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.
Generation details were not recorded for this description.
Original text from hospital filings
HC Dental Sealant per Tooth
Low
$18
Average
$192
Median
$78
High
$660
Each hospital's average Kaiser rate, under the methodology and billing class chosen below.
12 hospitals; the 90th percentile is 33.0× 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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15 hospital rates
iThe hospitals that file a Kaiser 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 | KAISER FOUNDATION HOSPITAL - SOUTH SACRAMENTO SACRAMENTO, CA percent of total billed charges · bothfrom % of charges | 2 | $18 | $18 | $9 | 50% | 2–20 | $9 – $28 |
| 2 | KAISER FOUNDATION HOSPITAL - MODESTO 95356, CA percent of total billed charges · bothfrom % of charges | 1 | $28 | $28 | — | — | 1–10 | $28 – $28 |
| 3 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 3 | $304 | $312 | $170 | 54% | — | $108 – $523 |
| 4 | Benefis Hospitals Inc Helena, MT percent of total billed charges · bothfrom % of charges | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 5 | Covenant Medical Center Inc Waterloo, IA facility · fee schedule · outpatient | 1 | $660 | $660 | — | — | — | $660 – $660 |
| 6 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 2 | $130 | $130 | $22 | 17% | — | $108 – $152 |
| 7 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA percent of total billed charges · outpatientfrom % of charges | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 8 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient | 1 | $660 | $660 | — | — | — | $660 – $660 |
| 9 | Mercy Medical Center - Dubuque Dubuque, IA facility · fee schedule · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 10 | OREGON HEALTH & SCIENCE UNIVERSITY PORTLAND, OR percent of total billed charges · outpatientfrom % of charges | 3 | $20 | $18 | $2 | 10% | — | $16 – $20 |
| 11 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $375 | $375 | — | — | — | $375 – $375 |
| 12 | REEDLEY COMMUNITY HOSPITAL Reedley, CA percent of total billed charges · outpatientfrom % of charges | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 13 | SONORA COMMUNITY HOSPITAL Sonora, CA percent of total billed charges · outpatientfrom % of charges | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 14 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 2 | $194 | $194 | $86 | 44% | — | $108 – $280 |
| 15 | UKIAH ADVENTIST HOSPITAL Ukiah, CA percent of total billed charges · outpatientfrom % of charges | 1 | $86 | $86 | — | — | — | $86 – $86 |
← Payers reporting HCPCS D1351 · Snapshot 20261111T120946Z-9134e7f7