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Scope Treatment of a Ureterocele in the Bladder

Ohio 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 $4,571 · 10th–90th $891$10,9650%10%10th90th$4,571Professionalmedian $339 · 10th–90th $269$5,7540%20%10th90th$339$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$549.54
Median
$6,606.93
Typical High
$12,022.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$8,912.51
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,548.13
Typical High
$15,135.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$338.84
Typical High
$575.44
CareSource
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$288.40
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$21,379.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$380.19
Typical High
$575.44
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$380.19
Typical High
$575.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$309.03
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$4,168.69
Typical High
$7,413.10
United
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$338.84
Typical High
$575.44