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
PREFABRICATED STAINLESS STEEL CROWN PRIMARY TOOTH
Troy, NY
See all hospitals reporting HCPCS D2930 →Price type
Samaritan Hospital’s median price of $1.5k is 23% above the median hospital's median price ($1.2k), higher than 60% of the 585 hospitals reporting HCPCS D2930. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 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 | Anthem empire medicaid facility · fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 2 | Anthem empire medicaid essential 1 2 3 4 facility · fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 3 | Excellus empire medicaid facility · fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 4 | Excellus empire medicaid essential 1 2 3 4 facility · fee schedule · outpatient | $8 | $8 | — | — | — | $8 – $8 |
| 5 | Aetna aetna facility · fee schedule · outpatient | $18 | $18 | — | — | — | $18 – $18 |
| 6 | Medical Mutual aetna facility · fee schedule · outpatient | $18 | $18 | — | — | — | $18 – $18 |
| 7 | UnitedHealthcare united healthcare medicaid harp chip facility · fee schedule · outpatient | $160 | $160 | — | — | — | $160 – $160 |
| 8 | UnitedHealthcare uhc essential plan medicaid facility · fee schedule · outpatient | $545 | $545 | — | — | — | $545 – $545 |
| 9 | Anthem empire bcbs medicare advantage facility · other · outpatient | $791 | $791 | — | — | — | $791 – $791 |
| 10 | UnitedHealthcare united healthcare medicare advantage facility · other · outpatient | $822 | $822 | — | — | — | $822 – $822 |
| 11 | Aetna aetna medicare advantage facility · other · outpatient | $854 | $854 | — | — | — | $854 – $854 |
| 12 | WellCare wellcare medicare advantage facility · other · outpatient | $882 | $882 | — | — | — | $882 – $882 |
| 13 | Excellus blue shield of ne new york medicare adv facility · other · outpatient | $888 | $888 | — | — | — | $888 – $888 |
| 14 | Highmark blue shield of ne new york medicare adv facility · other · outpatient | $888 | $888 | — | — | — | $888 – $888 |
| 15 | WellCare wellcare ep 1&2 medicaid facility · other · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 16 | Anthem empire bcbs blue access facility · other · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 17 | Anthem empire bcbs hmo epo ppo indemnity facility · other · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 18 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · other · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 19 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · other · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 20 | Wellmark empire bcbs hmo epo ppo indemnity facility · other · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 21 | Cigna cigna facility · fee schedule · outpatient | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
Last updated: Mar 31, 2026
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