Facilitymedian $4,467 · 10th–90th $1,318$4,4670%50%10th$4,467Professionalmedian $2,570 · 10th–90th $295$6,1660%10%10th90th$2,570$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$1,318.26
Median
$4,466.84
Typical High
$4,466.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$316.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$363.08
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$302.00
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,041.74
Typical High
$2,041.74
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$380.19
Typical High
$416.87
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$3,235.94
Typical High
$6,165.95