SelfPayRates — hospital cash prices, from the source
Cash prices at 3 facilities across 3 cities for code 99204, as an outpatient — the setting a self-pay patient normally buys. Collected Sep 23, 2026; the hospital files themselves were last updated between Apr 1, 2026 and Apr 1, 2026.
| Hospital | Cash price | List price | Off | File date | |
|---|---|---|---|---|---|
| Gouverneur Hospital
GOUVERNEUR, NY HC OFFICE_OUTPATIENT NEW MODERATE MDM 45 MINUTES |
$294.06 | $452.40 | 35% | — file |
|
| Massena Hospital Inc
MASSENA, NY HC OFFICE_OUTPATIENT NEW MODERATE MDM 45 MINUTES |
$295.61 | $454.78 | 35% | Apr 1, 2026 file |
|
| Canton-Potsdam Hospital
POTSDAM, NY HC OFFICE_OUTPATIENT NEW MODERATE MDM 45 MINUTES |
$299.83 | $461.28 | 35% | Apr 1, 2026 file |
Outpatient: lowest $294.06, median $295.61, highest $299.83.
As an inpatient, the same code is billed by 3 facilities here, median $295.61. Inpatient and outpatient prices are not comparable and are kept on separate pages: the inpatient charge covers admission, not the same purchase.
They are priced below $1 or below a tenth of the national median for code 99204 ($223.60). Such a line is almost always a physician's fee billed separately, an assistant's share or a placeholder — a real charge, but not the price of the procedure itself.
| Gouverneur Hospital
GOUVERNEUR, NY HC OMH E_M NEW PATIENT LEVEL 4 |
$20.98 | file |
| Massena Hospital Inc
MASSENA, NY HC OMH E_M NEW PATIENT LEVEL 4 |
$20.98 | file |
| Canton-Potsdam Hospital
POTSDAM, NY HC OMH E_M NEW PATIENT LEVEL 4 |
$21.27 | file |