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 |
|---|---|---|---|---|
| Frozen plasma, pooled, sd HCPCS P9023 | not published | not published | $1.02 – $1.02 | 1 |
| Fructosamine glycated protein CPT 82985 | $47.98 | $73.82 | $10.75 – $217.98 | 4 |
| Ftl cgen abnor 3 proteins CPT 81509 | not published | not published | $31.55 – $19,345.03 | 4 |
| Ftl cgen abnor five anal CPT 81512 | not published | not published | $55.79 – $904.19 | 4 |
| Ftl cgen abnor four anal CPT 81511 | $567.74 | $873.45 | $43.30 – $1,996.45 | 4 |
| Ftl cgen abnor three anal CPT 81510 | not published | not published | $36.73 – $722.36 | 4 |
| Ftl cgen abnor two proteins CPT 81508 | $237.73 | $365.74 | $24.99 – $706.24 | 4 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $37.03 – $37.03 | 1 |
| Full Spine X-ray (Scoliosis Survey) CPT 72082 | $184.47 | $283.80 | $50.30 – $50.30 | 1 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | not published | not published | $0.02 – $0.02 | 1 |
| Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 | not published | not published | $1.46 – $1.46 | 1 |
| Fxn gene charac alleles CPT 81285 | not published | not published | $166.55 – $3,574.49 | 4 |
| Fxn gene detc abnor alleles CPT 81284 | not published | not published | $83.83 – $1,781.85 | 4 |
| Fxn gene full gene sequence CPT 81286 | not published | not published | $266.59 – $3,574.49 | 3 |
| Fxn gene known famil variant CPT 81289 | not published | not published | $94.17 – $2,408.75 | 4 |
| G6pc gene CPT 81250 | not published | not published | $56.74 – $760.73 | 3 |
| G6pd full gene sequence CPT 81249 | $1,295.78 | $1,993.50 | $582.00 – $7,803.72 | 3 |
| G6pd gene alys cmn variant CPT 81247 | not published | not published | $169.57 – $2,273.61 | 3 |
| G6pd known familial variant CPT 81248 | not published | not published | $94.17 – $4,880.58 | 4 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | not published | not published | $162.02 – $162.02 | 1 |
| Ga-68 gallium 68 dotatate HCPCS A9587 | not published | not published | $66.67 – $66.67 | 1 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | not published | not published | $1.00 – $1.00 | 1 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | not published | not published | $6.18 – $6.18 | 1 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | not published | not published | $0.24 – $0.24 | 1 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | not published | not published | $17.04 – $17.04 | 1 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | not published | not published | $20.44 – $274.04 | 4 |
| Galactokinase - sendout CPT 82759 | not published | not published | $20.84 – $279.37 | 4 |
| Galactose transferase test CPT 82776 | not published | not published | $11.39 – $152.69 | 3 |
| Galectin-3 CPT 82777 | not published | not published | $42.92 – $575.52 | 3 |
| Gallbladder and Bile Duct Scan (HIDA Scan) CPT 78226 | not published | not published | $189.44 – $189.44 | 1 |
| Gallbladder Function Scan (HIDA with Medication) CPT 78227 | not published | not published | $257.87 – $257.87 | 1 |
| Gallium ga-68 dotatoc HCPCS C9067 | not published | not published | $9.09 – $9.09 | 1 |
| Gallium illuccix 1 millicure HCPCS A9596 | not published | not published | $1,128.00 – $1,128.00 | 1 |
| Gallium locametz 1 millicuri HCPCS A9800 | not published | not published | $960.00 – $960.00 | 1 |
| Gallium nitrate injection HCPCS J1457 | not published | not published | $1.06 – $1.06 | 1 |
| Galsulfase injection HCPCS J1458 | not published | not published | $484.88 – $502.08 | 2 |
| Gamma globulin > 10 cc inj HCPCS J1560 | not published | not published | $488.85 – $503.60 | 2 |
| Gamma globulin 1 cc inj HCPCS J1460 | not published | not published | $48.89 – $55.39 | 2 |
| Gammaglobulin iga CPT 82784 | $20.14 | $30.99 | $9.02 – $120.96 | 4 |
| Gammaglobulin ige CPT 82785 | $212.84 | $327.44 | $12.63 – $214.08 | 4 |
| Gamma glutamyltransferase CPT 82977 | $64.49 | $99.21 | $5.08 – $93.64 | 4 |
| Gammaplex injection HCPCS J1557 | not published | not published | $57.48 – $118.52 | 2 |
| Gamunex-c/gammaked HCPCS J1561 | not published | not published | $48.35 – $80.04 | 2 |
| Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 | not published | not published | $32.09 – $86.40 | 2 |
| Ganciclovir long act implant HCPCS J7310 | not published | not published | $3,355.13 – $3,355.13 | 1 |
| Gardner vag dna amp probe CPT 87511 | not published | not published | $34.04 – $456.39 | 3 |
| Gardner vag dna quant CPT 87512 | not published | not published | $40.51 – $543.14 | 3 |
| Gastric analy w/ph ea spec CPT 82930 | not published | not published | $6.51 – $87.27 | 3 |
| Gastric emptying imag study CPT 78265 | not published | not published | $334.19 – $334.19 | 1 |
| Gastric emptying imag study CPT 78266 | not published | not published | $396.46 – $396.46 | 1 |
| Gastric mucosa imaging CPT 78261 | not published | not published | $183.74 – $183.74 | 1 |
| Gastrin test CPT 82938 | not published | not published | $17.16 – $230.08 | 4 |
| Gastroesophageal reflux study CPT 78262 | not published | not published | $156.91 – $156.91 | 1 |
| Gated heart multiple CPT 78473 | not published | not published | $212.53 – $212.53 | 1 |
| Gauze >16 <=48 sq in w/bordr HCPCS A6220 | not published | not published | $1.70 – $1.70 | 1 |
| Gauze <= 16 sq in w/border HCPCS A6219 | not published | not published | $1.11 – $1.11 | 1 |
| Gba gene CPT 81251 | not published | not published | $45.83 – $614.54 | 3 |
| Gefitinib oral HCPCS J8565 | not published | not published | $134.60 – $311.56 | 2 |
| Gel-one HCPCS J7326 | not published | not published | $538.48 – $1,380.00 | 2 |
| Gel-syn injection 0.1 mg HCPCS J7328 | $4.23 | $6.51 | $0.59 – $2.54 | 2 |
| Gemcitabine 1 gram intravenous solution HCPCS J9201 | not published | not published | $2.98 – $12.49 | 2 |
| Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln HCPCS J9203 | not published | not published | $233.12 – $246.22 | 2 |
| General health panel CPT 80050 | $47.43 | $72.97 | not published | 0 |
| Genetic tstg severe inh cond CPT 81443 | $4,774.69 | $7,345.68 | $2,375.10 – $31,846.46 | 3 |
| Genome re-evaluation CPT 81427 | not published | not published | $2,267.52 – $30,403.94 | 3 |
| Genome sequence analysis CPT 81425 | not published | not published | $4,880.26 – $65,436.79 | 3 |
| Genome sequence analysis CPT 81426 | not published | not published | $2,628.65 – $35,246.15 | 3 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $3.43 | $5.28 | $2.47 – $2.86 | 2 |
| Gentamicin peak therapeutic drug level CPT 80170 | $55.52 | $85.41 | $10.61 – $213.04 | 4 |
| Genvisc 850, inj, 1mg HCPCS J7320 | not published | not published | $6.31 – $19.15 | 2 |
| Ghs abscess perianal iandd CPT 46050 | $1,691.24 | $2,601.90 | not published | 0 |
| Ghs abscess postoperative iandd complex CPT 10180 | $5,846.86 | $8,995.17 | not published | 0 |
| Ghs acetylcholinesterase, rbc CPT 82482 | not published | not published | $9.52 – $127.59 | 3 |
| Ghs alcohol, methyl (methanol)-medtox CPT 84600 | not published | not published | $16.60 – $222.54 | 3 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | not published | not published | $99.19 – $1,330.01 | 3 |
| Ghs analysis neurostim without reprogramming CPT 95970 | $343.19 | $527.98 | not published | 0 |
| Ghs antibodies (torch) igm CPT 86694 | $63.75 | $98.07 | $13.96 – $187.16 | 3 |
| Ghs bladder cath - complex-foley CPT 51703 | $303.83 | $467.43 | not published | 0 |
| Ghs bleeding time (ivy) CPT 85002 | not published | not published | $3.03 – $62.69 | 4 |
| Ghs change cysto/gastrost CPT 43762 | $615.93 | $947.58 | not published | 0 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $41.77 | $64.26 | $21.64 – $456.39 | 4 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $522.66 | $804.09 | not published | 0 |
| Ghs closed reduction ankle dislocation CPT 27840 | $671.50 | $1,033.08 | not published | 0 |
| Ghs closed tx tibial fracture w/manip CPT 27752 | $3,026.98 | $4,656.90 | not published | 0 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $3,955.24 | $6,084.99 | not published | 0 |
| Ghs clsd tx frac distal tibia w/manipulation CPT 27825 | $2,848.48 | $4,382.28 | not published | 0 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $438.15 | $674.07 | not published | 0 |
| Ghs community re-entry 15 minutes CPT 97537 | $96.64 | $148.67 | $64.62 – $64.62 | 1 |
| Ghs conjunctiva foreign body-embed bil CPT 65210 | $986.17 | $1,517.19 | not published | 0 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $185.26 | $285.01 | not published | 0 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $235.97 | $363.03 | not published | 0 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $198.64 | $305.60 | not published | 0 |
| Ghs cricothyroidotomy CPT 31605 | $438.54 | $674.68 | not published | 0 |
| Ghs diphtheria toxoid ab igg CPT 86648 | not published | not published | $14.75 – $197.82 | 3 |
| Ghs dislocation elbow closed treatment CPT 24600 | $626.35 | $963.61 | not published | 0 |
| Ghs ed rmvl or bivalving cast CPT 29700 | $603.08 | $927.82 | not published | 0 |
| Ghs excision ingrown nail CPT 11765 | $477.58 | $734.74 | not published | 0 |
| Ghs fat & muscle CPT 89160 | not published | not published | $4.70 – $63.08 | 3 |
| Ghs fb removal foot - deep - left CPT 28192 | $3,297.87 | $5,073.65 | not published | 0 |
| Ghs febrile agglutinns(mayo) CPT 86000 | not published | not published | $6.77 – $90.78 | 3 |
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.