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 |
|---|---|---|---|---|
| Npsy fam hlth interv ea addl 15 min CPT 96168 | not published | not published | $18.98 – $18.98 | 1 |
| Npsy grp hlth intrv ea addl 15 min CPT 96165 | not published | not published | $3.02 – $3.02 | 1 |
| Npsy indiv hlth intrv ea addl 15 min CPT 96159 | not published | not published | $22.47 – $22.47 | 1 |
| Npsy tst eval phsy/qhp 1st hr CPT 96132 | not published | not published | $101.09 – $101.09 | 1 |
| Npsy tst eval phsy/qhp ea l hr CPT 96133 | not published | not published | $77.11 – $77.11 | 1 |
| Nras gene variants exon 2&3 CPT 81311 | not published | not published | $179.24 – $3,847.10 | 4 |
| Nr lnr acclrtr tx max 5 sessions CPT 77373 | not published | not published | $1,024.69 – $1,024.69 | 1 |
| Nsl/sinus ndsc cryoabltj pnn CPT 31243 | $11,304.18 | $17,391.04 | not published | 0 |
| Nsl/sinus ndsc rf abltj pnn CPT 31242 | $11,304.18 | $17,391.04 | not published | 0 |
| Ntrk1 translocation analysis CPT 81191 | not published | not published | $125.63 – $2,696.32 | 4 |
| Ntrk2 translocation analysis CPT 81192 | not published | not published | $125.63 – $2,696.32 | 4 |
| Ntrk3 translocation analysis CPT 81193 | not published | not published | $125.63 – $2,696.32 | 4 |
| Ntrk translocation analysis CPT 81194 | not published | not published | $314.08 – $6,740.85 | 4 |
| Ntsty modul rad tx dlvr cplx CPT 77386 | not published | not published | $418.70 – $418.70 | 1 |
| Ntsty modul rad tx dlvr smpl CPT 77385 | not published | not published | $334.96 – $334.96 | 1 |
| Nuclear exam of tear flow CPT 78660 | not published | not published | $118.46 – $118.46 | 1 |
| Nuclear localization/abscess CPT 78807 | not published | not published | $224.41 – $224.41 | 1 |
| Nuclear matrix protein 22 CPT 86386 | not published | not published | $21.13 – $283.28 | 3 |
| Nuclear rx intra-articular CPT 79440 | not published | not published | $136.55 – $136.55 | 1 |
| Nuclear rx intracav admin CPT 79200 | not published | not published | $142.37 – $142.37 | 1 |
| Nuclear rx IV admin CPT 79101 | not published | not published | $140.27 – $140.27 | 1 |
| Nuclear Stress Test (Heart) CPT 78452 | not published | not published | $305.59 – $305.59 | 1 |
| Nuclr rx interstit colloid CPT 79300 | not published | not published | $300.49 – $300.49 | 1 |
| Nudt15 gene common variants CPT 81306 | not published | not published | $282.62 – $3,789.49 | 3 |
| Nushield 1 square cm HCPCS Q4160 | not published | not published | $256.20 – $256.20 | 1 |
| Nusinersen (pf) 12 mg/5 ml intrathecal solution HCPCS J2326 | not published | not published | $1,136.30 – $1,332.38 | 2 |
| Obinutuzumab 1,000 mg/40 ml intravenous solution HCPCS J9301 | not published | not published | $75.21 – $87.61 | 2 |
| Observation direct referral from physician office for admission HCPCS G0379 | $192.54 | $296.21 | not published | 0 |
| Observation/inpatient hospital care hi severity 99236 CPT 99236 | not published | not published | $118.08 – $118.08 | 1 |
| Obstetric panel inc HIV tstg CPT 80081 | not published | not published | $72.61 – $973.64 | 3 |
| Obstetrics panel CPT 80055 | not published | not published | $46.38 – $621.83 | 3 |
| Obtaining screen pap smear HCPCS Q0091 | $15.50 | $23.84 | not published | 0 |
| Ob Ultrasound nuchal meas 1 gest CPT 76813 | $232.59 | $357.83 | $137.93 – $137.93 | 1 |
| Ob Ultrasound nuchal meas add-on CPT 76814 | not published | not published | $87.89 – $87.89 | 1 |
| Occupational Therapy Evaluation (high complexity) CPT 97167 | $153.10 | $235.54 | $178.25 – $178.25 | 1 |
| Occupational Therapy Evaluation (low complexity) CPT 97165 | $133.76 | $205.78 | $178.93 – $178.93 | 1 |
| Occupational Therapy Evaluation (moderate complexity) CPT 97166 | $136.94 | $210.68 | $178.25 – $178.25 | 1 |
| Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 | not published | not published | $57.81 – $71.19 | 2 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | not published | not published | $0.59 – $2.70 | 2 |
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | not published | not published | $204.59 – $255.88 | 2 |
| Ofatumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9302 | not published | not published | $57.92 – $72.40 | 2 |
| Office consultation CPT 99241 | not published | not published | $19.46 – $19.46 | 1 |
| Off/op cnsltj new/est low 30 CPT 99243 | $158.91 | $244.47 | $58.38 – $58.38 | 1 |
| Off/op cnsltj new/est mod 40 CPT 99244 | $298.91 | $459.86 | $58.38 – $58.38 | 1 |
| Off/op consltj new/est hi 55 CPT 99245 | not published | not published | $58.38 – $58.38 | 1 |
| Off/op consltj new/est sf 20 CPT 99242 | not published | not published | $24.71 – $24.71 | 1 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | not published | not published | $0.93 – $0.93 | 1 |
| Olanzapine long-acting inj HCPCS J2358 | not published | not published | $2.92 – $3.37 | 2 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | not published | not published | $40.12 – $48.85 | 2 |
| Onc breast mrna 12 genes CPT 81522 | not published | not published | $3,756.81 – $50,373.01 | 3 |
| Onc breast mrna 58 genes CPT 81520 | not published | not published | $2,434.90 – $32,648.29 | 3 |
| Onc breast mrna 70 genes CPT 81521 | not published | not published | $3,756.81 – $50,373.01 | 3 |
| Onc brst mrna 11 genes CPT 81518 | not published | not published | $2,069.49 – $50,373.01 | 4 |
| Onc brst mrna 70 cnt 31 gene CPT 81523 | not published | not published | $3,756.81 – $50,373.01 | 3 |
| Onc cutan mlnma mrna 31 gene CPT 81529 | not published | not published | $6,977.21 – $93,553.60 | 3 |
| Oncology colon mrna CPT 81525 | not published | not published | $3,022.52 – $40,527.32 | 3 |
| Oncology colorectal scr CPT 81528 | not published | not published | $413.09 – $6,618.46 | 4 |
| Oncology gynecologic CPT 81535 | not published | not published | $562.08 – $7,536.57 | 3 |
| Oncology gynecologic CPT 81536 | not published | not published | $172.23 – $2,309.38 | 3 |
| Oncology lung CPT 81538 | not published | not published | $119.26 – $37,340.80 | 4 |
| Oncology prostate prob score CPT 81539 | $1,676.97 | $2,579.96 | $737.20 – $9,884.71 | 3 |
| Oncology tissue of origin CPT 81504 | not published | not published | $504.40 – $6,763.22 | 3 |
| Oncology tum unknown origin CPT 81540 | not published | not published | $3,637.50 – $48,773.25 | 3 |
| Onco (ovar) five proteins CPT 81503 | not published | not published | $870.09 – $11,666.56 | 3 |
| Onco (ovar) two proteins CPT 81500 | not published | not published | $252.68 – $3,388.12 | 3 |
| Oncoprotein dcp CPT 83951 | $160.42 | $246.80 | $62.48 – $837.73 | 4 |
| Oncoprotein her-2/neu CPT 83950 | not published | not published | $62.48 – $837.73 | 4 |
| Onc prostate 3 genes CPT 81551 | not published | not published | $1,969.10 – $26,402.59 | 3 |
| Onc prostate mrna 22 cnt gen CPT 81542 | not published | not published | $3,756.81 – $50,373.01 | 3 |
| Onc prostate mrna 46 genes CPT 81541 | not published | not published | $3,756.81 – $50,373.01 | 3 |
| Onc thyr mrna 10,196 gen alg CPT 81546 | not published | not published | $3,492.00 – $46,822.32 | 3 |
| Onc uveal mlnma mrna 15 gene CPT 81552 | not published | not published | $7,542.72 – $101,136.21 | 3 |
| Ondansetron 4 mg s0119 HCPCS S0119 | not published | not published | $0.43 – $0.55 | 2 |
| Ondansetron 8 mg disintegrating tablet HCPCS Q0162 | not published | not published | $0.01 – $0.14 | 2 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $0.29 | $0.45 | $0.09 – $0.22 | 2 |
| One-way allow prorated trip HCPCS P9604 | not published | not published | $9.44 – $9.44 | 1 |
| Ophthalmic mitomycin HCPCS J7315 | not published | not published | $412.80 – $516.00 | 2 |
| Ophth Ultrasound b & quant a CPT 76510 | not published | not published | $105.30 – $105.30 | 1 |
| Oph Ultrasound dx ant sgm Ultrasound uni/bi CPT 76513 | not published | not published | $55.84 – $55.84 | 1 |
| Oph Ultrasound dx quan a-scan only CPT 76511 | not published | not published | $62.93 – $62.93 | 1 |
| Opioids & opiate analogs 3/4 CPT 80363 | not published | not published | $5.05 – $5.05 | 1 |
| Oprelvekin injection HCPCS J2355 | not published | not published | $423.14 – $423.14 | 1 |
| Oral aprepitant HCPCS J8501 | not published | not published | $3.04 – $13.19 | 2 |
| Oral busulfan HCPCS J8510 | not published | not published | $131.87 – $150.00 | 2 |
| Oral everolimus HCPCS J7527 | not published | not published | $2.02 – $7.23 | 2 |
| Oral hiv-1/hiv-2 screen HCPCS G0435 | not published | not published | $11.62 – $155.81 | 3 |
| Oral methotrexate (jylamvo) HCPCS J8611 | not published | not published | $17.53 – $17.53 | 1 |
| Oral methotrexate (xatmep) HCPCS J8612 | not published | not published | $20.00 – $20.00 | 1 |
| Oral netupitant, palonosetro HCPCS J8655 | not published | not published | $409.01 – $828.12 | 2 |
| Organic acids total quant ea spec CPT 83918 | $49.87 | $76.72 | $22.89 – $306.95 | 4 |
| Oritavancin 1,200 mg intravenous solution HCPCS J2406 | not published | not published | $42.77 – $50.31 | 2 |
| Oritavancin 400 mg intravenous solution HCPCS J2407 | not published | not published | $28.53 – $32.83 | 2 |
| Oropharyngeal biopsy 42800 CPT 42800 | $3,294.95 | $5,069.15 | not published | 0 |
| Orphenadrine citrate 30 mg/ml injection solution HCPCS J2360 | not published | not published | $12.33 – $18.72 | 2 |
| Orthopantogram CPT 70355 | not published | not published | $13.71 – $13.71 | 1 |
| Orthovisc inj per dose HCPCS J7324 | not published | not published | $125.30 – $573.60 | 2 |
| Oscillation chest wall mechanical per session CPT 94669 | $152.39 | $234.45 | not published | 0 |
| Osmolality blood CPT 83930 | $60.82 | $93.57 | $6.10 – $85.97 | 4 |
| Osmolality urine CPT 83935 | $14.41 | $22.17 | $6.10 – $88.70 | 4 |
| Ostomy clamp, replacement HCPCS A4363 | not published | not published | $1.80 – $1.80 | 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.