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 |
|---|---|---|---|---|
| Ghs fish cytogen CPT 88271 | $68.17 | $104.88 | $20.78 – $278.59 | 4 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $131.98 | $203.05 | $49.65 – $665.79 | 4 |
| Ghs flow volume loop CPT 94375 | $192.13 | $295.58 | not published | 0 |
| Ghs gastric intub aspiration lavage CPT 43753 | $317.68 | $488.74 | not published | 0 |
| Ghs hcv amplificaiton CPT 87521 | not published | not published | $34.04 – $456.39 | 4 |
| Ghs heavy metals bld (ars,lead,merc) CPT 82715 | not published | not published | $22.28 – $298.75 | 3 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | not published | not published | $15.03 – $201.47 | 4 |
| Ghs hgb stability-thal CPT 83068 | not published | not published | $9.19 – $123.17 | 3 |
| Ghs histoplasma antigen CPT 87385 | $112.11 | $172.47 | $12.53 – $172.33 | 4 |
| Ghs HIV antibody CPT 86703 | not published | not published | $13.30 – $178.32 | 4 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $102.96 – $1,380.48 | 3 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $2,657.23 | $4,088.05 | not published | 0 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $1,225.34 | $1,885.14 | not published | 0 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $757.22 | $1,164.96 | not published | 0 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $27.69 – $389.15 | 4 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $272.60 | $419.38 | not published | 0 |
| Ghs inhibitor screen CPT 85335 | $27.20 | $41.84 | $12.48 – $167.39 | 4 |
| Ghs init tx 1st degree burn CPT 16000 | $381.04 | $586.22 | not published | 0 |
| Ghs inj tendon origin/insertion CPT 20551 | $434.12 | $667.87 | not published | 0 |
| Ghs insertion of needle - bone CPT 36680 | $796.70 | $1,225.70 | not published | 0 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $1,546.82 | $2,379.72 | not published | 0 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $601.07 | $924.72 | not published | 0 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $492.57 | $757.80 | not published | 0 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $915.44 | $1,408.37 | not published | 0 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $1,037.28 | $1,595.82 | not published | 0 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $762.87 | $1,173.64 | not published | 0 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $579.72 | $891.87 | not published | 0 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $594.51 | $914.63 | not published | 0 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $576.89 | $887.53 | not published | 0 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $1,274.46 | $1,960.71 | not published | 0 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | not published | not published | $8.34 – $111.85 | 4 |
| Ghs mbp CPT 83873 | $36.34 | $55.91 | $16.68 – $223.71 | 3 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $256.52 | $394.64 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $269.26 | $414.25 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $98.16 | $151.02 | not published | 0 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $222.23 | $341.89 | not published | 0 |
| Ghs myocardial strain img spckl track CPT 93356 | $52.84 | $81.29 | not published | 0 |
| Ghs nailbed repair/nail removal CPT 11760 | $674.81 | $1,038.17 | not published | 0 |
| Ghs ng placement w fluoro guidance CPT 43752 | $440.28 | $677.35 | not published | 0 |
| Ghs o2 saturation CPT 82810 | not published | not published | $9.48 – $127.07 | 4 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $66.57 | $102.41 | not published | 0 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | $67.89 | $104.45 | not published | 0 |
| Ghs ot group caregiver training CPT 97552 | $15.92 | $24.49 | not published | 0 |
| Ghs ot prosthetic training/15 min CPT 97761 | $130.62 | $200.95 | $82.40 – $82.40 | 1 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $64.75 | $99.61 | $101.41 – $101.41 | 1 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $121.01 | $186.17 | $8.38 – $8.38 | 1 |
| Ghs peritonsillar abscess i andd CPT 42700 | $527.74 | $811.91 | not published | 0 |
| Ghs phenylketonurid CPT 84030 | $18.64 | $28.68 | $5.34 – $71.53 | 4 |
| Ghs plngl fx pm cl CPT 26725 | $617.08 | $949.36 | not published | 0 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $2.02 – $56.06 | 4 |
| Ghs ppd (tb intradermal) CPT 86580 | $32.96 | $50.71 | not published | 0 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $9.37 – $125.64 | 4 |
| Ghs protein, misc fluid CPT 84160 | $55.68 | $85.66 | $5.08 – $72.96 | 4 |
| Ghs protoporphyrins fract CPT 84202 | $45.66 | $70.25 | $9.09 – $186.64 | 4 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $11.88 – $159.33 | 3 |
| Ghs quinidine CPT 80194 | not published | not published | $10.61 – $189.89 | 4 |
| Ghs removal intranasal foreign body CPT 30300 | $243.02 | $373.87 | not published | 0 |
| Ghs removal pharyngeal foreign body CPT 42809 | $740.28 | $1,138.89 | not published | 0 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $8.11 – $206.67 | 4 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $1.44 – $56.06 | 4 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | not published | not published | $8.11 – $180.92 | 4 |
| Ghs sedimentation rate CPT 85651 | $49.45 | $76.08 | $2.02 – $55.54 | 4 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $11.94 – $160.11 | 3 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.54 – $127.98 | 3 |
| Ghs sensitivity (per antimicro) CPT 87184 | $15.81 | $24.32 | $6.66 – $97.29 | 4 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $440.28 | $677.35 | not published | 0 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $482.79 | $742.76 | not published | 0 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $739.46 | $1,137.63 | not published | 0 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $311.34 | $478.99 | not published | 0 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $597.57 | $919.34 | not published | 0 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $342.34 | $526.67 | not published | 0 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $371.42 | $571.42 | not published | 0 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $152.29 | $234.29 | $101.97 – $101.97 | 1 |
| Ghs sp train/fitting sp device - kx CPT 92609 | not published | not published | $213.83 – $213.83 | 1 |
| Ghs strapping shoulder - 29240 CPT 29240 | $191.59 | $294.76 | $37.73 – $37.73 | 1 |
| Ghs st - re-eval for alt comm CPT 92597 | not published | not published | $144.86 – $144.86 | 1 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $857.95 | $1,319.92 | not published | 0 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.08 – $94.95 | 3 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $23.57 – $316.05 | 4 |
| Ghs urine, porphyrins quant CPT 84120 | not published | not published | $14.27 – $191.32 | 4 |
| Ghs vaginal delivery only CPT 59409 | $3,695.80 | $5,685.85 | not published | 0 |
| Giardia ag if CPT 87269 | $28.76 | $44.24 | $13.20 – $177.01 | 4 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $14.28 – $191.45 | 4 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $81.03 – $81.03 | 1 |
| Gi inhouse confirmation CPT 87045 | $58.99 | $90.76 | $8.23 – $122.78 | 4 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $98.09 – $1,315.19 | 3 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $59.67 – $800.14 | 3 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $33.95 – $455.22 | 3 |
| Glassia injection HCPCS J0257 | not published | not published | $5.45 – $7.20 | 2 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $190.76 – $204.60 | 2 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $150.44 – $199.50 | 2 |
| Glucagon plasma - sendout CPT 82943 | not published | not published | $13.86 – $185.86 | 4 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $44.69 – $599.20 | 3 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $48.98 – $656.81 | 3 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.24 – $231.12 | 3 |
| Glucose 1 hr post dose CPT 82950 | $65.93 | $101.43 | $4.61 – $61.78 | 4 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $3.03 – $78.69 | 4 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $19.05 | $29.31 | $3.18 – $42.66 | 3 |
| Glucose blood quantitative CPT 82947 | $55.68 | $85.66 | $3.81 – $51.11 | 4 |
| Glucose body fluid CPT 82945 | $75.48 | $116.12 | $3.81 – $51.11 | 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.