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Anesthesia For Diagnostic Shoulder Scope

Washington 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 $302 · 10th to 90th $50 to $380Professionalmedian $229 · 10th to 90th $50 to $1,202
$50$100$200$500$1K$2Kfacility $302professional $229

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$354.81
Typical High
$371.54
Aetna
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$50.12
Typical High
$371.54
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$269.15
Median
$1,202.26
Typical High
$2,398.83
Asuris Northwest Health
Setting
Professional
Modifier
AD · Supervising 5+
Typical Low
$128.82
Median
$134.90
Typical High
$190.55
Asuris Northwest Health
Setting
Professional
Modifier
QK · Directing 2–4 cases
Typical Low
$134.90
Median
$134.90
Typical High
$190.55
Asuris Northwest Health
Setting
Professional
Modifier
QX · CRNA, directed
Typical Low
$134.90
Median
$134.90
Typical High
$190.55
Asuris Northwest Health
Setting
Professional
Modifier
QY · Directing one CRNA
Typical Low
$134.90
Median
$134.90
Typical High
$190.55
Cigna
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$218.78
Typical High
$346.74
Molina
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$75.86
Typical High
$93.33
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$257.04
Typical High
$380.19
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$309.03
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$269.15
Median
$269.15
Typical High
$389.05
Regence BlueShield
Setting
Professional
Modifier
AD · Supervising 5+
Typical Low
$134.90
Median
$134.90
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
QK · Directing 2–4 cases
Typical Low
$134.90
Median
$134.90
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
QX · CRNA, directed
Typical Low
$134.90
Median
$134.90
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
QY · Directing one CRNA
Typical Low
$134.90
Median
$134.90
Typical High
$194.98
United
Setting
Professional
Modifier
None
Typical Low
$45.71
Median
$56.23
Typical High
$83.18
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$3.98
Median
$81.28
Typical High
$81.28
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
Ambetter
Setting
Professional
Modifier
AA · Anesthesiologist
Typical Low
$478.63
Median
$478.63
Typical High
$478.63