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Utah rates for HCPCS D0220

Intraoral - Periapical First Radiographic Image

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $10.96 / $20.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $44.67 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.45 / $14.45
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $15.14 / $17.38