go back

Scope Treatment of a Ureterocele in the Bladder

South Dakota 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 $776 · 10th–90th $347$4,3650%10%10th90th$776Professionalmedian $490 · 10th–90th $245$8130%10%10th90th$490$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$3,548.13
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$269.15
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$660.69
Typical High
$812.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$562.34
Typical High
$776.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$512.86
Typical High
$2,137.96
Midlands
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$630.96
Typical High
$676.08
Midlands
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$489.78
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$7,244.36
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$575.44
Typical High
$812.83
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$602.56
Typical High
$630.96