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

WellCare pricing summary

Low

$57

Average

$281

Median

$94

High

$22k

WellCare rate distribution

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175 hospital rates

#		Plans
1	Brunswick Community Hospital, LLC Bolivia, NC percent of total billed charges · outpatientfrom % of charges	1	$330	$330	—	—	1–10	$330 – $330
2	Forsyth Memorial Hospital, Inc. Winston-Salem, NC percent of total billed charges · outpatientfrom % of charges	1	$148	$148	—	—	1–10	$148 – $148
3	Novant Health New Hanover Regional Medical Center LLC Wilmington, NC percent of total billed charges · outpatientfrom % of charges	1	$312	$312	—	—	1–10	$312 – $312
4	Acadia Hospital Bangor, ME facility · case rate · outpatient	1	$87	$87	—	—	—	$87 – $87
5	Adventhealth Carrollwood Tampa, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
6	Adventhealth North Pinellas Palm Harbor, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
7	Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
8	Adventhealth Tampa Brandon, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
9	Adventhealth Wesley Chapel Lutz, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
10	Adventhealth Zephyrhills Zephyrhills, FL fee schedule · outpatient	1	$102	$102	—	—	—	$102 – $102
11	Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient	1	$88	$88	—	—	—	$88 – $88
12	Arkansas Childrens Hospital Little Rock, AR facility · other · outpatient	1	$81	$81	—	—	—	$81 – $81
13	Bartow Regional Medical Center Bartow, FL facility · case rate · outpatient	1	$124	$124	—	—	—	$124 – $124
14	Baycare Hospital Wesley Chapel Chapel, FL facility · case rate · outpatient	1	$124	$124	—	—	—	$124 – $124
15	Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient	1	$81	$81	—	—	—	$81 – $81
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	Boston Medical Center Boston, MA other · both	1	$105	$105	—	—	—	$105 – $105
19	Bradley Medical Center Cleveland, TN facility · fee schedule · outpatient	1	$83	$83	—	—	—	$83 – $83
20	CHRISTUS Good Shepherd Hospital - Northpark Longview, TX fee schedule · outpatient	1	$84	$84	—	—	—	$84 – $84
21	CHRISTUS Hospital - Orange Orange, TX fee schedule · outpatient	1	$88	$88	—	—	—	$88 – $88
22	CHRISTUS West Beaumont Beaumont, TX fee schedule · outpatient	1	$88	$88	—	—	—	$88 – $88
23	CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient	1	$89	$89	—	—	—	$89 – $89
24	CRAWFORD LONG HOSPITAL Atlanta, GA facility · fee schedule · outpatient	1	$94	$94	—	—	—	$94 – $94
25	CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient	1	$89	$89	—	—	—	$89 – $89