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 |
|---|---|---|---|---|
| Pregnancy Ultrasound (first trimester) CPT 76801 | $568.22 | $874.19 | $140.09 – $140.09 | 1 |
| Pregnancy Ultrasound (limited) CPT 76815 | $493.27 | $758.88 | $96.69 – $96.69 | 1 |
| Pr e&m preventive medicine initial comprehensive new patient 12-17 years CPT 99384 | $63.90 | $98.30 | $91.84 – $91.84 | 1 |
| Pressure max expiratory/inspiratory CPT 94799 | $337.49 | $519.21 | not published | 0 |
| Pretreat rbc density gradient separation reference CPT 86972 | $290.37 | $446.73 | not published | 0 |
| Pr evaluation psychiatric diagnostic w/medical services CPT 90792 | $349.99 | $538.44 | $65.16 – $206.00 | 2 |
| Prev med cnsl indiv apprx 15 CPT 99401 | $36.17 | $55.65 | not published | 0 |
| Prev med cnsl indiv apprx 30 CPT 99402 | $154.41 | $237.56 | not published | 0 |
| Prev med cnsl indiv apprx 45 CPT 99403 | $96.92 | $149.11 | not published | 0 |
| Prev med cnsl indiv apprx 60 CPT 99404 | $271.61 | $417.86 | not published | 0 |
| Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment HCPCS G0402 | $283.28 | $435.82 | not published | 0 |
| Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm CPT 11404 | $3,679.56 | $5,660.86 | not published | 0 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $915.44 | $1,408.37 | not published | 0 |
| Pr hospital ip/obs care initial high level per day CPT 99223 | not published | not published | $92.71 – $92.71 | 1 |
| Pr hospital ip/obs care initial moderate level per day CPT 99222 | not published | not published | $80.25 – $80.25 | 1 |
| Pr hospital ip/obs care initial straightforward or low level per day CPT 99221 | not published | not published | $44.17 – $44.17 | 1 |
| Pr hospital ip/obs care subsequent high level per day CPT 99233 | not published | not published | $62.32 – $62.32 | 1 |
| Pr hospital ip/obs care subsequent moderate level per day CPT 99232 | not published | not published | $44.83 – $44.83 | 1 |
| Pr hospital ip/obs care subsequent straightforward or low level per day CPT 99231 | not published | not published | $31.49 – $31.49 | 1 |
| Pr incision & drainage abscess complicated/multiple CPT 10061 | $1,043.41 | $1,605.25 | not published | 0 |
| Pr incision & drainage abscess simple/single CPT 10060 | $523.88 | $805.97 | not published | 0 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $839.47 | $1,291.49 | not published | 0 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $859.90 | $1,322.92 | not published | 0 |
| Pr management transitional care high w/in 7 days of discharge CPT 99496 | $320.85 | $493.61 | not published | 0 |
| Pr management transitional care moderate w/in 14 days of discharge CPT 99495 | $296.56 | $456.25 | not published | 0 |
| Pr moderate sedation same physician >= 5 years initial 15 minutes CPT 99152 | $361.49 | $556.14 | not published | 0 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | not published | not published | $284.34 – $412.61 | 2 |
| Procalcitonin CPT 84145 | $157.14 | $241.76 | $26.40 – $354.03 | 3 |
| Procarbazine 50 mg caps 100 each bottle HCPCS S0182 | not published | not published | $142.58 – $143.63 | 2 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | not published | not published | $2.92 – $7.62 | 2 |
| Prochlorperazine maleate 5 mg tablet HCPCS Q0164 | not published | not published | $0.33 – $0.42 | 2 |
| Progenamatrix, per sq cm HCPCS Q4222 | not published | not published | $216.00 – $216.00 | 1 |
| Progesterone CPT 84144 | $106.61 | $164.01 | $20.23 – $271.31 | 4 |
| Prolactin CPT 84146 | $256.78 | $395.05 | $18.80 – $252.06 | 4 |
| Prolng off/op e/m ea 15 min 99417 CPT 99417 | $114.46 | $176.09 | not published | 0 |
| Promethazine 25 mg tablet HCPCS Q0169 | not published | not published | $0.08 – $0.10 | 2 |
| Promethazine hcl injection HCPCS J2550 | not published | not published | $3.31 – $4.50 | 2 |
| Propofol infusion 10 mg/ml HCPCS J2704 | not published | not published | $0.09 – $0.14 | 2 |
| _propoxygc/msur CPT 80367 | not published | not published | $5.05 – $5.05 | 1 |
| Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J1800 | not published | not published | $9.35 – $9.60 | 2 |
| Prostate biopsy, any mthd HCPCS G0416 | $573.12 | $881.72 | not published | 0 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | not published | not published | $1.40 – $2.35 | 2 |
| Protector nerve neurawrap 4cm HCPCS C9353 | not published | not published | $938.63 – $938.63 | 1 |
| Protein analysis w/probe CPT 88372 | not published | not published | $25.43 – $341.02 | 3 |
| Protein c activity CPT 85303 | $268.52 | $413.10 | $13.42 – $180.01 | 4 |
| Protein c concentrate HCPCS J2724 | not published | not published | $15.02 – $18.00 | 2 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $108.06 | $166.24 | $8.08 – $139.69 | 4 |
| Protein s total CPT 85305 | $22.64 | $34.83 | $11.26 – $151.00 | 4 |
| Protein total 24 hour urine CPT 84156 | $56.42 | $86.80 | $3.56 – $47.73 | 4 |
| Protein total body fluid CPT 84157 | $11.08 | $17.05 | $3.88 – $52.02 | 4 |
| Protein total serum plasma whole blood CPT 84155 | $85.73 | $131.89 | $3.56 – $47.73 | 4 |
| Protein western blot tissue CPT 88371 | not published | not published | $21.56 – $289.13 | 3 |
| Prothrombin complex kcentra HCPCS J7168 | not published | not published | $2.86 – $3.41 | 2 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $89.04 | $136.98 | $3.82 – $51.24 | 3 |
| Protoporphyrin rbc screen CPT 84203 | not published | not published | $9.45 – $126.68 | 3 |
| Pr planning advance care 1st 30 minutes CPT 99497 | $113.32 | $174.34 | not published | 0 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $184.55 | $283.92 | not published | 0 |
| Pr removal intrauterine device CPT 58301 | $604.24 | $929.60 | not published | 0 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $915.44 | $1,408.37 | not published | 0 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $302.89 | $465.98 | not published | 0 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $443.10 | $681.70 | not published | 0 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $273.31 | $420.47 | not published | 0 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $307.11 | $472.48 | not published | 0 |
| Pr robotic surgical system HCPCS S2900 | $0.01 | $0.01 | not published | 0 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $1,737.03 | $2,672.35 | not published | 0 |
| PSA (Prostate) Test CPT 84153 | $58.56 | $90.10 | $17.84 – $239.18 | 4 |
| Psych/neuropsych test admin automated result 96146 CPT 96146 | not published | not published | $1.63 – $1.63 | 1 |
| Psychoanalysis CPT 90845 | not published | not published | $128.52 – $128.52 | 1 |
| Psychophysiological therapy CPT 90875 | not published | not published | $68.00 – $68.00 | 1 |
| Psychophysiological therapy CPT 90876 | not published | not published | $117.00 – $117.00 | 1 |
| Psychotherapy group therapy CPT 90853 | $206.48 | $317.66 | $30.00 – $34.99 | 2 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $209.24 | $321.91 | $34.00 – $43.08 | 2 |
| Psychotherapy patient individual therapy 45 minutes CPT 90834 | $196.14 | $301.76 | $57.29 – $73.00 | 2 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $349.25 | $537.31 | $68.88 – $80.00 | 2 |
| Psych test eval svc phys/qhp 1st hr CPT 96130 | $343.10 | $527.84 | $89.92 – $110.00 | 2 |
| Psych test eval svc phys/qhp ea addl hr CPT 96131 | $171.55 | $263.93 | $68.39 – $87.00 | 2 |
| Psycl/nrpsyc tech 1st CPT 96138 | not published | not published | $29.43 – $29.43 | 1 |
| Psy evaluation of records CPT 90885 | not published | not published | $54.00 – $54.00 | 1 |
| Psy/npsy phys/qhp 2> tst 1st 30 min CPT 96136 | $229.07 | $352.42 | $36.24 – $45.00 | 2 |
| Psy/npsy phys/qhp 2> tst ea l 30 min CPT 96137 | $114.53 | $176.20 | $33.52 – $42.00 | 2 |
| Psy/npsy tst admin tech 2> ea l 30 min CPT 96139 | not published | not published | $29.43 – $29.43 | 1 |
| Psytx complex interactive CPT 90785 | not published | not published | $3.72 – $3.72 | 1 |
| Psytx pt w/e&m 16-37 min CPT 90833 | $43.27 | $66.57 | $24.00 – $29.08 | 2 |
| Psytx pt w/e&m 38-52 min CPT 90836 | $180.43 | $277.58 | $43.73 – $80.00 | 2 |
| Psytx pt w/e&m 53+ min CPT 90838 | $371.14 | $570.99 | $58.38 – $98.00 | 2 |
| Pt application of modality >=1 area hot/cold packs CPT 97010 | $46.16 | $71.01 | $12.27 – $12.27 | 1 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $51.10 | $78.62 | $40.89 – $40.89 | 1 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $24.62 | $37.88 | $28.45 – $28.45 | 1 |
| Pt application of modality traction mechanical CPT 97012 | $32.32 | $49.73 | $29.96 – $29.96 | 1 |
| Pten gene dup/delet variant CPT 81323 | not published | not published | $291.00 – $3,901.86 | 3 |
| Pten gene full sequence CPT 81321 | not published | not published | $582.00 – $7,803.72 | 3 |
| Pten gene known fam variant CPT 81322 | not published | not published | $45.20 – $606.09 | 3 |
| Pt-focused hlth risk assmt CPT 96160 | $65.88 | $101.36 | not published | 0 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $87.82 | $135.10 | $75.17 – $75.17 | 1 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $71.56 | $110.09 | $26.99 – $26.99 | 1 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $84.52 | $130.03 | $57.56 – $57.56 | 1 |
| Pt wheelchair management each 15 minutes CPT 97542 | $93.74 | $144.21 | $65.30 – $65.30 | 1 |
| Pulm ds ipf mrna 190 gen alg CPT 81554 | not published | not published | $5,247.31 – $70,358.34 | 3 |
| Pulmonary vent imaging CPT 78579 | not published | not published | $100.62 – $100.62 | 1 |
| Pulse ox continuous overnight monitoring CPT 94762 | $214.69 | $330.29 | not published | 0 |
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.