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
$1
Average
$866
Median
$51
High
$23.1k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
71 hospitals; the 90th percentile is 35.9× 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.
Filter by billing methodology
Filter by billing class
74 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 | Wesley Health System LLC Hattiesburg, MS facility · other · outpatient | 2 | $34 | $34 | $1 | 3% | 2–20 | $33 – $36 |
| 2 | Brandon HMA LLC Brandon, MS facility · other · outpatient | 2 | $34 | $34 | $1 | 3% | 1–10 | $33 – $36 |
| 3 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | 1–10 | $51 – $51 |
| 4 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | 1–10 | $51 – $51 |
| 5 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | 1–10 | $51 – $51 |
| 6 | PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 1 | $51 | $51 | — | — | 1–10 | $51 – $51 |
| 7 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $922 | $922 | — | — | — | $922 – $922 |
| 8 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 1 | $31 | $31 | — | — | — | $31 – $31 |
| 10 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 11 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 12 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 13 | Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient | 1 | $207 | $207 | — | — | — | $207 – $207 |
| 14 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $895 | $895 | — | — | — | $895 – $895 |
| 15 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 16 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $992 | $992 | — | — | — | $992 – $992 |
| 17 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 18 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 19 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $80 | $80 | — | — | — | $80 – $80 |
| 20 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 21 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $900 | $900 | — | — | — | $900 – $900 |
| 22 | Covenant Medical Center Inc Waterloo, IA facility · other · outpatient | 1 | $625 | $625 | — | — | — | $625 – $625 |
| 23 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · both | 3 | $47 | $67 | $28 | 42% | — | $47 – $107 |
| 24 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 1 | $350 | $350 | — | — | — | $350 – $350 |
| 25 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $952 | $952 | — | — | — | $952 – $952 |
← Payers reporting HCPCS D1351 · Snapshot 20261111T120946Z-9134e7f7