Dental tomographic imaging survey

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

Dental tomographic survey

Payers reporting HCPCS D0322

Payer pricing summary

Low

$92

Average

$190

Median

$168

High

$529

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +7 other terms	285	$114	$149	$108	73%	—	$58 – $1.1k
2	Humana fee schedule · outpatient · +5 other terms	192	$125	$432	$637	147%	—	$88 – $2.1k
3	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	175	$112	$199	$143	72%	—	$0 – $839
4	UnitedHealthcare fee schedule · outpatient · +8 other terms	170	$113	$188	$201	107%	—	$93 – $3.1k
5	Cigna fee schedule · outpatient · +6 other terms	104	$109	$136	$60	44%	—	$94 – $342
6	Molina fee schedule · outpatient · +5 other terms	89	$126	$151	$77	51%	—	$76 – $761
7	WellCare fee schedule · outpatient · +3 other terms	77	$108	$130	$47	36%	—	$96 – $249
8	Devoted fee schedule · outpatient · +2 other terms	47	$114	$108	$7	7%	—	$97 – $118
9	Ambetter facility · fee schedule · outpatient · +3 other terms	40	$184	$188	$39	21%	—	$113 – $256
10	Oscar fee schedule · outpatient · +4 other terms	39	$218	$203	$44	22%	—	$123 – $299
11	Anthem facility · fee schedule · outpatient · +5 other terms	38	$150	$205	$182	89%	—	$98 – $1.2k
12	Kaiser fee schedule · outpatient · +3 other terms	30	$224	$232	$113	49%	—	$106 – $523
13	Bcbs Tx fee schedule · outpatient	23	$104	$104	$3	3%	—	$100 – $110
14	Optum fee schedule · outpatient · +3 other terms	23	$109	$161	$85	53%	—	$95 – $386
15	Clover fee schedule · outpatient · +3 other terms	21	$116	$113	$9	8%	—	$94 – $125
16	Caresource facility · fee schedule · outpatient · +3 other terms	17	$160	$150	$43	28%	—	$107 – $208
17	Regence facility · case rate · outpatient · +2 other terms	16	$109	$132	$65	49%	—	$98 – $342
18	First Health fee schedule · outpatient · +1 other terms	14	$109	$124	$36	29%	—	$109 – $213
19	MultiPlan fee schedule · outpatient · +4 other terms	14	$176	$176	—	—	—	$176 – $176
20	Highmark fee schedule · outpatient · +3 other terms	13	$175	$177	$69	39%	—	$48 – $761
21	Bcbs Nj fee schedule · outpatient	12	$119	$252	$169	67%	—	$116 – $514
22	Tricare fee schedule · outpatient · +2 other terms	11	$95	$100	$4	5%	—	$95 – $105
23	Medical Mutual fee schedule · outpatient · +2 other terms	10	$291	$261	$90	34%	—	$91 – $439
24	Aetna Better Health facility · case rate · outpatient · +1 other terms	7	$174	$173	$2	1%	—	$167 – $174
25	Amerihealth Caritas facility · case rate · outpatient · +5 other terms	7	$159	$162	$5	3%	—	$159 – $174

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