Initial intraoral X-ray of one tooth

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

INTRAORAL PERIAPICAL FIRST

Anthem pricing summary

Low

Average

$183

Median

$126

High

$1.0k

Anthem rate distribution

Filter by billing methodology

Filter by billing class

126 hospital rates

#		Plans
1	AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient	1	$585	$585	—	—	—	$585 – $585
2	AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient	3	$207	$178	$69	39%	—	$82 – $244
3	AKRON GENERAL MEDICAL CENTER Akron, OH professional · fee schedule · outpatient	5	$52	$39	$15	39%	—	$20 – $52
4	Acadia Hospital Bangor, ME facility · case rate · outpatient	1	$85	$85	—	—	—	$85 – $85
5	Acadia Hospital Bangor, ME professional · fee schedule · outpatient	1	$19	$19	—	—	—	$19 – $19
6	Alta Bates Summit Medical Center Oakland, CA facility · fee schedule · outpatient	1	$124	$124	—	—	—	$124 – $124
7	Alta Bates Summit Medical Center-Summit Campus-Hawthorne Oakland, CA facility · fee schedule · outpatient	1	$124	$124	—	—	—	$124 – $124
8	Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient	2	$360	$360	$274	76%	—	$86 – $634
9	Aspirus Plover Hospital Stevens Point, WI fee schedule · outpatient	2	$362	$362	$275	76%	—	$87 – $637
10	Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient	2	$360	$360	$274	76%	—	$86 – $634
11	Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient	2	$135	$135	$45	33%	—	$90 – $180
12	Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient	2	$360	$360	$274	76%	—	$86 – $634
13	Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient	2	$362	$362	$275	76%	—	$87 – $637
14	Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient	2	$360	$360	$274	76%	—	$86 – $634
15	Atrium Medical Center Middletown, OH fee schedule · outpatient	3	$189	$191	$59	31%	—	$120 – $263
16	Benefis Hospitals Inc Helena, MT other · outpatient	1	$89	$89	—	—	—	$89 – $89
17	Benefis Senior Services Great Falls, MT other · outpatient	1	$89	$89	—	—	—	$89 – $89
18	Blue Hill Memorial Hospital Hill, ME facility · case rate · outpatient	2	$361	$361	$45	12%	—	$316 – $405
19	Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient	2	$15	$15	—	—	—	$15 – $15
20	CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient	1	$568	$568	—	—	—	$568 – $568
21	CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · fee schedule · outpatient	2	$130	$130	$48	37%	—	$82 – $178
22	CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient	1	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
23	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient	1	$629	$629	—	—	—	$629 – $629
24	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · fee schedule · outpatient	3	$202	$174	$66	38%	—	$82 – $237
25	CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient	1	$643	$643	—	—	—	$643 – $643

Page 1 of 6

← Payers reporting HCPCS D0220 · Snapshot 20261111T120946Z-9134e7f7

HCPCS D0220