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.
Original text from hospital filings
SALIVA SUBSTITUTE COMBO NO.9 MOUTHWASH
Low
$0
Average
$22
Median
$19
High
$51
Each hospital's average Molina rate, under the methodology and billing class chosen below.
43 hospitals; the 90th percentile is 6.6× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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55 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 2 | Bristol Regional Medical Center BRISTOL, VA fee schedule · both | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 3 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $14 | $14 | — | — | — | $14 – $14 |
| 4 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 6 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 7 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · inpatientfrom % of charges | 2 | $4 | $4 | — | — | — | $4 – $4 |
| 9 | Carle BroMenn Medical Center Normal, IL percent of total billed charges · outpatientfrom % of charges | 2 | $4 | $4 | — | — | — | $4 – $4 |
| 10 | Carle Eureka Hospital Eureka, IL percent of total billed charges · inpatientfrom % of charges | 2 | $4 | $4 | — | — | — | $4 – $4 |
| 11 | Carle Eureka Hospital Eureka, IL percent of total billed charges · outpatientfrom % of charges | 2 | $7 | $7 | $3 | 41% | — | $4 – $10 |
| 12 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 13 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 14 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 15 | Greeneville Community Hospital GREENEVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 16 | Hancock County Hospital SNEEDVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $33 | $33 | — | — | — | $33 – $33 |
| 17 | Hawkins County Memorial Hospital ROGERSVILLE, TN fee schedule · both | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 18 | Holston Valley Medical Center KINGSPORT, TN fee schedule · both | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 19 | Hoopeston Community Memorial Hospital Hoopeston, IL percent of total billed charges · inpatientfrom % of charges | 2 | $6 | $6 | — | — | — | $6 – $6 |
| 20 | Hoopeston Community Memorial Hospital Hoopeston, IL percent of total billed charges · outpatientfrom % of charges | 2 | $5 | $5 | $1 | 18% | — | $5 – $6 |
| 21 | IHC Health Services Inc., DBA Intermountain Health Cassia Regional Hospital Burley, ID facility · percent of total billed charges · inpatientfrom % of charges | 2 | $47 | $47 | — | — | — | $47 – $47 |
| 22 | IHC Health Services Inc., DBA Intermountain Health Cassia Regional Hospital Burley, ID facility · percent of total billed charges · outpatientfrom % of charges | 4 | $31 | $31 | $16 | 52% | — | $15 – $47 |
| 23 | IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital Logan, UT facility · percent of total billed charges · inpatientfrom % of charges | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 24 | IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital Logan, UT facility · percent of total billed charges · outpatientfrom % of charges | 2 | $22 | $22 | — | — | — | $22 – $22 |
| 25 | IHC Health Services Inc., DBA Intermountain Health McKay-Dee Hospital Ogden, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $51 | $51 | — | — | — | $51 – $51 |
← Payers reporting HCPCS A9154 · Snapshot 20261111T120946Z-9134e7f7