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 |
|---|---|---|---|---|
| Calcium infusion test CPT 82331 | not published | not published | $12.94 – $173.50 | 3 |
| Calcium ionized CPT 82330 | $134.43 | $206.82 | $5.08 – $177.92 | 4 |
| Calcium total CPT 82310 | $67.76 | $104.25 | $5.01 – $67.11 | 4 |
| Calculi urinary-sendout CPT 82360 | not published | not published | $12.48 – $167.39 | 4 |
| Calculus analysis qual CPT 82355 | not published | not published | $11.23 – $150.61 | 4 |
| Calprotectin fecal CPT 83993 | $178.39 | $274.44 | $11.39 – $255.31 | 4 |
| Campylobacter antibody CPT 86625 | not published | not published | $8.11 – $170.64 | 4 |
| Canakinumab injection HCPCS J0638 | not published | not published | $136.56 – $136.99 | 2 |
| Candida dna CPT 87480 | $42.37 | $65.19 | $14.09 – $260.77 | 4 |
| Candida dna quant CPT 87482 | not published | not published | $54.07 – $724.97 | 3 |
| Cannabinoids synthetic 1-3 CPT 80350 | $57.37 | $88.26 | $5.05 – $5.05 | 1 |
| Cannabinoids synthetic 4-6 CPT 80351 | not published | not published | $5.05 – $5.05 | 1 |
| Cannabinoid synthetic 7/more CPT 80352 | not published | not published | $5.05 – $5.05 | 1 |
| Cantharidin top, applicator HCPCS J7354 | not published | not published | $682.26 – $682.26 | 1 |
| Capecitabine, oral, 50 mg HCPCS J8522 | not published | not published | $0.07 – $0.07 | 1 |
| Capsaicin 8% patch HCPCS J7336 | not published | not published | $3.38 – $3.73 | 2 |
| Carbamazepine free CPT 80157 | $74.73 | $114.97 | $10.61 – $172.33 | 4 |
| Carbamazepine free -sendout CPT 80161 | not published | not published | $10.61 – $242.44 | 4 |
| Carbamazepine total therapeutic drug level CPT 80156 | $121.62 | $187.10 | $10.61 – $189.50 | 4 |
| Carbidopa levodopa ent 100ml HCPCS J7340 | not published | not published | $235.77 – $253.11 | 2 |
| Carbohydrate deficient transf - sendout CPT 82373 | $191.59 | $294.76 | $7.97 – $234.89 | 4 |
| Carbohydrate urine - sendout CPT 84377 | $13.51 | $20.79 | $5.34 – $71.53 | 4 |
| Carbon dioxide CPT 82374 | $10.32 | $15.87 | $4.73 – $63.47 | 4 |
| Carboplatin 10 mg/ml desensitization HCPCS J9045 | not published | not published | $2.93 – $9.90 | 2 |
| Carboxyhemoglobin quantitative CPT 82375 | $112.11 | $172.47 | $11.11 – $160.24 | 4 |
| Carcinoembryonic ag (cea) CPT 82378 | $382.04 | $587.75 | $18.39 – $246.60 | 4 |
| Cardiac MRI w/stress img CPT 75559 | not published | not published | $393.43 – $393.43 | 1 |
| Cardiac perf planar mult/ef/wm CPT 78454 | not published | not published | $116.26 – $116.26 | 1 |
| Cardiac perf planar sgl/ef/wm CPT 78453 | not published | not published | $187.49 – $187.49 | 1 |
| Cardiac perf spect sgl/ef/wm rst/strs CPT 78451 | not published | not published | $217.90 – $217.90 | 1 |
| Cardiolipin antibody iga CPT 86147 | $63.75 | $98.07 | $7.90 – $331.01 | 4 |
| Cardiology hrt trnspl mrna CPT 81595 | not published | not published | $1,343.43 – $42,140.09 | 4 |
| Cardioversion (Scheduled Heart Rhythm Shock) CPT 92960 | $884.72 | $1,361.10 | not published | 0 |
| Card MRI veloc flow mapping CPT 75565 | not published | not published | $57.80 – $57.80 | 1 |
| Caregiver training strategies&tq 1st 30 minutes CPT 97550 | $38.23 | $58.81 | not published | 0 |
| Caregiver training strategies&tq ea addl 15 min CPT 97551 | $19.06 | $29.33 | not published | 0 |
| Carfilzomib 10 mg intravenous solution HCPCS J9047 | not published | not published | $51.85 – $56.26 | 2 |
| Car ion chnnlpath inc 10 gns CPT 81413 | not published | not published | $567.35 – $7,607.33 | 3 |
| Car ion chnnlpath inc 2 gns CPT 81414 | not published | not published | $567.35 – $7,607.33 | 3 |
| Carmustine 100 mg intravenous powder for solution HCPCS J9050 | not published | not published | $145.60 – $1,186.82 | 2 |
| Carotene CPT 82380 | $19.49 | $29.98 | $8.94 – $119.92 | 3 |
| Carotid Artery Ultrasound (Duplex) CPT 93880 | $508.19 | $781.83 | not published | 0 |
| Caspofungin acetate HCPCS J0637 | not published | not published | $3.34 – $11.75 | 2 |
| Cast sup shrt leg ped fbrgls HCPCS Q4040 | $45.67 | $70.26 | not published | 0 |
| Cast sup sht arm adult fbrgl HCPCS Q4010 | $43.17 | $66.42 | not published | 0 |
| Cast sup sht arm ped fbrglas HCPCS Q4012 | $20.81 | $32.01 | not published | 0 |
| Cast sup sht arm splint fbrg HCPCS Q4022 | $26.98 | $41.50 | not published | 0 |
| Catecholamines,fractionated, urine CPT 82382 | not published | not published | $18.58 – $355.07 | 4 |
| Cath cv dl inj 7fx16cm HCPCS C1751 | $123.21 | $189.56 | not published | 0 |
| Catheterization collection of specimen single patient all places of service HCPCS P9612 | not published | not published | $9.06 – $121.48 | 3 |
| Cath ext adhere actv m 28mm HCPCS A4349 | not published | not published | $1.49 – $1.49 | 1 |
| Cath follower heyman 20f HCPCS A4352 | not published | not published | $0.78 – $0.78 | 1 |
| Cath infuse micro 150cm rapidtransit HCPCS A4351 | not published | not published | $0.67 – $0.67 | 1 |
| Cath stripping venous s&i CPT 75901 | not published | not published | $107.44 – $107.44 | 1 |
| Cauterization chemical granulation tissue CPT 17250 | $443.10 | $681.70 | not published | 0 |
| Cbc/diffwbc without platelet HCPCS G0306 | not published | not published | $7.54 – $101.06 | 3 |
| CBC without platelet HCPCS G0307 | not published | not published | $6.28 – $84.15 | 3 |
| #cbg+cort-cbg CPT 84449 | $56.18 | $86.43 | $17.46 – $234.11 | 4 |
| Cciiv4 vacc abx free im CPT 90756 | not published | not published | $32.19 – $32.19 | 1 |
| Cciiv4 vac no prsv 0.5 ml im CPT 90674 | $44.71 | $68.78 | $33.98 – $33.98 | 1 |
| Ccnd1/igh translocation alys CPT 81168 | not published | not published | $125.63 – $2,696.32 | 4 |
| Cdna analysis for variants CPT 81403 | $407.70 | $627.23 | $179.64 – $2,408.75 | 3 |
| Cebpa gene full sequence CPT 81218 | not published | not published | $199.69 – $3,146.20 | 4 |
| Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 | not published | not published | $0.83 – $2.16 | 2 |
| Cefepime 1 gram solution for injection HCPCS J0692 | $2.49 | $3.83 | $1.20 – $3.54 | 2 |
| Cefotaxime sodium injection HCPCS J0698 | not published | not published | $9.41 – $11.76 | 2 |
| Cefotetan 1 gm vial HCPCS S0074 | not published | not published | $11.62 – $12.64 | 2 |
| Cefoxitin 1 gram intravenous solution HCPCS J0694 | not published | not published | $5.01 – $7.66 | 2 |
| Ceftaroline fosamil 600 mg intravenous solution HCPCS J0712 | not published | not published | $3.99 – $6.67 | 2 |
| Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr HCPCS J0713 | $3.40 | $5.23 | $1.60 – $2.56 | 2 |
| Ceftazidime and avibactam HCPCS J0714 | not published | not published | $100.50 – $107.64 | 2 |
| Ceftizoxime sodium / 500 mg HCPCS J0715 | not published | not published | $4.56 – $4.56 | 1 |
| Ceftriaxone 1 gram solution for injection HCPCS J0696 | $0.56 | $0.86 | $0.49 – $1.64 | 2 |
| Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr HCPCS J0697 | not published | not published | $2.01 – $3.59 | 2 |
| #celiac hla-dq2 CPT 81377 | not published | not published | $91.90 – $1,232.21 | 3 |
| #celiac hla-dq8 CPT 81383 | not published | not published | $105.86 – $1,419.37 | 3 |
| Cell count body fluid CPT 89050 | not published | not published | $2.83 – $61.39 | 4 |
| Cell count w differential body fluid CPT 89051 | $229.66 | $353.33 | $2.83 – $72.83 | 4 |
| Cell cryopreserve/storage CPT 88240 | not published | not published | $12.68 – $169.99 | 3 |
| Cell enumeration & id CPT 86152 | not published | not published | $243.26 – $3,261.69 | 3 |
| Cellesta or duo per sq cm HCPCS Q4184 | not published | not published | $589.00 – $589.00 | 1 |
| Cell function assay w/stim CPT 86352 | $432.47 | $665.34 | $131.78 – $1,767.02 | 3 |
| Cemiplimab-rwlc 50 mg/ml intravenous solution HCPCS J9119 | not published | not published | $28.92 – $32.95 | 2 |
| Centruroides immune f(ab) HCPCS J0716 | not published | not published | $5,036.26 – $5,995.55 | 2 |
| Cephalin floculation test HCPCS P2028 | not published | not published | $4.80 – $64.38 | 3 |
| Cerebrospinal fld flw imag CPT 78645 | not published | not published | $186.59 – $186.59 | 1 |
| Cerebrospinal fluid scan CPT 78647 | not published | not published | $259.76 – $259.76 | 1 |
| Certolizumab pegol 400 mg (200 mg x 2 vials) subcutaneous kit HCPCS J0717 | not published | not published | $3.98 – $15.30 | 2 |
| Cervical or vaginal cancer screening g0101 HCPCS G0101 | $50.78 | $78.13 | not published | 0 |
| Cetuximab 100 mg/50 ml intravenous solution HCPCS J9055 | not published | not published | $77.52 – $87.42 | 2 |
| #cf-97variants CPT 81220 | $559.71 | $861.09 | $328.25 – $7,239.25 | 4 |
| Cftr gene dup/delet variants CPT 81222 | not published | not published | $422.02 – $5,658.61 | 3 |
| Cftr gene intron poly t CPT 81224 | not published | not published | $163.69 – $2,194.80 | 3 |
| Cftr gene known fam variants CPT 81221 | not published | not published | $94.30 – $1,264.46 | 3 |
| Change cystostomy tube; complex 51710 CPT 51710 | $1,400.79 | $2,155.06 | not published | 0 |
| Change cystostomy tube simple CPT 51705 | $533.98 | $821.50 | not published | 0 |
| Change of windpipe airway 31502 CPT 31502 | $549.65 | $845.61 | not published | 0 |
| Chemodenerv 1 extrem 5/> mus 64644 CPT 64644 | $1,096.41 | $1,686.78 | not published | 0 |
| Chemo ia push tecnique CPT 96420 | $731.71 | $1,125.71 | not published | 0 |
| Chemotaxis assay CPT 86155 | not published | not published | $15.51 – $207.97 | 3 |
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.