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Scope Treatment of a Ureterocele in the Bladder

Washington 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 $2,042 · 10th–90th $389$15,8490%10%10th90th$2,042Professionalmedian $537 · 10th–90th $269$8320%20%10th90th$537$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
$537.03
Median
$6,456.54
Typical High
$18,620.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$371.54
Typical High
$776.25
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$7,079.46
Median
$10,964.78
Typical High
$19,054.61
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$562.34
Typical High
$724.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$2,344.23
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$537.03
Typical High
$851.14
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$676.08
Typical High
$9,772.37
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$630.96
Typical High
$3,090.30
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$562.34
Typical High
$588.84
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$389.05
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$602.56
Typical High
$831.76
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$10,471.29
Typical High
$19,054.61
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$562.34
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$10,964.78
Typical High
$19,952.62
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$478.63
Typical High
$812.83
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$346.74
Typical High
$512.86