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Scope Treatment of a Ureterocele in the Bladder

Virginia 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 $331$8,9130%5%10th90th$4,074Professionalmedian $331 · 10th–90th $275$3,3880%10%20%10th90th$331$200.0$500.0$1.0K$2.0K$5.0K$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
$331.13
Median
$5,011.87
Typical High
$8,912.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$4,365.16
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,888.44
Median
$6,760.83
Typical High
$7,413.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$354.81
Typical High
$512.86
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$426.58
Typical High
$5,495.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$380.19
Typical High
$676.08
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$295.12
Typical High
$758.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$512.86
Typical High
$660.69
Medcost
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$416.87
Typical High
$602.56
Sentara
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$389.05
Typical High
$8,709.64
Sentara
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$389.05
Typical High
$8,709.64
United
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$6,606.93
Typical High
$13,489.63
United
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$371.54
Typical High
$588.84