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Scope Treatment of a Ureterocele in the Bladder

Wisconsin 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 $7,586 · 10th–90th $3,548$11,7490%10%10th90th$7,586Professionalmedian $550 · 10th–90th $288$1,3180%10%10th90th$550$50.0$200.0$1.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$588.84
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$363.08
Typical High
$1,318.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$7,943.28
Typical High
$13,182.57
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$549.54
Typical High
$1,380.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$870.96
Typical High
$1,380.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$912.01
Typical High
$1,023.29
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$3,090.30
Typical High
$5,370.32
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$707.95
Typical High
$870.96
Medica
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$5,623.41
Typical High
$8,709.64
Medica
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$524.81
Typical High
$1,949.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$389.05
Network Health
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$5,754.40
Typical High
$7,762.47
Network Health
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$724.44
Typical High
$933.25
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$338.84
Typical High
$575.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$645.65
Typical High
$933.25
Quartz
Setting
Facility
Modifier
Global
Typical Low
$6,760.83
Median
$9,772.37
Typical High
$9,772.37
Quartz
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$912.01
Typical High
$2,089.30
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$1,479.11
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,698.24
Typical High
$2,089.30
United
Setting
Facility
Modifier
Global
Typical Low
$4,073.80
Median
$7,413.10
Typical High
$9,120.11
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$489.78
Typical High
$1,258.93