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 |
|---|---|---|---|---|
| Cystogram >= 3 views supervision & interpretation CPT 74430 | not published | not published | $38.96 – $38.96 | 1 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $3,356.67 | $5,164.11 | not published | 0 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | not published | not published | $0.81 – $1.22 | 2 |
| Cytarabine liposome inj HCPCS J9098 | not published | not published | $569.09 – $569.09 | 1 |
| Cytog alys chrml abnr lw-ps CPT 81349 | not published | not published | $1,162.00 – $15,580.65 | 3 |
| Cytogenetics 25-99 CPT 88274 | $105.14 | $161.76 | $41.11 – $551.20 | 4 |
| Cytogenetics 3-5 CPT 88272 | not published | not published | $37.37 – $529.35 | 4 |
| Cytogenomic neo microra alys CPT 81277 | not published | not published | $1,125.20 – $15,087.19 | 3 |
| Cytogenom microarray copy nmbr var CPT 81228 | not published | not published | $873.00 – $11,705.58 | 3 |
| Cytog genom-wid alys hem mal CPT 81195 | not published | not published | $1,807.32 – $24,233.41 | 3 |
| Cytomegalovirus ag ia CPT 87332 | not published | not published | $11.62 – $155.81 | 4 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $133.34 | $205.14 | $13.96 – $187.16 | 4 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $189.02 | $290.80 | $8.11 – $219.15 | 4 |
| Cytomegalovirus dfa CPT 87271 | not published | not published | $13.02 – $174.54 | 4 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | not published | not published | $1,812.01 – $2,108.22 | 2 |
| Cytomeg dna dir probe CPT 87495 | not published | not published | $16.07 – $390.58 | 4 |
| Cyto/molecular report CPT 88291 | not published | not published | $20.20 – $20.20 | 1 |
| Cytopath c/v auto in fluid CPT 88174 | not published | not published | $24.61 – $329.97 | 4 |
| Cytopath c/v automated CPT 88147 | not published | not published | $15.57 – $657.59 | 4 |
| Cytopath c/v auto redo CPT 88152 | not published | not published | $26.81 – $359.49 | 3 |
| Cytopath c/v auto rescreen CPT 88148 | not published | not published | $15.57 – $241.13 | 4 |
| Cytopath c/v index add-on CPT 88155 | not published | not published | $14.21 – $190.54 | 3 |
| Cytopath c/v manual CPT 88150 | not published | not published | $14.80 – $241.13 | 4 |
| Cytopath c/v redo CPT 88153 | not published | not published | $15.57 – $312.54 | 4 |
| Cytopath c/v thin layer redo CPT 88143 | not published | not published | $22.35 – $299.66 | 4 |
| Cytopath fl nongyn filter CPT 88106 | not published | not published | $19.31 – $19.31 | 1 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $100.68 | $154.89 | $29.11 – $29.11 | 1 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | not published | not published | $25.81 – $346.09 | 4 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $84.24 | $129.60 | $19.65 – $263.51 | 4 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | not published | not published | $19.31 – $19.31 | 1 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $77.60 | $119.39 | $19.31 – $19.31 | 1 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $82.89 | $127.53 | not published | 0 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $384.34 | $591.30 | not published | 0 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | not published | not published | $19.31 – $19.31 | 1 |
| Cytopath smear other source CPT 88160 | not published | not published | $19.31 – $19.31 | 1 |
| Cytopath smear other source CPT 88162 | not published | not published | $19.31 – $19.31 | 1 |
| Cytopath smear oth prep screen & interp CPT 88161 | $96.71 | $148.79 | $19.31 – $19.31 | 1 |
| Cytopath tbs c/v auto redo CPT 88166 | not published | not published | $17.98 – $241.13 | 3 |
| Cytopath tbs c/v manual CPT 88164 | not published | not published | $14.80 – $241.13 | 4 |
| Cytopath tbs c/v redo CPT 88165 | not published | not published | $15.57 – $549.12 | 4 |
| Cytopath tbs c/v select CPT 88167 | not published | not published | $17.98 – $241.13 | 3 |
| Cytotoxic antibody screening CPT 86807 | not published | not published | $76.29 – $1,022.94 | 3 |
| Cytotoxic antibody screening CPT 86808 | not published | not published | $28.79 – $386.02 | 3 |
| Cytp urine 3-5 probes cmptr CPT 88121 | not published | not published | $179.38 – $179.38 | 1 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | not published | not published | $4.50 – $9.85 | 2 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | not published | not published | $288.80 – $1,822.59 | 2 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | not published | not published | $15.57 – $20.12 | 2 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $16.04 – $29.94 | 2 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $0.06 | $0.09 | $0.03 – $0.14 | 2 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | not published | not published | $0.05 – $0.05 | 1 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | not published | not published | $52.99 – $58.17 | 2 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $11.70 | $18.00 | $2.92 – $9.29 | 2 |
| Darbepoetin alfa, esrd use HCPCS J0882 | not published | not published | $2.92 – $9.29 | 2 |
| Dark field exam spec collj CPT 87164 | not published | not published | $8.08 – $139.69 | 4 |
| Dark field exam without collj CPT 87166 | not published | not published | $8.08 – $146.97 | 4 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | not published | not published | $249.02 – $252.27 | 2 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | not published | not published | $26.40 – $80.49 | 2 |
| Daunorubicin citrate inj HCPCS J9151 | not published | not published | $42.30 – $42.30 | 1 |
| Dch glucoscan CPT 82948 | not published | not published | $2.02 – $65.55 | 4 |
| Dch validity tests CPT 81002 | $43.96 | $67.63 | $2.02 – $45.26 | 4 |
| Deamidated gliadin antibody iga CPT 86258 | $24.36 | $37.48 | $6.98 – $156.72 | 4 |
| Debridement (>20 cm) charge pt CPT 97598 | $394.61 | $607.09 | not published | 0 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $915.44 | $1,408.37 | not published | 0 |
| Debride nail1-5 11720 CPT 11720 | $141.04 | $216.98 | not published | 0 |
| Debride nail6 or more 11721 CPT 11721 | $141.04 | $216.98 | not published | 0 |
| Debride skin bone at fx site CPT 11012 | $2,358.16 | $3,627.94 | not published | 0 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $728.59 | $1,120.91 | not published | 0 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $1,425.53 | $2,193.13 | not published | 0 |
| Decalcification CPT 88311 | $53.50 | $82.31 | not published | 0 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | not published | not published | $1.77 – $9.00 | 2 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | not published | not published | $8.21 – $15.54 | 2 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | not published | not published | $4.36 – $7.33 | 2 |
| Delivery of placenta 59414 CPT 59414 | $2,930.27 | $4,508.11 | not published | 0 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $558.13 | $858.66 | not published | 0 |
| Dengue vacc quad 3 dose subq CPT 90587 | not published | not published | $118.80 – $118.80 | 1 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | not published | not published | $27.81 – $29.54 | 2 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $288.10 | $443.23 | not published | 0 |
| Deodorant ostmy adapt lube 8ml HCPCS A4394 | not published | not published | $2.14 – $2.14 | 1 |
| Depo-estradiol cypionate inj HCPCS J1000 | not published | not published | $33.62 – $42.32 | 2 |
| Derma-gide, 1 sq cm HCPCS Q4203 | not published | not published | $339.83 – $339.83 | 1 |
| Dermagraft HCPCS Q4106 | not published | not published | $50.99 – $50.99 | 1 |
| Dermapure 1 square cm HCPCS Q4152 | not published | not published | $115.00 – $115.00 | 1 |
| Derm-maxx, per sq cm HCPCS Q4238 | not published | not published | $281.02 – $281.02 | 1 |
| Description not available HCPCS S0013 | not published | not published | $14.30 – $14.65 | 2 |
| Design mlc device for imrt CPT 77338 | not published | not published | $302.89 – $302.89 | 1 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | not published | not published | $4.49 – $15.75 | 2 |
| Desoxycorticosterone CPT 82633 | not published | not published | $30.05 – $402.93 | 3 |
| Dest mal lesion feenlm <0.5cm 17280 CPT 17280 | $431.61 | $664.02 | not published | 0 |
| Dest mal lesion tal 0.6-1.0cm 17261 CPT 17261 | $431.61 | $664.02 | not published | 0 |
| Destroy vulva lesion simple 56501 CPT 56501 | $2,166.46 | $3,333.01 | not published | 0 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $131.87 | $202.88 | not published | 0 |
| Destruction 2-14 lesions 17003 CPT 17003 | $22.93 | $35.28 | not published | 0 |
| Destruction benign lesions < 14 lesions CPT 17110 | $137.16 | $211.01 | not published | 0 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $1,093.55 | $1,682.38 | not published | 0 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $857.10 | $1,318.61 | not published | 0 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $29.13 – $390.58 | 3 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $28.19 – $567.98 | 4 |
| Developmental screen/score/document 96110 CPT 96110 | $142.38 | $219.04 | not published | 0 |
| Device intraute mirena HCPCS J7298 | $1,773.21 | $2,728.02 | $1,214.63 – $1,259.09 | 2 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | not published | not published | $18.28 – $18.28 | 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.