Gouverneur Hospital
77 West Barney Street, Gouverneur, NY · Rochesterregional · · NPI 1629409925
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Pet scan brain perf study CPT 78609 | not published | not published | $594.00 – $594.00 | 1 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | not published | not published | $51.14 – $51.14 | 1 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | not published | not published | $76.33 – $76.33 | 1 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | not published | not published | $25.67 – $25.67 | 1 |
| Pharmacologic management w/psytx CPT 90863 | not published | not published | $34.84 – $34.84 | 1 |
| Ph body fluid CPT 83986 | not published | not published | $3.47 – $46.56 | 3 |
| Phencyclidine (pcp) CPT 83992 | $207.92 | $319.88 | not published | 0 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | not published | not published | $29.44 – $48.48 | 2 |
| Phenobarbital therapeutic drug level CPT 80184 | $127.11 | $195.55 | $10.61 – $198.99 | 4 |
| Phentolaine mesylate inj HCPCS J2760 | not published | not published | $449.30 – $545.86 | 2 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | not published | not published | $0.01 – $0.01 | 1 |
| Phenylep ketorolac opth soln HCPCS J1097 | not published | not published | $113.28 – $139.50 | 2 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | not published | not published | $0.52 – $1.02 | 2 |
| Phenytoin total therapeutic drug level CPT 80185 | $135.17 | $207.96 | $10.61 – $172.33 | 4 |
| Phone e/m phys/qhp 11-20 min CPT 99442 | $152.61 | $234.79 | $17.49 – $17.49 | 1 |
| Phone e/m phys/qhp 21-30 min CPT 99443 | $135.48 | $208.43 | $21.65 – $21.65 | 1 |
| Phone e/m phys/qhp 5-10 min CPT 99441 | $131.57 | $202.41 | $8.75 – $8.75 | 1 |
| Phosphorus CPT 84100 | $55.68 | $85.66 | $4.60 – $61.65 | 4 |
| Phosphorus 24 hour urine CPT 84105 | not published | not published | $5.08 – $75.18 | 4 |
| Phys blood bank serv xmatch CPT 86077 | $77.60 | $119.39 | not published | 0 |
| Physical Therapy Evaluation (high complexity) CPT 97163 | $169.56 | $260.86 | $168.71 – $168.71 | 1 |
| Physical Therapy Evaluation (low complexity) CPT 97161 | $133.76 | $205.78 | $168.71 – $168.71 | 1 |
| Physical Therapy Evaluation (moderate complexity) CPT 97162 | $151.66 | $233.33 | $168.71 – $168.71 | 1 |
| Physical Therapy Re-Evaluation CPT 97164 | $86.90 | $133.70 | $115.77 – $115.77 | 1 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | not published | not published | $2.45 – $6.45 | 2 |
| Piflu f-18, dia 1 millicurie HCPCS A9595 | not published | not published | $631.73 – $631.73 | 1 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $266.59 – $3,574.49 | 3 |
| Pinworm exam CPT 87172 | not published | not published | $2.02 – $55.54 | 4 |
| Pinworm examinations HCPCS Q0113 | not published | not published | $4.14 – $55.54 | 3 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $4.62 | $7.10 | $1.12 – $3.60 | 2 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $562.10 – $7,536.83 | 3 |
| Place gastrostomy tube perc CPT 49440 | $3,008.64 | $4,628.67 | not published | 0 |
| Placental lactogen CPT 83632 | not published | not published | $19.61 – $262.99 | 3 |
| Place right device/marker pros CPT 55876 | $2,741.41 | $4,217.56 | not published | 0 |
| Plasma cryoprecipitate reduced each unit HCPCS P9044 | $164.84 | $253.60 | $16.01 – $16.01 | 1 |
| Plasmaprotein fract,5%,250ml HCPCS P9048 | not published | not published | $50.78 – $63.47 | 2 |
| Plasma protein fract,5%,50ml HCPCS P9043 | not published | not published | $21.62 – $27.02 | 2 |
| Plasma volume multiple CPT 78111 | not published | not published | $83.55 – $83.55 | 1 |
| Plasma volume single CPT 78110 | not published | not published | $55.50 – $55.50 | 1 |
| Platelet aggregation each agent teg CPT 85576 | $48.74 | $74.99 | $10.82 – $323.98 | 4 |
| Platelet automated CPT 85049 | $20.14 | $30.99 | $3.20 – $58.27 | 4 |
| Platelet pheresis each unit HCPCS P9034 | $812.90 | $1,250.61 | not published | 0 |
| Platelet pheresis irr ea HCPCS P9036 | $1,517.68 | $2,334.90 | not published | 0 |
| Platelets each unit HCPCS P9019 | $178.87 | $275.18 | not published | 0 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $376.15 | $578.69 | not published | 0 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $534.87 | $822.87 | not published | 0 |
| Platelets leukoreduced cmv negative apheresis/phresis each unit HCPCS P9055 | $1,204.43 | $1,852.97 | not published | 0 |
| Platelets pheresis leukocytes reduced cmv negative irradiated each unit HCPCS P9053 | $1,122.31 | $1,726.63 | not published | 0 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $1,548.92 | $2,382.96 | not published | 0 |
| Platelets pheresis pathogen-reduced each unit HCPCS P9073 | $887.87 | $1,365.95 | not published | 0 |
| Platelet survival CPT 78191 | not published | not published | $197.00 – $197.00 | 1 |
| Plcg2 gene common variants CPT 81320 | not published | not published | $282.62 – $3,789.49 | 3 |
| Plerixafor injection HCPCS J2562 | not published | not published | $24.98 – $465.80 | 2 |
| Pml/raralpha 1 breakpoint CPT 81316 | not published | not published | $201.09 – $2,696.32 | 4 |
| Pmp22 gene dup/delet CPT 81324 | not published | not published | $735.61 – $9,863.38 | 3 |
| Pmp22 gene full sequence CPT 81325 | not published | not published | $746.49 – $10,009.31 | 3 |
| Pmp22 gene known fam variant CPT 81326 | not published | not published | $45.20 – $606.09 | 3 |
| Pms2 gene dup/delet variants CPT 81319 | not published | not published | $197.40 – $2,646.76 | 3 |
| Pms2 gene full seq analysis CPT 81317 | not published | not published | $656.20 – $8,798.69 | 3 |
| Pms2 known familial variants CPT 81318 | not published | not published | $321.07 – $4,305.05 | 3 |
| Pne flu hepb cov home admin HCPCS M0201 | not published | not published | $39.55 – $39.55 | 5 |
| #pnh-flow cytometry interp CPT 88187 | $93.05 | $143.15 | $20.20 – $20.20 | 1 |
| Pn soln nos 10 grams lipids HCPCS B4185 | not published | not published | $5.00 – $5.00 | 1 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $63.77 | $98.11 | $16.36 – $339.07 | 4 |
| Polatuzumab vedotin-piiq 140 mg intravenous solution HCPCS J9309 | not published | not published | $132.73 – $133.71 | 2 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $2,292.97 | $3,527.65 | not published | 0 |
| Polyvalent mult org ea ag ia CPT 87451 | not published | not published | $10.19 – $136.70 | 3 |
| Porfimer sodium injection HCPCS J9600 | not published | not published | $22,390.08 – $25,980.00 | 2 |
| Post-coital mucous exam HCPCS Q0115 | not published | not published | $24.25 – $325.15 | 3 |
| Potassium 24 hour urine CPT 84133 | $78.75 | $121.15 | $4.59 – $61.52 | 4 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | not published | not published | $0.21 – $0.28 | 2 |
| Potassium hydroxide preps HCPCS Q0112 | not published | not published | $5.66 – $75.83 | 3 |
| Potassium serum/plasma/whole blood CPT 84132 | $61.57 | $94.72 | $4.62 – $61.91 | 4 |
| Pouch clsd w barr attached HCPCS A5051 | not published | not published | $2.33 – $2.33 | 1 |
| Pouch drainable w barrier at HCPCS A5061 | not published | not published | $3.66 – $3.66 | 1 |
| Pouch high output 2pc 50mm red HCPCS A4413 | not published | not published | $5.73 – $5.73 | 1 |
| Pouch ostmy flat lk n 2.5in roll premier 1pc trnsp HCPCS A4388 | not published | not published | $5.02 – $5.02 | 1 |
| Pouch ostmy nb pouchkin ctf HCPCS A5062 | not published | not published | $5.27 – $5.27 | 1 |
| Pouch uros new (both sides) 2.75in clr HCPCS A4432 | not published | not published | $3.88 – $3.88 | 1 |
| Powder prem protct 1oz HCPCS A4371 | not published | not published | $7.71 – $7.71 | 1 |
| Ppp2r2b gen detc abnor allel CPT 81343 | not published | not published | $83.83 – $1,781.85 | 4 |
| Pq biliary strict dil s&i CPT 74363 | not published | not published | $229.59 – $229.59 | 1 |
| Pq dr cath chg w cont s&i CPT 75984 | not published | not published | $73.42 – $73.42 | 1 |
| Pralatrexate injection HCPCS J9307 | not published | not published | $373.77 – $401.23 | 2 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | not published | not published | $83.23 – $104.04 | 2 |
| Pr application of long arm splint CPT 29105 | $357.66 | $550.25 | $82.60 – $82.60 | 1 |
| Pr application splint static short arm CPT 29125 | $284.91 | $438.33 | $76.91 – $76.91 | 1 |
| Pr biopsy skin punch single lesion CPT 11104 | $915.44 | $1,408.37 | not published | 0 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | $72.82 | $112.03 | $20.60 – $20.60 | 1 |
| Pr cystourethroscopy with insertion indwelling ureteral stent CPT 52332 | $6,553.88 | $10,082.90 | not published | 0 |
| Pr discharge day management hospital ip/obs <=30 min on ecounter date CPT 99238 | not published | not published | $83.09 – $83.09 | 1 |
| Pr discharge day management hospital ip/obs > 30 min on encounter date CPT 99239 | not published | not published | $83.09 – $83.09 | 1 |
| Prealbumin CPT 84134 | $50.58 | $77.81 | $7.39 – $189.76 | 4 |
| Pr ecg 12 lead report only CPT 93010 | $11.31 | $17.40 | not published | 0 |
| Prednisolone acetate inj HCPCS J2650 | not published | not published | $0.40 – $0.40 | 1 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | not published | not published | $0.48 – $2.93 | 2 |
| Prednisone 1 mg tablet HCPCS J7512 | not published | not published | $0.01 – $0.23 | 2 |
| Pregabalin - sendout CPT 80366 | $99.94 | $153.76 | not published | 0 |
| Pregnancy associated plasma protein-a CPT 84163 | not published | not published | $12.49 – $195.74 | 4 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $305.96 | $470.71 | $151.16 – $151.16 | 1 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.