Intraoral periapical x-ray, each additional image

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 EA ADD

Payers reporting HCPCS D0230

Payer pricing summary

Low

Average

$1.2k

Median

$173

High

$22k

Payer rate distribution

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Filter by billing class

#
1	Humana fee schedule · outpatient · +10 other terms	71	$54	$49	$32	65%	—	$9 – $152
2	Aetna fee schedule · outpatient · +13 other terms	32	$11	$30	$82	269%	—	$5 – $619
3	UnitedHealthcare fee schedule · outpatient · +13 other terms	30	$14	$25	$42	166%	—	$3 – $230
4	Molina facility · case rate · outpatient · +8 other terms	29	$423	$335	$333	99%	—	$21 – $1.0k
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +11 other terms	22	$7	$420	$2.1k	506%	—	$0 – $22k
6	Anthem professional · fee schedule · outpatient · +6 other terms	17	$11	$19	$11	57%	—	$11 – $44
7	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +7 other terms	16	$10	$2.8k	$7.8k	273%	—	$10 – $24.9k
8	Caresource facility · case rate · outpatient · +3 other terms	15	$615	$661	$151	23%	—	$411 – $1.0k
9	Optum facility · case rate · outpatient · +3 other terms	13	$546	$533	$253	47%	—	$23 – $927
10	Highmark fee schedule · outpatient · +5 other terms	11	$9	$10	$6	66%	—	$9 – $70
11	Cigna professional · fee schedule · outpatient · +7 other terms	10	$2	$3	$2	50%	—	$2 – $6
12	Clover facility · percent of total billed charges · outpatientfrom % of charges	10	$2	$2	—	—	—	$2 – $2
13	Medcost percent of total billed charges · bothfrom % of charges	8	$173	$173	$10	6%	—	$163 – $183
14	Medicaid fee schedule · outpatient · +2 other terms	8	$35	$32	$8	26%	—	$9 – $37
15	Tricare fee schedule · both · +4 other terms	8	$27	$27	—	—	—	$27 – $27
16	Aetna Better Health facility · case rate · outpatient · +3 other terms	7	$29	$29	$0	1%	—	$28 – $29
17	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$26	$27	$1	3%	—	$26 – $29
18	Medica fee schedule · outpatient · +3 other terms	5	$6	$4	$2	47%	—	$2 – $6
19	Kaiser fee schedule · outpatient · +3 other terms	4	$223	$218	$171	79%	—	$35 – $523
20	Excellus facility · fee schedule · outpatient · +4 other terms	3	$660	$11.2k	$10.8k	97%	—	$4 – $22k
21	Regence facility · fee schedule · outpatient · +1 other terms	3	$12	$297	$325	110%	—	$4 – $660
22	Wellmark facility · case rate · outpatient · +2 other terms	3	$91	$80	$25	32%	—	$37 – $101
23	Ambetter facility · other · outpatient · +2 other terms	2	$1.1k	$1.1k	$46	4%	—	$1.1k – $1.2k
24	Carefirst facility · fee schedule · outpatient	2	$332	$332	$328	99%	—	$4 – $660
25	Oscar facility · other · outpatient · +1 other terms	2	$898	$898	$21	2%	—	$877 – $918

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