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 |
|---|---|---|---|---|
| Methadone oral 5mg HCPCS S0109 | not published | not published | $0.30 – $0.37 | 2 |
| Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) HCPCS J2800 | not published | not published | $6.36 – $16.80 | 2 |
| Methotrexate sodium 2.5 mg tablet HCPCS J8610 | not published | not published | $0.20 – $0.76 | 2 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | not published | not published | $2.58 – $3.30 | 2 |
| Methotrexate therapeutic drug level CPT 80204 | not published | not published | $23.37 – $501.65 | 4 |
| Methyl aminolevulinate, top HCPCS J7309 | not published | not published | $75.79 – $75.79 | 1 |
| Methyldopate hcl injection HCPCS J0210 | not published | not published | $38.40 – $38.40 | 1 |
| Methylene blue (antidote) 5 mg/ml intravenous solution HCPCS Q9968 | not published | not published | $21.13 – $21.13 | 1 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | not published | not published | $21.29 – $23.71 | 2 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | not published | not published | $1.36 – $1.45 | 2 |
| Methylphenidate CPT 80360 | $57.37 | $88.26 | not published | 0 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | not published | not published | $0.24 – $0.37 | 2 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $0.34 | $0.53 | $0.11 – $0.11 | 1 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $0.47 | $0.72 | $0.25 – $0.25 | 1 |
| Metoclopramide in d5w IV syringe 0.2 mg/ml (neo/ped) - cnr HCPCS J2765 | not published | not published | $1.13 – $2.03 | 2 |
| Metronidazole 500 mg/100 ml in sodium chlor(iso) intravenous piggyback HCPCS J1836 | not published | not published | $0.03 – $0.03 | 1 |
| Metyrapone panel CPT 80436 | not published | not published | $58.48 – $1,185.65 | 4 |
| Mgmt promoter methylation analysis CPT 81287 | not published | not published | $120.90 – $1,621.09 | 3 |
| Micafungin 100 mg intravenous solution HCPCS J2248 | $0.29 | $0.44 | $0.28 – $2.02 | 2 |
| Microalbumin urine screen CPT 82044 | not published | not published | $0.51 – $81.03 | 4 |
| Microbe susceptible mlc CPT 87187 | not published | not published | $38.96 – $522.46 | 3 |
| Microdissection manual CPT 88381 | $306.83 | $472.04 | not published | 0 |
| Microfluid analy tears CPT 83861 | not published | not published | $21.81 – $292.38 | 3 |
| Microsatellite instability CPT 81301 | not published | not published | $338.10 – $4,533.44 | 4 |
| Mid and Lower Back (Thoracolumbar Spine) X-ray CPT 72080 | $258.56 | $397.78 | $23.48 – $23.48 | 1 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | not published | not published | $0.13 – $0.38 | 2 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | not published | not published | $0.17 – $0.44 | 2 |
| Middle cerebral artery echo CPT 76821 | not published | not published | $77.06 – $77.06 | 1 |
| Mifepristone 200 mg ta HCPCS S0190 | not published | not published | $34.40 – $43.00 | 2 |
| Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk HCPCS J2260 | not published | not published | $1.57 – $3.31 | 2 |
| Minocycline hydrochloride HCPCS J2265 | not published | not published | $2.48 – $2.73 | 2 |
| Minoxidil, 10 mg HCPCS S0139 | not published | not published | $0.44 – $0.55 | 2 |
| Miroderm HCPCS Q4175 | not published | not published | $77.62 – $77.62 | 1 |
| Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution HCPCS J9063 | not published | not published | $68.07 – $68.07 | 1 |
| Misoprostol, oral, 200 mcg HCPCS S0191 | not published | not published | $0.93 – $1.16 | 2 |
| Mitochondrial gene CPT 81440 | not published | not published | $3,224.28 – $43,232.61 | 3 |
| Mitomycin 40 mg intravenous solution HCPCS J9280 | $251.28 | $386.59 | $25.60 – $272.46 | 2 |
| Mitomycin instillation HCPCS J9281 | not published | not published | $313.00 – $331.65 | 2 |
| Mitoxantrone 2 mg/ml concentrate,intravenous HCPCS J9293 | not published | not published | $27.69 – $64.94 | 2 |
| Mlh1 gene CPT 81288 | $495.87 | $762.88 | $186.55 – $2,501.35 | 4 |
| Mlh1 gene dup/delete variant CPT 81294 | not published | not published | $192.59 – $2,632.45 | 4 |
| Mlh1 gene full seq CPT 81292 | not published | not published | $652.70 – $8,784.39 | 4 |
| Mlh1 gene known variants CPT 81293 | not published | not published | $88.05 – $4,305.05 | 4 |
| Mnpj anes sho jt fixj aprats CPT 23700 | $3,229.58 | $4,968.59 | not published | 0 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | $73.57 | $113.19 | $7.30 – $490.72 | 4 |
| Mometasone sinus sinuva HCPCS J7402 | not published | not published | $11.35 – $13.11 | 2 |
| Monovisc inj per dose HCPCS J7327 | $1,125.72 | $1,731.87 | $663.64 – $1,800.00 | 2 |
| Mopath procedure level 1 CPT 81400 | not published | not published | $62.04 – $831.88 | 3 |
| Mopath procedure level 3 CPT 81402 | not published | not published | $145.82 – $1,955.22 | 3 |
| Mopath procedure level 5 CPT 81404 | $708.60 | $1,090.16 | $266.59 – $3,574.49 | 3 |
| Mopath procedure level 6 CPT 81405 | $776.98 | $1,195.36 | $292.31 – $3,919.42 | 3 |
| Mopath procedure level 7 CPT 81406 | $776.77 | $1,195.03 | $274.39 – $3,679.19 | 3 |
| Mopath procedure level 8 CPT 81407 | $1,827.62 | $2,811.73 | $820.88 – $11,006.76 | 3 |
| Mopath procedure level 9 CPT 81408 | $4,319.25 | $6,645.00 | $1,940.00 – $26,012.40 | 3 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | not published | not published | $3.36 – $4.63 | 2 |
| Morphine 4 mg/ml injection (wrapper)|discarded drug not administered HCPCS J2272 | not published | not published | $3.66 – $6.64 | 2 |
| Morphine 500 mg HCPCS S0093 | not published | not published | $7.13 – $8.14 | 2 |
| Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr HCPCS J2274 | not published | not published | $9.82 – $21.88 | 2 |
| Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain CPT 88374 | $279.99 | $430.75 | $179.38 – $179.38 | 1 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 | not published | not published | $25.62 – $25.62 | 1 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | not published | not published | $25.62 – $25.62 | 1 |
| Mosunetuzumab-axgb 1 mg/ml intravenous solution HCPCS J9350 | not published | not published | $640.96 – $640.96 | 1 |
| Mouth piece HCPCS A4617 | not published | not published | $0.25 – $0.25 | 1 |
| M/phmtrc alys ishquant/semiq CPT 88373 | not published | not published | $179.38 – $179.38 | 1 |
| M/phmtrc alys ishquant/semiq CPT 88377 | not published | not published | $179.38 – $179.38 | 1 |
| M/phmtrc alysishquant/semiq CPT 88369 | not published | not published | $179.38 – $179.38 | 1 |
| Mpl gene analysis common variants CPT 81338 | not published | not published | $91.10 – $1,955.22 | 4 |
| M.pneumon dna dir probe CPT 87580 | not published | not published | $19.45 – $260.77 | 3 |
| M.pneumon dna quant CPT 87582 | not published | not published | $293.54 – $3,935.94 | 3 |
| MRA abdomen post contrast CPT 74185 | not published | not published | $354.13 – $354.13 | 1 |
| MRA aorta thoracic w/wo contrast CPT 71555 | not published | not published | $356.31 – $356.31 | 1 |
| MRA ext low(run-off)pst cntrst CPT 73725 | not published | not published | $355.64 – $355.64 | 1 |
| MRA pelvis CPT 72198 | not published | not published | $354.79 – $354.79 | 1 |
| MRA spinal canal CPT 72159 | not published | not published | $491.39 – $491.39 | 1 |
| MRA upper extremity post contrast-bil CPT 73225 | not published | not published | $387.80 – $387.80 | 1 |
| MRA w/cont, abd HCPCS C8900 | $2,794.39 | $4,299.06 | not published | 0 |
| MRA without fol w/cont, abd HCPCS C8902 | $3,105.38 | $4,777.51 | not published | 0 |
| MRA without fol w/cont, pelvis HCPCS C8920 | $1,860.62 | $2,862.50 | not published | 0 |
| MRI brain w/dye CPT 70558 | not published | not published | $438.83 – $438.83 | 1 |
| MRI brain without dye CPT 70557 | not published | not published | $384.90 – $384.90 | 1 |
| MRI brain without & w/dye CPT 70559 | not published | not published | $542.96 – $542.96 | 1 |
| MRI breast c- unilateral CPT 77046 | $462.95 | $712.23 | not published | 0 |
| MRI breast without cont bi CPT 77047 | $3,289.62 | $5,060.95 | not published | 0 |
| MRI cardiac morph & func wo IV cont CPT 75557 | not published | not published | $286.23 – $286.23 | 1 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | not published | not published | $388.36 – $388.36 | 1 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | not published | not published | $544.74 – $544.74 | 1 |
| MRI chest without contrast CPT 71550 | $1,067.55 | $1,642.38 | $330.85 – $330.85 | 1 |
| MRI chest without & w/contrast CPT 71552 | $1,963.67 | $3,021.03 | $507.34 – $507.34 | 1 |
| MRI chest w IV cont CPT 71551 | $2,193.68 | $3,374.90 | $384.08 – $384.08 | 1 |
| MRI fetal ea addl gestation CPT 74713 | not published | not published | $185.74 – $185.74 | 1 |
| MRI fetal sngl/1st gestation CPT 74712 | not published | not published | $387.41 – $387.41 | 1 |
| MRI guid ndl plc s&i CPT 77021 | not published | not published | $277.82 – $277.82 | 1 |
| MRI guid parenchymal tiss ablation CPT 77022 | not published | not published | $556.28 – $556.28 | 1 |
| MRI loex nonjt w IV cont CPT 73719 | $2,758.86 | $4,244.40 | $380.27 – $380.27 | 1 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $1,561.11 | $2,401.71 | $326.77 – $326.77 | 1 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $3,696.19 | $5,686.44 | $502.55 – $502.55 | 1 |
| MRI orbit fac&nck w IV cont CPT 70542 | $2,294.38 | $3,529.82 | $380.27 – $380.27 | 1 |
| MRI tmj CPT 70336 | $1,234.49 | $1,899.21 | $305.28 – $305.28 | 1 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $2,088.20 | $3,212.62 | $326.77 – $326.77 | 1 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $3,681.54 | $5,663.91 | $502.86 – $502.86 | 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.