ENDOSCOPY SWALLOW TST (FEES) at Samaritan Medical Center

Watertown, NY

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Pricing by billing methodology

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Payers reporting CPT 92612-GN at Samaritan Medical Center

Negotiated rates from the hospital’s own file: 4 payers, 7 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	Excellus medicare advantage facility · case rate · outpatient	$191	$191	—	—	—	$191 – $191
2	WellCare medicare advantage facility · case rate · outpatient	$191	$191	—	—	—	$191 – $191
3	Aetna medicare advantage facility · case rate · outpatient	$195	$195	—	—	—	$195 – $195
4	UnitedHealthcare medicare advantage facility · case rate · outpatient	$197	$197	—	—	—	$197 – $197
5	UnitedHealthcare commercial facility · case rate · outpatient	$275	$275	—	—	—	$275 – $275
6	Excellus commercial facility · case rate · outpatient	$879	$879	—	—	—	$879 – $879
7	Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k

Last updated: Feb 2, 2026

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