Initial intraoral X-ray of one tooth at MVHS, Inc.

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

HC Intraoral - Periapical First Radiographic Image

Utica, NY

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Pricing by billing methodology

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How this price compares nationally

MVHS, Inc.’s median price of $109 is 17% above the median hospital's median price ($93), higher than 73% of the 757 hospitals reporting HCPCS D0220. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS D0220 at MVHS, Inc.

Negotiated rates from the hospital’s own file: 11 payers, 21 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Excellus excellus bcbs medicaid percent of total billed charges · outpatientfrom % of charges	$7	$7	—	—	—	$7 – $7
2	UnitedHealthcare uhc empire plan percent of total billed charges · bothfrom % of charges	$11	$11	—	—	—	$11 – $11
3	Aetna aetna commercial percent of total billed charges · bothfrom % of charges	$16	$16	—	—	—	$16 – $16
4	Humana humana hmo/pos percent of total billed charges · inpatientfrom % of charges	$18	$18	—	—	—	$18 – $18
5	Bcbs Ny excellus bcbs indemnity percent of total billed charges · bothfrom % of charges	$18	$18	—	—	—	$18 – $18
6	Blue Cross Blue Shield excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges	$18	$18	—	—	—	$18 – $18
7	Excellus excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges	$18	$18	—	—	—	$18 – $18
8	Excellus excellus bcbs indemnity percent of total billed charges · bothfrom % of charges	$18	$18	—	—	—	$18 – $18
9	Cigna mvp and cigna commercial percent of total billed charges · inpatientfrom % of charges	$19	$19	—	—	—	$19 – $19
10	Humana humana hmo/pos percent of total billed charges · outpatientfrom % of charges	$20	$20	—	—	—	$20 – $20
11	Humana humana military other · outpatient	$99	$99	—	—	—	$99 – $99
12	Tricare humana military other · outpatient	$99	$99	—	—	—	$99 – $99
13	Excellus excellus bcbs medicare advantage other · outpatient	$109	$109	—	—	—	$109 – $109
14	Humana humana medicare advantage other · outpatient	$109	$109	—	—	—	$109 – $109
15	Medicare medicare other · outpatient	$109	$109	—	—	—	$109 – $109
16	Optum vaccn optum other · outpatient	$109	$109	—	—	—	$109 – $109
17	UnitedHealthcare uhc medicare advantage other · outpatient	$110	$110	—	—	—	$110 – $110
18	Aetna aetna medicare advantage other · outpatient	$111	$111	—	—	—	$111 – $111
19	WellCare wellcare medicare advantage other · outpatient	$112	$112	—	—	—	$112 – $112
20	Cigna mvp and cigna commercial other · outpatient	$312	$312	—	—	—	$312 – $312
21	UnitedHealthcare uhc commercial case rate · inpatient	$2.6k	$2.6k	—	—	—	$2.6k – $2.6k

Last updated: Aug 7, 2026

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