ULTRAVIOLET at Samaritan Medical Center

Watertown, NY

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Pricing by billing methodology

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Payers reporting CPT 97028-GP 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	$8	$8	—	—	—	$8 – $8
2	WellCare medicare advantage facility · case rate · outpatient	$8	$8	—	—	—	$8 – $8
3	Aetna medicare advantage facility · case rate · outpatient	$8	$8	—	—	—	$8 – $8
4	UnitedHealthcare medicare advantage facility · case rate · outpatient	$8	$8	—	—	—	$8 – $8
5	Excellus commercial facility · case rate · outpatient	$37	$37	—	—	—	$37 – $37
6	Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges	$143	$143	—	—	—	$143 – $143
7	UnitedHealthcare commercial facility · case rate · outpatient	$275	$275	—	—	—	$275 – $275

Last updated: Feb 2, 2026

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