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 |
|---|---|---|---|---|
| Pulse ox multiple CPT 94761 | $125.65 | $193.31 | not published | 0 |
| Pulse ox single CPT 94760 | $70.73 | $108.81 | not published | 0 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $284.91 | $438.33 | not published | 0 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $915.44 | $1,408.37 | not published | 0 |
| Puncture spinal lumbar diagnostic CPT 62270 | $1,581.07 | $2,432.42 | not published | 0 |
| Puraply 1 sq cm HCPCS Q4195 | not published | not published | $206.40 – $206.40 | 1 |
| Puraply xt 1 sq cm HCPCS Q4197 | not published | not published | $300.00 – $300.00 | 1 |
| Pyridoxine hcl 100 mg HCPCS J3415 | not published | not published | $12.57 – $19.88 | 2 |
| Pyruvate CPT 84210 | not published | not published | $14.05 – $188.33 | 3 |
| Pyruvate kinase CPT 84220 | $7.74 | $11.90 | $9.16 – $122.78 | 4 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | not published | not published | $174.16 – $174.16 | 1 |
| Quant diff pulm perf w/imaging CPT 78597 | not published | not published | $113.17 – $113.17 | 1 |
| Quest t3 uptake CPT 84479 | $12.62 | $19.41 | $3.33 – $84.15 | 4 |
| Quinupristin/dalfopristin HCPCS J2770 | not published | not published | $447.37 – $559.21 | 2 |
| Rabies ig heat-treated human im/subq 90376 CPT 90376 | not published | not published | $517.22 – $517.22 | 1 |
| Rabies ig ht&sol human im/sc CPT 90377 | not published | not published | $427.88 – $427.88 | 1 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | not published | not published | $402.26 – $402.26 | 1 |
| Radiation physics consult CPT 77336 | not published | not published | $33.69 – $33.69 | 1 |
| Radiation therapy dose plan CPT 77300 | not published | not published | $44.23 – $44.23 | 1 |
| Radiation therapy management CPT 77431 | not published | not published | $61.09 – $61.09 | 1 |
| Radiation treatment aid(s) CPT 77332 | not published | not published | $50.02 – $50.02 | 1 |
| Radiation treatment aid(s) CPT 77333 | not published | not published | $37.36 – $37.36 | 1 |
| Radiation treatment aid(s) CPT 77334 | not published | not published | $97.26 – $97.26 | 1 |
| Radiation treatment delivery CPT 77401 | not published | not published | $37.55 – $37.55 | 1 |
| Radiation treatment delivery CPT 77402 | not published | not published | $97.23 – $97.23 | 1 |
| Radiation treatment delivery CPT 77412 | not published | not published | $149.95 – $149.95 | 1 |
| Radiation tx management x5 CPT 77427 | not published | not published | $111.36 – $111.36 | 1 |
| Radiesse injection HCPCS Q2026 | not published | not published | $56.48 – $56.48 | 1 |
| Radiology port images(s) CPT 77417 | not published | not published | $9.61 – $9.61 | 1 |
| Radiotherapy dose plan imrt CPT 77301 | not published | not published | $1,334.03 – $1,334.03 | 1 |
| Radium ra223 dichl ther/uci HCPCS A9606 | not published | not published | $180.17 – $180.17 | 1 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | not published | not published | $209.37 – $209.37 | 1 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | not published | not published | $441.02 – $441.02 | 1 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | not published | not published | $224.82 – $224.82 | 1 |
| Radphm lcl tumor plr sgl day CPT 78800 | not published | not published | $145.73 – $145.73 | 1 |
| Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 | not published | not published | $73.37 – $79.19 | 2 |
| Ranibizumab injection HCPCS J2778 | not published | not published | $90.41 – $468.00 | 2 |
| Rapid desensitization CPT 95180 | $557.97 | $858.41 | not published | 0 |
| Rapid Strep Test CPT 87880 | $40.44 | $62.21 | $3.79 – $214.99 | 4 |
| Rasburicase 1.5 mg intravenous solution HCPCS J2783 | not published | not published | $370.46 – $405.05 | 2 |
| Ravulizumab-cwvz 100 mg/ml intravenous solution HCPCS J1303 | $360.76 | $555.02 | $220.32 – $256.16 | 2 |
| Rbc count only automated CPT 85041 | not published | not published | $2.93 – $39.28 | 4 |
| Rbc deglycerolized each unit HCPCS P9039 | $1,095.56 | $1,685.48 | not published | 0 |
| Rbc mechanical fragility CPT 85547 | not published | not published | $8.34 – $111.85 | 3 |
| Rbc osmotic fragility CPT 85555 | $22.66 | $34.86 | $7.25 – $97.16 | 4 |
| Red blood cells each unit HCPCS P9021 | $345.33 | $531.27 | not published | 0 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | $611.86 | $941.32 | not published | 0 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $446.43 | $686.81 | not published | 0 |
| Red blood cells washed each unit HCPCS P9022 | $953.09 | $1,466.29 | not published | 0 |
| Red cell mass multiple CPT 78121 | not published | not published | $92.93 – $92.93 | 1 |
| Red cell mass single CPT 78120 | not published | not published | $69.47 – $69.47 | 1 |
| Red cell survival kinetics CPT 78135 | not published | not published | $236.06 – $236.06 | 1 |
| Red cell survival study CPT 78130 | not published | not published | $121.32 – $121.32 | 1 |
| Refill/maint pump/resvr syst CPT 96522 | $576.66 | $887.17 | not published | 0 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $91.95 | $141.46 | $4.41 – $77.33 | 2 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | not published | not published | $6.35 – $6.35 | 1 |
| Rem interrog dev eval scrms CPT 93298 | $82.64 | $127.14 | not published | 0 |
| Remote 30 day ecg tech supp CPT 93229 | $307.13 | $472.51 | not published | 0 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $1,419.51 | $2,183.86 | not published | 0 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $2,650.02 | $4,076.96 | not published | 0 |
| Removal cerumen impacted (both sides) CPT 69210 | $123.27 | $189.64 | not published | 0 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $389.72 | $599.57 | not published | 0 |
| Removal embedded foreign body vestibule mouth smpl CPT 40804 | $2,039.82 | $3,138.18 | not published | 0 |
| Removal foreign body foot subcutaneous right CPT 28190 | $1,307.20 | $2,011.08 | not published | 0 |
| Removal implant superficial separate procedure CPT 20670 | $3,679.56 | $5,660.86 | not published | 0 |
| Removal of skin tags each add'l 10 CPT 11201 | $232.34 | $357.45 | not published | 0 |
| Removal skin tags fibrocutaneous any area <= 15 lesions CPT 11200 | $523.88 | $805.97 | not published | 0 |
| Removal sutr and stapl no anes CPT 15854 | $25.12 | $38.64 | not published | 0 |
| Removal sutr or stapl no anes CPT 15853 | $25.97 | $39.96 | not published | 0 |
| Remove cva lumen obstruct CPT 75902 | not published | not published | $49.30 – $49.30 | 1 |
| Remove esophagus obstruction CPT 74235 | not published | not published | $129.58 – $129.58 | 1 |
| Renal cyst study s&i CPT 74470 | not published | not published | $60.75 – $60.75 | 1 |
| Renal function panel CPT 80069 | $184.97 | $284.57 | $8.42 – $112.89 | 4 |
| Renal venogram bil s&i CPT 75833 | not published | not published | $316.84 – $316.84 | 1 |
| Renin stimulation panel CPT 80416 | not published | not published | $166.65 – $2,722.46 | 4 |
| Renin stimulation panel CPT 80417 | not published | not published | $42.67 – $572.14 | 3 |
| Repair complex wound scalp/arms/legs 2.6 - 7.5 cm CPT 13121 | $1,675.44 | $2,577.60 | not published | 0 |
| Repair dental ellis ii fx CPT 41899 | $453.82 | $698.19 | not published | 0 |
| Repair of digit nerve hand/foot 1 nerve CPT 64831 | $3,600.45 | $5,539.16 | not published | 0 |
| Repair rpr lip full thickness vermilion only CPT 40650 | $1,031.74 | $1,587.30 | not published | 0 |
| Replace g/c tube perc CPT 49450 | $2,372.05 | $3,649.31 | not published | 0 |
| Reptilase test CPT 85635 | not published | not published | $8.56 – $128.11 | 4 |
| Reslizumab 10 mg/ml intravenous solution HCPCS J2786 | not published | not published | $10.49 – $12.35 | 2 |
| Respirator motion mgmt simul CPT 77293 | not published | not published | $335.26 – $335.26 | 1 |
| #resp virpnl dfa-adenovirus CPT 87260 | not published | not published | $8.11 – $187.68 | 4 |
| #resp virpnl dfa-parainfluenza CPT 87279 | not published | not published | $8.11 – $213.69 | 4 |
| Resp virus 6-11 targets CPT 87632 | $644.56 | $991.63 | $211.52 – $2,836.13 | 3 |
| Restorigin 1 sq cm HCPCS Q4191 | not published | not published | $485.00 – $485.00 | 1 |
| Reteplase injection HCPCS J2993 | not published | not published | $2,900.19 – $3,452.61 | 2 |
| Reticulated platelet assay CPT 85055 | not published | not published | $23.40 – $464.84 | 4 |
| Reticulocyte automated CPT 85045 | $12.07 | $18.57 | $3.20 – $51.89 | 4 |
| Reticulocyte direct measurement automated CPT 85046 | not published | not published | $1.44 – $72.44 | 4 |
| Retifanlimab-dlwr 500 mg/20 ml intravenous solution HCPCS J9345 | not published | not published | $29.74 – $29.74 | 1 |
| Retrograde ejaculation anal CPT 89331 | not published | not published | $19.00 – $254.79 | 3 |
| Revefenacin inh non-com 1mcg HCPCS J7677 | not published | not published | $0.20 – $0.28 | 2 |
| Revitalon 1 square cm HCPCS Q4157 | not published | not published | $209.56 – $209.56 | 1 |
| Revita, per sq cm HCPCS Q4180 | not published | not published | $265.90 – $265.90 | 1 |
| Rezafungin 200 mg intravenous solution HCPCS J0349 | not published | not published | $10.42 – $10.42 | 1 |
| Rheumatoid factor qualitative CPT 86430 | not published | not published | $4.93 – $79.86 | 4 |
| Rheumatoid factor quantitative CPT 86431 | $65.93 | $101.43 | $5.25 – $73.75 | 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.