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Anesthesia For Diagnostic Shoulder Scope

Virginia rates for HCPCS 01622

Anesthesia care provided while a scope is used to look inside the shoulder joint. The examination is diagnostic rather than a treatment. The charge covers the anesthesia care, not the shoulder procedure.

Rates data updated October 2026.

How much rates vary

Facilitymedian $37 · 10th to 90th $20 to $447Professionalmedian $166 · 10th to 90th $30 to $363
$20$100$500$2Kfacility $37professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$30.20
Median
$302.00
Typical High
$446.68
Aetna
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$37.15
Typical High
$426.58
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$338.84
Median
$338.84
Typical High
$398.11
CareFirst
Setting
Professional
Modifier
None
Typical Low
$3.31
Median
$3.31
Typical High
$5.50
Cigna
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$263.03
Typical High
$354.81
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$354.81
Typical High
$426.58
Sentara
Setting
Facility
Modifier
None
Typical Low
$19.05
Median
$31.62
Typical High
$97.72
Sentara
Setting
Professional
Modifier
None
Typical Low
$22.91
Median
$60.26
Typical High
$85.11
United
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$57.54
Typical High
$77.62
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
CareFirst
Setting
Professional
Modifier
NA
Typical Low
$3.02
Median
$3.31
Typical High
$3.47