Supplies, drugs & other prices at Gouverneur Hospital
Gouverneur, NY · every code in this section with a posted price and a Medicare benchmark.
36 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) | $2,160.39 | $3,323.67 | 2.2× |
| 2d tte w or w/o fol w/con,fu (C8924) | $1,653.52 | $2,543.87 | 3.8× |
| Admin hepatitis b vaccine (G0010) | $43.45 | $66.85 | 0.7× |
| Admin influenza virus vac (G0008) | $21.30 | $32.77 | 0.4× |
| Admin pneumococcal vaccine (G0009) | $21.30 | $32.77 | 0.4× |
| Alcohol/subs interv 15-30mn (G0396) | $63.11 | $97.09 | 1.3× |
| Annual alcohol screen 15 min (G0442) | $109.58 | $168.58 | 2.3× |
| Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) | $81.57 | $125.49 | 1.8× |
| Brief alcohol misuse counsel (G0443) | $259.46 | $399.17 | 2.0× |
| Ca screen;pelvic/breast exam (G0101) | $50.78 | $78.13 | 0.4× |
| Direct refer hospital observ (G0379) | $192.54 | $296.21 | 0.3× |
| Drug test def 1-7 classes (G0480) | $157.66 | $242.56 | 1.4× |
| Drug test def 15-21 classes (G0482) | $512.42 | $788.34 | 2.6× |
| Drug test def 8-14 classes (G0481) | $330.90 | $509.08 | 2.1× |
| Elec stim other than wound (G0283) | $71.56 | $110.09 | 5.6× |
| Fecal blood scrn immunoassay (G0328) | $73.26 | $112.70 | 4.1× |
| Home sleep test/type 3 porta (G0399) | $464.35 | $714.38 | 1.7× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) | $96.36 | $148.25 | 2.2× |
| Initial preventive exam (G0402) | $283.28 | $435.82 | 1.7× |
| Inj for sacroiliac jt anesth (G0260) | $1,895.48 | $2,916.13 | 2.2× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) | $257.62 | $396.34 | 2.1× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $1,022.86 | $1,573.63 | 2.0× |
| Mra w/cont, abd (C8900) | $2,794.39 | $4,299.06 | 6.4× |
| Mra w/o fol w/cont, abd (C8902) | $3,105.38 | $4,777.51 | 7.1× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,860.62 | $2,862.50 | 4.3× |
| Nfct ds bact&fng org id bld cul rrna fish 6+trgt (0086U) | $281.76 | $433.47 | 1.4× |
| Obtaining screen pap smear (Q0091) | $15.50 | $23.84 | 0.4× |
| Ppps, subseq visit (G0439) | $94.20 | $144.92 | 0.7× |
| Prostate biopsy, any mthd (G0416) | $573.12 | $881.72 | 1.3× |
| Psa screening (G0103) | $163 | $250.77 | 8.4× |
| Screen cerv/vag thin layer (G0123) | $80.59 | $123.98 | 4.0× |
| Tomosynthesis, mammo (G0279) | $84.37 | $129.80 | 6.6× |
| Tpmt and Nudt15 Genotype (0034U) | $1,034.36 | $1,591.32 | 2.2× |
| Tte w or w/o contr, cont ecg (C8930) | $2,312.04 | $3,556.99 | 2.4× |
| Tte w or wo fol wcon,doppler (C8929) | $1,760.86 | $2,709.02 | 1.8× |
| Visit to determ ldct elig (G0296) | $264.56 | $407.02 | 2.1× |