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 |
|---|---|---|---|---|
| Crbrospnl fld flw imag cistern CPT 78630 | not published | not published | $215.75 – $215.75 | 1 |
| C-reactive protein CPT 86140 | $86.81 | $133.56 | $4.14 – $67.37 | 4 |
| C-reactive protein high sensitivity CPT 86141 | $84.99 | $130.75 | $10.35 – $168.43 | 4 |
| C-reactive protein, quantitative CPT 86406 | not published | not published | $10.32 – $138.39 | 3 |
| Creatine isoforms CPT 82554 | not published | not published | $11.51 – $154.38 | 3 |
| Creatine kinase CPT 82550 | $41.77 | $64.26 | $5.08 – $84.67 | 4 |
| Creatine kinase isoenzymes CPT 82552 | $4,292.42 | $6,603.72 | $9.49 – $174.15 | 4 |
| Creatine kinase mb CPT 82553 | $78.75 | $121.15 | $8.13 – $150.22 | 4 |
| Creatine - sendout CPT 82540 | not published | not published | $4.50 – $60.35 | 3 |
| Creatinine CPT 82565 | $55.68 | $85.66 | $4.97 – $66.59 | 4 |
| Creatinine 24 hour urine CPT 82570 | $25.64 | $39.45 | $5.02 – $67.37 | 4 |
| Creatinine clearance urine CPT 82575 | $86.81 | $133.56 | $5.89 – $123.04 | 4 |
| #creutz-prot.,western blot CPT 84182 | $108.80 | $167.38 | $28.33 – $379.91 | 3 |
| Crh stimulation panel CPT 80412 | not published | not published | $777.57 – $10,426.03 | 3 |
| Crisis psychotherapy 90839 CPT 90839 | $299.99 | $461.52 | $82.44 – $83.00 | 2 |
| Crisis psychotherapy additional 30 mins 90840 CPT 90840 | $149.99 | $230.76 | $3.72 – $55.00 | 2 |
| Critical care each additional 30 minutes CPT 99292 | $491.67 | $756.41 | not published | 0 |
| Critical Care (first 30 to 74 minutes) CPT 99291 | $1,619.98 | $2,492.27 | not published | 0 |
| Crizanlizumab-tmca 10 mg/ml intravenous solution HCPCS J0791 | not published | not published | $129.50 – $145.72 | 2 |
| Cromolyn sodium noncomp unit HCPCS J7631 | not published | not published | $0.29 – $3.26 | 2 |
| Crotalidae poly immune fab HCPCS J0840 | not published | not published | $1,755.81 – $3,837.60 | 2 |
| Cryofibrinogen qualitative - sendout CPT 82585 | not published | not published | $13.72 – $183.91 | 3 |
| Cryoprecipitate each unit HCPCS P9012 | $200.34 | $308.22 | not published | 0 |
| Cryptococcus abs qn - sendout CPT 86641 | not published | not published | $8.11 – $187.42 | 4 |
| Cryptosporidium antigen CPT 87272 | $25.32 | $38.95 | $11.62 – $155.81 | 4 |
| Crystal identification light microscopy CPT 89060 | $82.80 | $127.38 | $6.06 – $95.34 | 4 |
| Csf leakage imaging CPT 78650 | not published | not published | $211.43 – $211.43 | 1 |
| Csf ventriculography CPT 78635 | not published | not published | $198.26 – $198.26 | 1 |
| Cstb gene detc abnor allele CPT 81188 | not published | not published | $83.83 – $1,781.85 | 4 |
| Cstb gene full gene sequence CPT 81189 | not published | not published | $166.55 – $3,574.49 | 4 |
| Cstb gene known famil vrnt CPT 81190 | not published | not published | $94.17 – $2,408.75 | 4 |
| CT 3d report other modality w/workstation CPT 76377 | not published | not published | $59.32 – $59.32 | 1 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $2,116.03 | $3,255.43 | $336.26 – $336.26 | 1 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $4,313.73 | $6,636.51 | $323.20 – $323.20 | 1 |
| CT Angiogram of the Abdomen CPT 74175 | $2,309.42 | $3,552.95 | $335.67 – $335.67 | 1 |
| CT Angiogram of the Abdomen and Both Legs CPT 75635 | $2,462.91 | $3,789.09 | $355.24 – $355.24 | 1 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $2,462.91 | $3,789.09 | $336.84 – $336.84 | 1 |
| CT Angiogram of the Head CPT 70496 | $2,217.14 | $3,410.99 | $329.87 – $329.87 | 1 |
| CT Angiogram of the Neck CPT 70498 | $2,255.96 | $3,470.70 | $330.18 – $330.18 | 1 |
| CT angio hrt w/3d image CPT 75574 | not published | not published | $336.62 – $336.62 | 1 |
| CT angio pelvis CPT 72191 | $879.20 | $1,352.61 | $332.72 – $332.72 | 1 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $2,042.14 | $3,141.76 | $332.66 – $332.66 | 1 |
| CT bone density axial CPT 77078 | not published | not published | $67.66 – $67.66 | 1 |
| CT colonography screening CPT 74263 | $446.52 | $686.95 | not published | 0 |
| CT guidance for needle placement CPT 77012 | $371.23 | $571.12 | $103.96 – $103.96 | 1 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | not published | not published | $86.16 – $86.16 | 1 |
| CT guid parench tis ablat CPT 77013 | not published | not published | $373.30 – $373.30 | 1 |
| CT limited or localized follow-up study CPT 76380 | not published | not published | $117.39 – $117.39 | 1 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,009.89 | $1,553.67 | $307.39 – $307.39 | 1 |
| CT scan for localization CPT 77011 | not published | not published | $310.14 – $310.14 | 1 |
| CT scan for therapy guide CPT 77014 | not published | not published | $122.51 – $122.51 | 1 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,267.99 | $5,027.68 | $258.80 – $258.80 | 1 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $2,772.77 | $4,265.80 | $204.00 – $204.00 | 1 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $1,900.31 | $2,923.55 | $129.06 – $129.06 | 1 |
| CT t-spine w /wo contrast CPT 72130 | not published | not published | $309.29 – $309.29 | 1 |
| CT uppr extremity w/o&w/dye CPT 73202 | $286.86 | $441.33 | $307.08 – $307.08 | 1 |
| Culture aerobic additional method definitive id each CPT 87077 | $39.94 | $61.45 | $7.84 – $105.09 | 4 |
| Culture afb any source CPT 87116 | $172.54 | $265.45 | $10.48 – $140.47 | 4 |
| Culture anaerobic additional method definitive id each CPT 87076 | $82.80 | $127.38 | $7.84 – $105.09 | 4 |
| Culture anaerobic except blood CPT 87075 | $28.59 | $43.98 | $9.19 – $123.17 | 4 |
| Culture bacteria anaerobic CPT 87073 | not published | not published | $9.37 – $125.64 | 3 |
| Culture bact stool aero addl path ea CPT 87046 | $134.43 | $206.82 | $2.98 – $122.78 | 4 |
| Culture body fluid CPT 87070 | $27.44 | $42.21 | $8.23 – $112.11 | 4 |
| Culture fungi definitive id mold CPT 87107 | $65.22 | $100.34 | $9.80 – $134.22 | 4 |
| Culture fungi definitive id yeast CPT 87106 | $78.05 | $120.07 | $9.80 – $134.22 | 4 |
| Culture fungi other (except blood) CPT 87102 | $74.73 | $114.97 | $8.16 – $109.38 | 4 |
| Culture fungi skin/hair/nail CPT 87101 | $24.52 | $37.73 | $7.48 – $100.28 | 4 |
| Culture mycobacteria definitive id each isolate CPT 87118 | $29.69 | $45.67 | $14.17 – $190.02 | 4 |
| Culture mycoplasma any source CPT 87109 | $69.96 | $107.63 | $8.23 – $200.17 | 4 |
| Culture of specimen by kit CPT 87084 | not published | not published | $26.26 – $352.08 | 3 |
| Culture quantitative aerobic other source CPT 87071 | not published | not published | $9.59 – $128.63 | 3 |
| Culture screening strep group a CPT 87081 | $82.80 | $127.38 | $5.25 – $86.23 | 4 |
| Culture type pulse field gel CPT 87152 | not published | not published | $7.51 – $100.67 | 3 |
| Culture typing added method CPT 87158 | $16.35 | $25.16 | $7.51 – $100.67 | 3 |
| Culture typing glc/hplc CPT 87143 | not published | not published | $12.14 – $162.84 | 3 |
| Culture typing immunologic CPT 87147 | $10.95 | $16.84 | $5.02 – $67.37 | 3 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $443.08 | $681.66 | $211.52 – $2,836.13 | 3 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $90.84 | $139.75 | $34.04 – $456.39 | 3 |
| Culture urine each isolate CPT 87088 | $45.44 | $69.90 | $7.85 – $105.22 | 4 |
| Culture virus isolation CPT 87250 | not published | not published | $18.97 – $254.40 | 4 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $43.24 | $66.53 | $13.89 – $186.25 | 4 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $8.83 | $13.58 | $0.67 – $4.24 | 2 |
| Cyclic citrullinated peptide antibody CPT 86200 | $339.55 | $522.39 | $12.56 – $168.43 | 3 |
| Cyclophosphamide 100 mg inj HCPCS J9070 | not published | not published | $82.60 – $82.60 | 1 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | not published | not published | $0.80 – $0.80 | 1 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | not published | not published | $1.14 – $3.82 | 2 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | not published | not published | $46.93 – $71.40 | 2 |
| Cyclosporine 2 hour CPT 80158 | not published | not published | $10.61 – $234.76 | 4 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | not published | not published | $0.74 – $1.32 | 2 |
| Cyclosporine oral 100 mg HCPCS J7502 | not published | not published | $2.02 – $5.28 | 2 |
| Cygnus matrix, per sq cm HCPCS Q4199 | not published | not published | $474.00 – $474.00 | 1 |
| Cygnus, per sq cm HCPCS Q4170 | not published | not published | $242.25 – $242.25 | 1 |
| Cyp2c19 gene com variants CPT 81225 | not published | not published | $282.62 – $3,789.49 | 3 |
| Cyp2c9 gene com variants CPT 81227 | not published | not published | $106.05 – $2,273.61 | 4 |
| Cyp2d6 gene com variants CPT 81226 | not published | not published | $437.38 – $5,864.63 | 3 |
| Cyp3a4 gene common variants CPT 81230 | not published | not published | $169.57 – $2,273.61 | 3 |
| Cyp3a5 gene common variants CPT 81231 | not published | not published | $169.57 – $2,273.61 | 3 |
| Cystatin c CPT 82610 | $44.94 | $69.14 | $17.96 – $240.87 | 3 |
| Cystic fibrosis cftr CPT 81223 | not published | not published | $484.03 – $6,490.09 | 3 |
| Cystine urine quantitative CPT 82131 | not published | not published | $14.14 – $298.88 | 4 |
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.