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Scope Treatment of a Ureterocele in the Bladder

Pennsylvania 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 $4,074 · 10th–90th $977$8,3180%5%10%10th90th$4,074Professionalmedian $302 · 10th–90th $257$5890%20%10th90th$302$200.0$1.0K$5.0K$20.0K

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
$954.99
Median
$4,786.30
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$707.95
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$6,456.54
Median
$7,585.78
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$436.52
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$354.81
Typical High
$537.03
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$426.58
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$354.81
Typical High
$562.34
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,890.45
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$309.03
Typical High
$1,737.80
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$371.54
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,862.09
Typical High
$3,235.94
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$281.84
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$3,890.45
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$338.84
Typical High
$588.84