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 |
|---|---|---|---|---|
| MRI upper extremity w/dye CPT 73219 | $1,544.71 | $2,376.48 | $380.27 – $380.27 | 1 |
| Msh2 gene dup/delete variant CPT 81297 | not published | not published | $153.23 – $2,774.22 | 4 |
| Msh2 gene full seq CPT 81295 | not published | not published | $153.23 – $4,964.47 | 4 |
| Msh2 gene known variants CPT 81296 | not published | not published | $88.05 – $4,392.58 | 4 |
| Msh6 gene dup/delete variant CPT 81300 | not published | not published | $163.30 – $3,095.48 | 4 |
| Msh6 gene full seq CPT 81298 | not published | not published | $290.71 – $8,348.03 | 4 |
| Msh6 gene known variants CPT 81299 | not published | not published | $88.05 – $4,005.91 | 4 |
| Mthfr gene analy common variants CPT 81291 | $356.77 | $548.88 | $63.38 – $849.83 | 3 |
| M.tuberculo dna dir probe CPT 87555 | $56.80 | $87.39 | $26.07 – $349.61 | 3 |
| M.tuberculo dna quant CPT 87557 | not published | not published | $41.55 – $557.19 | 3 |
| Mucin synovial fluid CPT 83872 | not published | not published | $5.68 – $76.22 | 3 |
| Mucopolysaccharides CPT 83864 | not published | not published | $20.35 – $370.68 | 4 |
| Mucormycosis antibody CPT 86732 | not published | not published | $14.55 – $195.09 | 3 |
| Mult fam adapt bhv tx gdn CPT 97157 | not published | not published | $8.34 – $8.34 | 1 |
| Multi family grp psychotherapy CPT 90849 | $381.50 | $586.92 | $30.00 – $34.55 | 2 |
| Mumps antibody igg CPT 86735 | $67.76 | $104.25 | $8.11 – $169.73 | 4 |
| Mycobacteria dna amp probe CPT 87551 | not published | not published | $46.79 – $627.42 | 4 |
| Mycobacteria dna dir probe CPT 87550 | not published | not published | $19.45 – $260.77 | 3 |
| Mycobacteria dna quant CPT 87552 | not published | not published | $41.55 – $557.19 | 3 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | not published | not published | $0.15 – $0.53 | 2 |
| Mycophenolic acid HCPCS J7518 | not published | not published | $0.38 – $1.73 | 2 |
| Mycoplasma antibody igm CPT 86738 | $130.42 | $200.65 | $12.84 – $172.20 | 4 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | not published | not published | $106.29 – $2,281.29 | 4 |
| Myelogphy 2/> spine regions CPT 72270 | $2,162.45 | $3,326.85 | $206.97 – $206.97 | 1 |
| Myelography l-s spine CPT 72265 | not published | not published | $88.16 – $88.16 | 1 |
| Myelography neck spine CPT 72240 | $1,480.95 | $2,278.38 | $92.42 – $92.42 | 1 |
| Myelography thoracic spine CPT 72255 | not published | not published | $86.75 – $86.75 | 1 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $173.99 | $267.67 | $11.18 – $149.96 | 3 |
| Myocrd img pet 1std rst/strs CPT 78491 | not published | not published | $483.00 – $483.00 | 1 |
| Myocrd img pet mlt rst&strs CPT 78492 | not published | not published | $793.00 – $793.00 | 1 |
| Myown harv prep proc sq cm HCPCS Q4226 | not published | not published | $576.00 – $576.00 | 1 |
| Nabilone oral HCPCS J8650 | not published | not published | $37.63 – $37.63 | 1 |
| Nafcillin 2 gram solution for injection HCPCS J2290 | not published | not published | $0.21 – $0.21 | 1 |
| Nalbuphine 10 mg/ml injection solution HCPCS J2300 | not published | not published | $3.08 – $4.35 | 2 |
| Naltrexone, depot form HCPCS J2315 | not published | not published | $4.12 – $4.74 | 2 |
| Nandrolone decanoate 50 mg HCPCS J2320 | not published | not published | $3.40 – $3.40 | 1 |
| Narcosynthesis CPT 90865 | not published | not published | $252.00 – $252.00 | 1 |
| Nasopharyngoscopy w/endoscope CPT 92511 | $438.61 | $674.79 | not published | 0 |
| Natalizumab 300 mg/15 ml intravenous solution HCPCS J2323 | $44.25 | $68.08 | $24.37 – $31.42 | 2 |
| Natriuretic peptide CPT 83880 | $303.66 | $467.17 | $34.41 – $510.62 | 4 |
| Natural killer cells total count CPT 86357 | $76.66 | $117.94 | $23.40 – $490.72 | 4 |
| Navigational bronchoscopy 31627 CPT 31627 | $295.04 | $453.91 | not published | 0 |
| Nebulizer Breathing Treatment CPT 94640 | $479.95 | $738.39 | not published | 0 |
| Neck Airway (Soft Tissue) X-ray CPT 70360 | $193.80 | $298.15 | $17.69 – $17.69 | 1 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | not published | not published | $241.46 – $241.46 | 1 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | not published | not published | $268.04 – $268.04 | 1 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $1,199.23 | $1,844.97 | $197.33 – $197.33 | 1 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $3,351.15 | $5,155.61 | $517.39 – $517.39 | 1 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $2,642.74 | $4,065.75 | $391.04 – $391.04 | 1 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $2,501.71 | $3,848.79 | $335.74 – $335.74 | 1 |
| Neck (Cervical Spine) X-ray (2 to 3 views) CPT 72040 | $256.87 | $395.19 | $25.02 – $25.02 | 1 |
| Neck (Cervical Spine) X-ray (4 to 5 views) CPT 72050 | $328.43 | $505.27 | $33.88 – $33.88 | 1 |
| Neck (Cervical Spine) X-ray (6 or more views) CPT 72052 | $419.55 | $645.46 | $43.01 – $43.01 | 1 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $4,280.03 | $6,584.66 | $490.37 – $490.37 | 1 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | not published | not published | $364.44 – $364.44 | 1 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $2,642.74 | $4,065.75 | $320.89 – $320.89 | 1 |
| Neck Soft Tissue CT Scan (with and without contrast) CPT 70492 | $1,724.85 | $2,653.61 | $239.89 – $239.89 | 1 |
| Neck Soft Tissue CT Scan (with contrast) CPT 70491 | $1,449.78 | $2,230.43 | $198.41 – $198.41 | 1 |
| Neck Soft Tissue CT Scan (without contrast) CPT 70490 | $1,199.23 | $1,844.97 | $202.11 – $202.11 | 1 |
| Neisseria meningitidis CPT 86741 | not published | not published | $8.11 – $171.55 | 4 |
| Nelarabine injection HCPCS J9261 | not published | not published | $63.18 – $158.64 | 2 |
| Neopatch or therion, 1 sq cm HCPCS Q4176 | not published | not published | $190.00 – $190.00 | 1 |
| Neostigmine methylsulfate 1 mg/ml injection (wrapper) HCPCS J2710 | not published | not published | $0.77 – $0.96 | 2 |
| Neox 100 or clarix 100 HCPCS Q4156 | not published | not published | $180.00 – $180.00 | 1 |
| Nerobehav stas exam by psy/md f2f 1st hr CPT 96116 | not published | not published | $72.21 – $72.21 | 1 |
| Nerobehav stas exam phys/qhp f2f ea l hr CPT 96121 | not published | not published | $63.22 – $63.22 | 1 |
| Nerve conduction studies 1-2 CPT 95907 | $464.35 | $714.38 | not published | 0 |
| Nerve conduction studies 3-4 CPT 95908 | $687.21 | $1,057.25 | not published | 0 |
| Nesiritide injection HCPCS J2325 | not published | not published | $67.74 – $67.74 | 1 |
| Neuromatrix nerve cuff, cm HCPCS C9355 | not published | not published | $214.40 – $214.40 | 1 |
| Neuromuscular junction testing ea nerve any 1 method CPT 95937 | $408.76 | $628.86 | not published | 0 |
| Neutrlzg antb sarscov2 scr CPT 86408 | not published | not published | $40.87 – $547.95 | 3 |
| Neutrlzg antb sarscov2 titer CPT 86409 | not published | not published | $77.22 – $1,035.42 | 3 |
| Neutron beam tx complex CPT 77423 | not published | not published | $135.91 – $135.91 | 1 |
| New Patient Office Visit (level 2) CPT 99202 | $271.03 | $416.97 | $31.71 – $100.25 | 2 |
| New Patient Office Visit (level 3) CPT 99203 | $313.92 | $482.95 | $43.29 – $142.01 | 2 |
| New Patient Office Visit (level 4) CPT 99204 | $390.13 | $600.20 | $66.04 – $216.28 | 2 |
| New Patient Office Visit (level 5) CPT 99205 | $514.76 | $791.94 | $76.97 – $272.05 | 2 |
| Nfct agt gntyp alys sarscov2 CPT 87913 | not published | not published | $249.73 – $3,348.45 | 3 |
| Nfct ds bv&vaginitis dna alg CPT 81514 | not published | not published | $255.10 – $3,420.50 | 3 |
| N. gonorrhoeae assay w/optic CPT 87850 | not published | not published | $23.82 – $319.43 | 3 |
| N.gonorrhoeae dna quant CPT 87592 | not published | not published | $41.55 – $557.19 | 3 |
| Nicardipine 25 mg/10 ml intravenous solution HCPCS J2404 | not published | not published | $0.09 – $0.09 | 1 |
| Nitroblue tetrazolium dye CPT 86384 | not published | not published | $13.20 – $177.01 | 3 |
| Nitrogen n-13 ammonia HCPCS A9526 | not published | not published | $790.80 – $790.80 | 1 |
| Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 | not published | not published | $1.34 – $1.34 | 1 |
| Nivolumab 10 mg/ml intravenous solution (wrapper) HCPCS J9299 | not published | not published | $32.35 – $35.27 | 2 |
| Nivolumab 240 mg-relatlimab-rmbw 80 mg/20 ml intravenous solution HCPCS J9298 | not published | not published | $194.08 – $205.41 | 2 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | not published | not published | $161.05 – $161.05 | 1 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $644.48 | $991.51 | $231.22 – $231.22 | 1 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | not published | not published | $114.76 – $114.76 | 1 |
| Nm imaging pulmonary ventilation/perfusion CPT 78582 | not published | not published | $185.18 – $185.18 | 1 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | not published | not published | $193.10 – $193.10 | 1 |
| Nm radiopharmaceutical therapy oral administration CPT 79005 | not published | not published | $89.51 – $89.51 | 1 |
| Non-card vasc flow imaging CPT 78445 | not published | not published | $116.40 – $116.40 | 1 |
| Non-imaging heart function CPT 78414 | not published | not published | $242.26 – $242.26 | 1 |
| Noonan spectrum disorders CPT 81442 | not published | not published | $2,079.29 – $27,880.09 | 3 |
| Nose (Nasal Bone) X-ray (complete) CPT 70160 | $157.19 | $241.83 | $21.19 – $21.19 | 1 |
| Novachor 1 sq cm HCPCS Q4194 | not published | not published | $1,000.00 – $1,000.00 | 1 |
| Npm1 gene CPT 81310 | $500.90 | $770.62 | $239.12 – $3,206.29 | 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.