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 |
|---|---|---|---|---|
| Antibody htlv/hiv confirm test CPT 86689 | not published | not published | $18.77 – $251.67 | 4 |
| Antibody htlv-i CPT 86687 | not published | not published | $8.82 – $118.23 | 4 |
| Antibody htlv-ii CPT 86688 | not published | not published | $13.58 – $182.09 | 3 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | not published | not published | $17.82 – $238.92 | 3 |
| Antibody id rbc panel CPT 86870 | $573.12 | $881.72 | $14.24 – $14.24 | 1 |
| Antibody influenza virus CPT 86710 | not published | not published | $13.14 – $176.23 | 4 |
| Antibody lymphocytic choriomeningitis CPT 86727 | not published | not published | $8.11 – $167.39 | 4 |
| Antibody screen rbc CPT 86850 | $55.68 | $85.66 | $5.61 – $127.07 | 4 |
| Antibody tetanus CPT 86774 | $161.16 | $247.94 | $14.36 – $192.49 | 3 |
| Antidepressant tricyclic 3-5 CPT 80336 | not published | not published | $5.05 – $5.05 | 1 |
| Antigen therapy services CPT 95149 | $51.97 | $79.96 | not published | 0 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | not published | not published | $1.45 – $1.78 | 3 |
| Antihemophilic viii/vwf comp HCPCS J7186 | not published | not published | $1.20 – $1.52 | 3 |
| Anti-inhibitor HCPCS J7198 | not published | not published | $2.40 – $2.95 | 3 |
| Anti mog serum - sendout CPT 86362 | not published | not published | $11.69 – $156.72 | 3 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $25.47 | $39.18 | $7.30 – $156.72 | 4 |
| Antineutrophil cytoplasmic antibody titer each antibody CPT 86037 | not published | not published | $7.30 – $156.72 | 4 |
| Antinuclear antibodies CPT 86038 | $123.83 | $190.51 | $5.25 – $157.24 | 4 |
| Antinuclear antibodies titer CPT 86039 | $123.83 | $190.51 | $5.25 – $145.15 | 4 |
| Antiphosphatidylserine antibody CPT 86148 | $47.61 | $73.25 | $7.90 – $209.01 | 4 |
| Antistreptolysin o screen CPT 86063 | not published | not published | $3.79 – $75.05 | 4 |
| Antistreptolysin o titer CPT 86060 | $37.37 | $57.49 | $5.25 – $94.95 | 4 |
| Antithrombin iii activity CPT 85300 | $234.81 | $361.24 | $9.52 – $154.12 | 4 |
| Antithrombin iii injection HCPCS J7197 | not published | not published | $3.94 – $4.80 | 2 |
| Antithrombin recombinant HCPCS J7196 | not published | not published | $134.88 – $168.60 | 2 |
| Anti-thymocyte glob (equine)(1:1000) intradermal test dose HCPCS J7504 | not published | not published | $3,435.47 – $4,376.29 | 2 |
| Antithymocyte globuln rabbit HCPCS J7511 | not published | not published | $939.35 – $1,166.56 | 2 |
| Aortic Aneurysm Screening Ultrasound CPT 76706 | $187.41 | $288.33 | $76.23 – $76.23 | 1 |
| Aortic dysfunction/dilation CPT 81410 | $1,299.48 | $1,999.20 | $488.88 – $6,555.12 | 3 |
| Aortic dysfunction/dilation CPT 81411 | not published | not published | $1,309.68 – $17,560.84 | 3 |
| Apc gene dup/delet variants CPT 81203 | not published | not published | $194.00 – $2,601.24 | 3 |
| Apc gene full sequence CPT 81201 | not published | not published | $756.60 – $10,144.84 | 3 |
| Apc gene known fam variants CPT 81202 | not published | not published | $271.60 – $3,641.74 | 3 |
| Apl(pml-rara) quant - sendout CPT 81315 | $404.25 | $621.93 | $201.09 – $2,696.32 | 4 |
| Apomorphine hydrochloride HCPCS J0364 | not published | not published | $33.33 – $41.66 | 2 |
| Application finger splntstatic 29130 CPT 29130 | $284.91 | $438.33 | $57.84 – $57.84 | 1 |
| Application long leg splint 29505 CPT 29505 | $238.79 | $367.37 | not published | 0 |
| Application lower leg splint 29515 CPT 29515 | $357.66 | $550.25 | not published | 0 |
| Application multi layer compression below knee (both sides) CPT 29581 | $357.66 | $550.25 | not published | 0 |
| Application of forearm cast 29075 CPT 29075 | $797.02 | $1,226.19 | not published | 0 |
| Application of long leg cast CPT 29355 | $715.15 | $1,100.23 | not published | 0 |
| Application of paste boot 29580 CPT 29580 | $357.66 | $550.25 | not published | 0 |
| Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm CPT 15275 | $4,234.88 | $6,515.20 | not published | 0 |
| Appl modality 1/> areas paraffin bath 97018 CPT 97018 | $32.32 | $49.73 | $11.59 – $11.59 | 1 |
| Appl modality 1/> areas vasopneumatic devices 97016 CPT 97016 | $54.18 | $83.35 | $24.27 – $24.27 | 1 |
| Apply forearm splintdynamic 29126 CPT 29126 | not published | not published | $95.93 – $95.93 | 1 |
| Apply hand/wrist cast 29085 CPT 29085 | not published | not published | $130.83 – $130.83 | 1 |
| Apply interstit radiat compl CPT 77778 | not published | not published | $526.68 – $526.68 | 1 |
| Apply intrcav radiat compl CPT 77763 | not published | not published | $508.22 – $508.22 | 1 |
| Apply intrcav radiat interm CPT 77762 | not published | not published | $360.95 – $360.95 | 1 |
| Apply intrcav radiat simple CPT 77761 | not published | not published | $259.49 – $259.49 | 1 |
| Apply of finger splint 29131 CPT 29131 | not published | not published | $66.86 – $66.86 | 1 |
| Apply short leg castambul type 29425 CPT 29425 | $797.02 | $1,226.19 | not published | 0 |
| Apply surf ldr radionuclide CPT 77789 | not published | not published | $74.90 – $74.90 | 1 |
| Aprepitant 130 mg/18 ml (7.2 mg/ml) intravenous emulsion HCPCS J0185 | not published | not published | $1.71 – $3.88 | 2 |
| Aprotonin, 10,000 kiu HCPCS J0365 | not published | not published | $2.12 – $2.12 | 1 |
| #aptt mix-1:1 incubated CPT 87532 | $797.02 | $1,226.19 | $34.04 – $456.39 | 3 |
| Aqaprn-4 antb flo cytmtry ea CPT 86053 | $25.47 | $39.18 | $7.30 – $490.72 | 4 |
| Aquaporin-4 antibody cba each CPT 86052 | not published | not published | $7.30 – $156.72 | 4 |
| Aquaporin-4 antibody elisa CPT 86051 | not published | not published | $6.98 – $149.96 | 4 |
| Aqua therapy w/exercise/ea 15 min 97113 CPT 97113 | $117.88 | $181.35 | $76.20 – $76.20 | 1 |
| Aquatic exercise - group charge CPT 97150 | $56.01 | $86.17 | $36.23 – $36.23 | 1 |
| Architect ecm px fx 1 sq cm HCPCS Q4147 | not published | not published | $57.13 – $57.13 | 1 |
| Arformoterol non-comp unit HCPCS J7605 | not published | not published | $0.69 – $7.70 | 2 |
| Argatroban dialysis (accord) HCPCS J0892 | not published | not published | $3.80 – $4.75 | 2 |
| Argatroban dialysis, auromed HCPCS J0899 | not published | not published | $1.34 – $4.68 | 2 |
| Argatroban esrd dialysis 1mg HCPCS J0884 | not published | not published | $0.95 – $4.68 | 2 |
| Argatroban nonesrd (accord) HCPCS J0891 | not published | not published | $3.80 – $4.75 | 2 |
| Argatroban nonesrd (auromed) HCPCS J0898 | not published | not published | $1.34 – $4.68 | 2 |
| Argatroban nonesrd use 1mg HCPCS J0883 | not published | not published | $0.95 – $4.68 | 2 |
| Ar gene charac alleles CPT 81204 | $295.87 | $455.18 | $83.83 – $1,781.85 | 4 |
| Ar gene full gene sequence CPT 81173 | not published | not published | $292.31 – $3,919.42 | 3 |
| Ar gene known famil variant CPT 81174 | not published | not published | $94.17 – $2,408.75 | 4 |
| Aripiprazole 441 mg/1.6 ml inj HCPCS J1944 | not published | not published | $3.26 – $3.96 | 2 |
| Aripiprazole injection HCPCS J0400 | not published | not published | $0.26 – $0.26 | 1 |
| Arm CT Scan (with contrast, both arms) CPT 73201 | $2,047.53 | $3,150.04 | $192.11 – $192.11 | 1 |
| Arm CT Scan (without contrast, both arms) CPT 73200 | $1,199.23 | $1,844.97 | $195.06 – $195.06 | 1 |
| Arm or Leg Ultrasound (limited, left side) CPT 76882 | $493.27 | $758.88 | $18.87 – $18.87 | 1 |
| Arsenic trioxide 2 mg/ml intravenous solution HCPCS J9017 | not published | not published | $4.79 – $51.19 | 2 |
| Artacent ac 1 sq cm HCPCS Q4190 | not published | not published | $744.00 – $744.00 | 1 |
| Artacent wound, per sq cm HCPCS Q4169 | not published | not published | $474.00 – $474.00 | 1 |
| Arterial blood draw/perc 36620 CPT 36620 | $444.60 | $684.00 | not published | 0 |
| Artery xray each vessel 7577426 CPT 75774 | not published | not published | $102.35 – $102.35 | 1 |
| Artery xray of abdomen 75726-26 CPT 75726 | not published | not published | $148.10 – $148.10 | 1 |
| Artery x-rays adrenal gland CPT 75731 | not published | not published | $311.63 – $311.63 | 1 |
| Artery x-rays adrenals CPT 75733 | not published | not published | $338.13 – $338.13 | 1 |
| Artery x-rays arm/leg 75710-26 CPT 75710 | not published | not published | $149.27 – $149.27 | 1 |
| Artery x-rays arms/legs 75716-26 CPT 75716 | not published | not published | $172.53 – $172.53 | 1 |
| Artery x-rays chest CPT 75756 | not published | not published | $154.30 – $154.30 | 1 |
| Artery x-rays lung CPT 75741 | not published | not published | $302.75 – $302.75 | 1 |
| Artery x-rays lung CPT 75746 | not published | not published | $302.74 – $302.74 | 1 |
| Artery x-rays lungs CPT 75743 | not published | not published | $319.70 – $319.70 | 1 |
| Artery xrays of pelvis 75736 26 CPT 75736 | not published | not published | $308.56 – $308.56 | 1 |
| Artery x-rays spine CPT 75705 | not published | not published | $346.71 – $346.71 | 1 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $274.01 | $421.55 | not published | 0 |
| Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides) CPT 20611 | $667.15 | $1,026.39 | not published | 0 |
| Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance CPT 20600 | $667.15 | $1,026.39 | not published | 0 |
| Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604 CPT 20604 | $639.92 | $984.49 | not published | 0 |
| Artiss fibrin sealant HCPCS C9250 | not published | not published | $186.62 – $186.62 | 1 |
| Ashkenazi jewish assoc dis CPT 81412 | not published | not published | $2,375.10 – $31,846.46 | 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.