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 |
|---|---|---|---|---|
| Tgfbi gene common variants CPT 81333 | not published | not published | $132.89 – $1,781.85 | 3 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $736.74 – $9,878.60 | 3 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $2,832.01 – $37,972.90 | 3 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $579.97 – $7,776.54 | 3 |
| Theophylline therapeutic drug level CPT 80198 | $98.83 | $152.04 | $8.08 – $183.91 | 4 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $44.64 | $68.67 | $77.43 – $77.43 | 1 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $61.54 | $94.67 | $60.43 – $60.43 | 1 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $38.33 | $58.97 | not published | 0 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $68.39 | $105.21 | not published | 0 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $315.69 | $485.68 | $145.47 – $145.47 | 1 |
| Ther/proph/diag inj ia CPT 96373 | $66.68 | $102.58 | not published | 0 |
| Ther radiology tx plng cplx CPT 77263 | not published | not published | $99.63 – $99.63 | 1 |
| Ther radiology tx plng intrm CPT 77262 | not published | not published | $67.18 – $67.18 | 1 |
| Ther radiology tx plng smpl CPT 77261 | not published | not published | $44.65 – $44.65 | 1 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | not published | not published | $1.76 – $5.33 | 2 |
| Thiethylperazine maleate inj HCPCS J3280 | not published | not published | $5.94 – $5.94 | 1 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $157.19 | $241.83 | $26.18 – $26.18 | 1 |
| Thiotepa injection HCPCS J9340 | not published | not published | $245.05 – $900.00 | 2 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,258.15 | $1,935.62 | not published | 0 |
| Three-Phase Bone Scan (Nuclear Medicine) CPT 78315 | not published | not published | $233.29 – $233.29 | 1 |
| Throat x-ray & fluoroscopy CPT 70370 | not published | not published | $57.43 – $57.43 | 1 |
| Thrombin time CPT 85670 | $41.77 | $64.26 | $5.35 – $75.05 | 4 |
| Thrombin time titer CPT 85675 | not published | not published | $6.64 – $89.09 | 3 |
| Thrombomodulin CPT 85337 | not published | not published | $13.82 – $224.62 | 4 |
| Thromboplastin inhibition CPT 85705 | not published | not published | $7.69 – $125.25 | 4 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $58.25 | $89.62 | $6.25 – $84.15 | 4 |
| Thromboxane urine CPT 84431 | not published | not published | $34.06 – $456.65 | 3 |
| Thyroglobulin antibody CPT 86800 | $63.75 | $98.07 | $13.48 – $206.93 | 4 |
| Thyroid imaging CPT 78013 | not published | not published | $133.48 – $133.48 | 1 |
| Thyroid met imaging CPT 78015 | not published | not published | $147.38 – $147.38 | 1 |
| Thyroid met imaging/studies CPT 78016 | not published | not published | $215.96 – $215.96 | 1 |
| Thyroid mets imag whole body CPT 78018 | not published | not published | $204.11 – $204.11 | 1 |
| Thyroid met uptake CPT 78020 | not published | not published | $54.76 – $54.76 | 1 |
| Thyroid (TSH) Test CPT 84443 | $135.17 | $207.96 | $9.09 – $218.50 | 4 |
| Thyroid Ultrasound CPT 76536 | $707.93 | $1,089.12 | $75.83 – $75.83 | 1 |
| Thyroid uptake measurement CPT 78012 | not published | not published | $66.05 – $66.05 | 1 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | not published | not published | $2,078.71 – $2,204.59 | 2 |
| Thyrotropin releasing hormone CPT 80438 | not published | not published | $18.18 – $655.64 | 4 |
| Thyroxine binding globulin (tbg) CPT 84442 | $156.41 | $240.63 | $9.09 – $192.23 | 4 |
| Tic-brn enceph vac 0.25ml im CPT 90626 | not published | not published | $337.20 – $337.20 | 1 |
| Tic-brn enceph vac 0.5ml im CPT 90627 | not published | not published | $337.20 – $337.20 | 1 |
| Tigecycline injection HCPCS J3243 | not published | not published | $0.30 – $2.52 | 2 |
| Tilt table study CPT 93660 | $1,123.87 | $1,729.03 | not published | 0 |
| Tinzaparin sodium injection HCPCS J1655 | not published | not published | $2.91 – $2.91 | 1 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | not published | not published | $3.55 – $4.48 | 2 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | not published | not published | $183.42 – $188.65 | 2 |
| Tissue amnio epifix inj 100mg HCPCS Q4145 | not published | not published | $25.04 – $25.04 | 1 |
| Tissue culture placenta CPT 88235 | not published | not published | $133.23 – $1,954.83 | 4 |
| Tissue culture skin/biopsy CPT 88233 | not published | not published | $133.23 – $1,830.36 | 4 |
| Tissue culture tumor CPT 88239 | not published | not published | $133.23 – $1,918.67 | 4 |
| Tissue exam koh skin/hair/nails CPT 87220 | not published | not published | $4.14 – $55.54 | 3 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | not published | not published | $121.00 – $121.00 | 1 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | not published | not published | $19.81 – $19.81 | 1 |
| Tissue transglutaminase iga CPT 86364 | $24.36 | $37.48 | $6.98 – $149.96 | 4 |
| Tixagev and cilgav inj HCPCS M0220 | $369.83 | $568.97 | not published | 0 |
| Tl-201 thallium diag per mci HCPCS A9505 | not published | not published | $162.57 – $162.57 | 1 |
| Tobramycin comp unit HCPCS J7685 | not published | not published | $47.33 – $47.33 | 1 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | not published | not published | $1.60 – $2.38 | 2 |
| Tobramycin non-comp unit HCPCS J7682 | not published | not published | $14.80 – $106.04 | 2 |
| Tobramycin peak therapeutic drug level CPT 80200 | $52.76 | $81.17 | $10.61 – $209.79 | 4 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | not published | not published | $5.88 – $7.37 | 2 |
| Tocilizumab for covid-19 HCPCS Q0249 | not published | not published | $7.37 – $7.37 | 1 |
| Toe X-ray (both feet) CPT 73660 | $176.36 | $271.32 | $18.83 – $18.83 | 1 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $84.37 | $129.80 | not published | 0 |
| Tomosynthesis breast screen bilateral CPT 77063 | $84.37 | $129.80 | not published | 0 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | not published | not published | $1.27 – $4.20 | 2 |
| Topotecan oral HCPCS J8705 | not published | not published | $120.59 – $124.90 | 2 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | not published | not published | $39.10 – $39.10 | 1 |
| Total tau CPT 84394 | $230.00 | $353.85 | $125.05 – $1,676.76 | 3 |
| Tot estradiol response panel CPT 80415 | not published | not published | $54.21 – $726.92 | 4 |
| Toxoplasma antibody igg CPT 86777 | $82.06 | $126.25 | $13.96 – $187.16 | 4 |
| Toxoplasma antibody igm CPT 86778 | $68.50 | $105.39 | $13.98 – $187.42 | 4 |
| Tp53 gene full gene sequence CPT 81351 | not published | not published | $388.96 – $8,348.03 | 4 |
| Tp53 gene known famil vrnt CPT 81353 | not published | not published | $186.65 – $4,005.91 | 4 |
| Tp53 gene trgt sequence alys CPT 81352 | not published | not published | $199.69 – $4,285.67 | 4 |
| Tpmt gene com vrnts CPT 81335 | $427.63 | $657.89 | $169.57 – $2,273.61 | 3 |
| Tprnl plmt biodegrdabl matrl CPT 55874 | $11,538.11 | $17,750.94 | not published | 0 |
| Trabectedin 1 mg intravenous solution HCPCS J9352 | not published | not published | $363.83 – $379.11 | 2 |
| Transcatheter bx s&i CPT 75970 | not published | not published | $336.10 – $336.10 | 1 |
| Transcutaneous carboxyhb CPT 88740 | not published | not published | $9.09 – $121.87 | 3 |
| Transcutaneous hgb 88738 CPT 88738 | not published | not published | $4.87 – $65.29 | 3 |
| Transcutaneous methb CPT 88741 | not published | not published | $9.09 – $121.87 | 3 |
| Transferrin CPT 84466 | $39.94 | $61.45 | $12.38 – $165.96 | 4 |
| Transparent film <= 16 sq in HCPCS A6257 | not published | not published | $0.61 – $0.61 | 1 |
| Transvaginal Pelvic Ultrasound (not pregnancy) CPT 76830 | $493.27 | $758.88 | $80.05 – $80.05 | 1 |
| Transvaginal Pregnancy Ultrasound CPT 76817 | $717.31 | $1,103.55 | $101.87 – $101.87 | 1 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | not published | not published | $75.69 – $124.67 | 2 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | not published | not published | $108.81 – $108.81 | 1 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | not published | not published | $96.89 – $96.89 | 1 |
| Trb@ gene rearrange dirprobe CPT 81341 | not published | not published | $48.10 – $644.98 | 3 |
| Treat ankle dislocation CPT 27842 | $2,848.48 | $4,382.28 | not published | 0 |
| Treat elbow dislocation CPT 24605 | $2,848.48 | $4,382.28 | not published | 0 |
| Treat elbow fracture CPT 24620 | $4,219.38 | $6,491.35 | not published | 0 |
| Treat finger fracture each CPT 26742 | $1,383.84 | $2,128.99 | not published | 0 |
| Treat fracture of radius CPT 25505 | $2,848.48 | $4,382.28 | not published | 0 |
| Treat hip dislocation CPT 27252 | $4,283.02 | $6,589.26 | not published | 0 |
| Treat humerus fracture CPT 24535 | $4,283.02 | $6,589.26 | not published | 0 |
| Treat knee fracture 27530 CPT 27530 | $658.55 | $1,013.15 | not published | 0 |
| Treatment incomplete abortion completed surgically any trimester CPT 59812 | $8,180.93 | $12,586.05 | not published | 0 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $218.17 | $335.64 | not published | 0 |
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.