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 |
|---|---|---|---|---|
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $115.74 | $178.06 | not published | 0 |
| Treatment of ankle fracture 27786 CPT 27786 | $442.01 | $680.02 | not published | 0 |
| Treatment of choroid lesion CPT 67220 | $1,302.40 | $2,003.69 | not published | 0 |
| Treatment of thigh fracture CPT 27508 | $33.68 | $51.81 | not published | 0 |
| Treatment of toe fracture 28510 CPT 28510 | $715.15 | $1,100.23 | not published | 0 |
| Treatment radiation delivery level 2 CPT 77407 | not published | not published | $164.62 – $164.62 | 1 |
| Treat thigh fracture CPT 27246 | $656.57 | $1,010.11 | not published | 0 |
| Treat wrist dislocation CPT 25675 | $436.82 | $672.03 | not published | 0 |
| Tremelimumab-actl 20 mg/ml intravenous solution HCPCS J9347 | not published | not published | $138.24 – $138.24 | 1 |
| Treponema pallidum ag if CPT 87285 | not published | not published | $11.81 – $158.42 | 3 |
| Treponema pallidum antibody CPT 86780 | $42.13 | $64.81 | $12.76 – $172.20 | 4 |
| Treprostinil injection HCPCS J3285 | not published | not published | $56.83 – $72.58 | 2 |
| Treprostinil, non-comp unit HCPCS J7686 | not published | not published | $760.40 – $854.12 | 2 |
| Trg gene rearrangement anal CPT 81342 | $425.80 | $655.08 | $195.46 – $2,620.75 | 3 |
| Trh stimulation panel CPT 80439 | not published | not published | $65.19 – $874.15 | 3 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $3.70 | $5.69 | $0.87 – $2.90 | 2 |
| Triamcinolone a inj prs-free HCPCS J3300 | not published | not published | $4.74 – $25.02 | 2 |
| Triamcinolone diacetate inj HCPCS J3302 | not published | not published | $0.22 – $0.22 | 1 |
| Triamcinolone hexacetonl inj HCPCS J3303 | not published | not published | $7.80 – $9.75 | 2 |
| Trichinella antibody CPT 86784 | $39.99 | $61.53 | $8.11 – $163.36 | 4 |
| Trichomonas assay w/optic CPT 87808 | not published | not published | $3.79 – $198.86 | 4 |
| #tricyclicantidprssnt CPT 80337 | $110.77 | $170.42 | $5.05 – $5.05 | 1 |
| Triglycerides CPT 84478 | $74.73 | $114.97 | $5.08 – $74.66 | 4 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | not published | not published | $5.39 – $5.87 | 2 |
| Trimethobenzamide hci 250mg HCPCS Q0173 | not published | not published | $0.28 – $0.28 | 1 |
| Trimethobenzamide hcl inj HCPCS J3250 | not published | not published | $50.04 – $56.05 | 2 |
| Trim nondyst nails CPT 11719 | $141.04 | $216.98 | not published | 0 |
| Triptorelin pamoate HCPCS J3315 | not published | not published | $471.63 – $975.89 | 2 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | $2,048.16 | $3,151.02 | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | $4,771.98 | $7,341.50 | not published | 0 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | $4,771.98 | $7,341.50 | not published | 0 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $621.51 – $8,333.46 | 3 |
| Trnspl rej kdn mrna qpcr 139 CPT 81558 | not published | not published | $3,142.80 – $42,140.09 | 3 |
| Troponin quantitative CPT 84484 | $100.37 | $154.42 | $8.13 – $162.19 | 4 |
| Truskin, per sq centimeter HCPCS Q4167 | not published | not published | $120.94 – $120.94 | 1 |
| Tte w or without contr, cont ecg HCPCS C8930 | $2,312.04 | $3,556.99 | not published | 0 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $5,565.22 | $8,561.88 | not published | 0 |
| Tx closed tib shaft fx without manip CPT 27750 | $463.22 | $712.65 | not published | 0 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | $514.01 | $790.78 | not published | 0 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | $1,118.37 | $1,720.57 | not published | 0 |
| Tyms gene com variants CPT 81346 | not published | not published | $169.57 – $2,273.61 | 3 |
| Typhoid vaccine oral CPT 90690 | not published | not published | $113.40 – $113.40 | 1 |
| U2af1 gene common variants CPT 81357 | not published | not published | $117.11 – $2,513.45 | 4 |
| Ua w/micro/comp poc CPT 81000 | not published | not published | $3.90 – $52.28 | 4 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | not published | not published | $68.66 – $68.66 | 1 |
| Ugt1a1 gene analy common variants CPT 81350 | $456.44 | $702.22 | $226.98 – $3,043.45 | 3 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $6.67 – $6.67 | 1 |
| Ultrasound breast complete CPT 76641 | $882.15 | $1,357.15 | $73.24 – $73.24 | 1 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $356.52 | $548.49 | $60.08 – $60.08 | 1 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $262.25 | $403.46 | $36.92 – $36.92 | 1 |
| Ultrasound dx ophth b-scan CPT 76512 | $287.69 | $442.60 | $58.25 – $58.25 | 1 |
| Ultrasound elastography parenchyma CPT 76981 | $204.91 | $315.24 | not published | 0 |
| Ultrasound encephalogram CPT 76506 | $477.92 | $735.26 | $73.45 – $73.45 | 1 |
| Ultrasound exam k transpl w/doppler CPT 76776 | not published | not published | $97.01 – $97.01 | 1 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $493.27 | $758.88 | $103.32 – $103.32 | 1 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $308.82 | $475.10 | $126.68 – $126.68 | 1 |
| Ultrasound guidance for vascular access CPT 76937 | $292.32 | $449.72 | $22.07 – $22.07 | 1 |
| Ultrasound guide intraoperative CPT 76998 | $320.76 | $493.48 | $109.84 – $109.84 | 1 |
| Ultrasound guide tissue ablation CPT 76940 | not published | not published | $137.97 – $137.97 | 1 |
| Ultrasound hips infant dynamic CPT 76885 | not published | not published | $76.09 – $76.09 | 1 |
| Ultrasound infant hips ltd without stress CPT 76886 | not published | not published | $72.27 – $72.27 | 1 |
| Ultrasound joint complete left CPT 76881 | $261.93 | $402.97 | $75.83 – $75.83 | 1 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | $251.86 | $387.47 | not published | 0 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $360.83 | $555.12 | $105.30 – $105.30 | 1 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | not published | not published | $81.77 – $81.77 | 1 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $668.49 | $1,028.45 | $233.28 – $233.28 | 1 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $801.23 | $1,232.66 | $107.36 – $107.36 | 1 |
| Ultrasound prostate/transrectal CPT 76872 | not published | not published | $103.46 – $103.46 | 1 |
| Ultrasound spinal canal and contents CPT 76800 | $474.10 | $729.39 | $84.73 – $84.73 | 1 |
| Ultrasound transabd ea addl gest CPT 76812 | not published | not published | $152.16 – $152.16 | 1 |
| Unlisted misc path test CPT 89240 | $105.80 | $162.77 | not published | 0 |
| Unlisted procedure microbiology CPT 87999 | $977.50 | $1,503.84 | not published | 0 |
| Unlisted ultrasound procedure CPT 76999 | $199.93 | $307.59 | not published | 0 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $208.72 | $321.10 | $18.79 – $18.79 | 1 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | not published | not published | $199.48 – $199.48 | 1 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,199.23 | $1,844.97 | $197.33 – $197.33 | 1 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $3,057.03 | $4,703.12 | $517.31 – $517.31 | 1 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,642.74 | $4,065.75 | $337.97 – $337.97 | 1 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,282.34 | $3,511.29 | $335.71 – $335.71 | 1 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $261.14 | $401.75 | $21.79 – $21.79 | 1 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $291.77 | $448.88 | $24.20 – $24.20 | 1 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $489.83 | $753.59 | $93.31 – $93.31 | 1 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $391.87 | $602.88 | $71.48 – $71.48 | 1 |
| Urea nitrogen CPT 84520 | $54.94 | $84.53 | $3.83 – $51.37 | 4 |
| Urea nitrogen 24 hour urine CPT 84540 | $54.94 | $84.53 | $5.08 – $72.31 | 4 |
| Urea nitrogen clearance CPT 84545 | not published | not published | $6.98 – $93.64 | 3 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $4.98 – $66.72 | 3 |
| Ureteral reflux study CPT 78740 | not published | not published | $141.14 – $141.14 | 1 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $548.60 | $844.00 | $49.74 – $49.74 | 1 |
| Urethrocystography void s&i CPT 74455 | not published | not published | $57.56 – $57.56 | 1 |
| Uric acid blood CPT 84550 | $55.68 | $85.66 | $4.38 – $58.79 | 4 |
| Uric acid urine CPT 84560 | $65.93 | $101.43 | $4.93 – $66.07 | 4 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.56 – $61.13 | 3 |
| Urinalysis microscopic only CPT 81015 | $80.59 | $123.98 | $2.02 – $39.67 | 4 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | not published | not published | $2.10 – $28.22 | 3 |
| Urinalysis (with microscopy) CPT 81001 | $80.30 | $123.54 | $3.07 – $41.23 | 4 |
| Urinalysis (without microscopy) CPT 81003 | $52.76 | $81.17 | $2.02 – $29.26 | 4 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $61.34 – $61.34 | 1 |
| Urinary pouch on barr w/flng HCPCS A5073 | not published | not published | $3.42 – $3.42 | 1 |
| Urinary pouch w/barrier HCPCS A5071 | not published | not published | $4.64 – $4.64 | 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.