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 |
|---|---|---|---|---|
| Chest 2 vws w oblique CPT 71048 | $229.09 | $352.45 | not published | 0 |
| Chest CT scan (with and without contrast) CPT 71270 | $3,033.57 | $4,667.03 | $245.04 – $245.04 | 1 |
| Chest CT scan (with contrast) CPT 71260 | $2,729.94 | $4,199.91 | $199.46 – $199.46 | 1 |
| Chest CT scan (without contrast) CPT 71250 | $1,597.00 | $2,456.92 | $197.33 – $197.33 | 1 |
| Chest Physiotherapy (first session) CPT 94667 | $66.67 | $102.57 | not published | 0 |
| Chest Physiotherapy (follow-up session) CPT 94668 | $245.00 | $376.93 | not published | 0 |
| Chest Ultrasound CPT 76604 | $574.20 | $883.39 | $56.14 – $56.14 | 1 |
| Chest X-ray CPT 71046 | $276.45 | $425.31 | not published | 0 |
| Chest X-ray (single view) CPT 71045 | $204.91 | $315.24 | not published | 0 |
| Chg radiologic exam esophagus double contrast CPT 74221 | $405.09 | $623.22 | not published | 0 |
| Chimerism anal no cell selec CPT 81267 | not published | not published | $201.24 – $2,698.27 | 3 |
| Chimerism anal w/cell select CPT 81268 | not published | not published | $252.97 – $3,391.89 | 3 |
| Chlamydia culture CPT 87110 | $59.18 | $91.04 | $8.23 – $254.92 | 4 |
| Chlamydia trachomatis ag if CPT 87270 | not published | not published | $8.11 – $155.81 | 4 |
| Chlamydia type CPT 87140 | $16.83 | $25.89 | $5.40 – $72.44 | 3 |
| Chlmyd pneum dna dir probe CPT 87485 | not published | not published | $19.45 – $260.77 | 3 |
| Chlmyd pneum dna quant CPT 87487 | not published | not published | $41.55 – $557.19 | 3 |
| Chlnggrphy intraop addl s&i CPT 74301 | not published | not published | $26.98 – $26.98 | 1 |
| Chloramphenicol sodium injec HCPCS J0720 | not published | not published | $46.70 – $46.70 | 2 |
| Chlordiazepoxide injection HCPCS J1990 | not published | not published | $21.05 – $21.05 | 1 |
| Chloride CPT 82435 | $60.82 | $93.57 | $4.46 – $59.83 | 4 |
| Chloride 24 hour urine CPT 82436 | $78.75 | $121.15 | $5.08 – $74.79 | 4 |
| Chloroprocaine (clorotekal) HCPCS J2402 | not published | not published | $0.30 – $0.36 | 2 |
| Chloroprocaine hcl injection HCPCS J2401 | not published | not published | $0.04 – $0.06 | 2 |
| Chloroprocaine opht gel, 1mg HCPCS J2403 | not published | not published | $0.60 – $0.60 | 1 |
| Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 | not published | not published | $32.48 – $124.75 | 2 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | not published | not published | $29.04 – $54.53 | 2 |
| Chlorpromazine 100 mg tablet HCPCS Q0161 | not published | not published | $0.34 – $0.42 | 2 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | not published | not published | $47.87 – $47.87 | 1 |
| Cholera vaccine live oral CPT 90625 | not published | not published | $330.00 – $330.00 | 1 |
| Cholesterol CPT 82465 | $58.99 | $90.76 | $4.22 – $56.58 | 4 |
| Cholesterol body fluid CPT 84999 | $51.29 | $78.91 | not published | 0 |
| Cholesterol (Lipid) Test CPT 80061 | $118.34 | $182.06 | $6.10 – $174.15 | 4 |
| Choline c-11 HCPCS A9515 | not published | not published | $6,000.00 – $6,000.00 | 1 |
| Cholinesterase CPT 82480 | not published | not published | $7.63 – $102.36 | 4 |
| Chorionic gonadotropin/1000u HCPCS J0725 | not published | not published | $12.79 – $18.25 | 2 |
| Chrom analysis CPT 88273 | not published | not published | $33.77 – $452.75 | 4 |
| Chromatogram assay sugars CPT 84375 | not published | not published | $27.36 – $507.24 | 4 |
| Chromatography CPT 83021 | $112.11 | $172.47 | $17.52 – $234.89 | 4 |
| Chromogenic substrate assay CPT 85130 | $28.24 | $43.45 | $11.53 – $154.64 | 3 |
| Chromo high res and frag x - sendout CPT 81243 | not published | not published | $55.33 – $741.87 | 3 |
| Chromosome analys amniotic CPT 88269 | not published | not published | $75.75 – $2,258.66 | 4 |
| Chromosome analysis 100 CPT 88249 | not published | not published | $101.00 – $2,252.28 | 4 |
| Chromosome analysis 15-20 cell count CPT 88262 | not published | not published | $101.00 – $1,632.15 | 4 |
| Chromosome analysis 20-25 CPT 88245 | not published | not published | $90.90 – $2,252.28 | 4 |
| Chromosome analysis 45 CPT 88263 | not published | not published | $101.00 – $1,954.70 | 4 |
| Chromosome analysis 5 CPT 88261 | not published | not published | $256.41 – $3,438.06 | 3 |
| Chromosome analysis 50-100 CPT 88248 | not published | not published | $101.00 – $2,252.28 | 4 |
| Chromosome analys placenta CPT 88267 | not published | not published | $90.90 – $2,452.58 | 4 |
| Chromosome banding study CPT 88283 | not published | not published | $66.54 – $892.23 | 3 |
| Chromosome count additional CPT 88285 | not published | not published | $5.05 – $350.00 | 4 |
| Chromosome karyotype study CPT 88280 | $126.81 | $195.09 | $10.10 – $435.32 | 4 |
| Chromosome study additional CPT 88289 | not published | not published | $33.40 – $447.80 | 3 |
| Chronic urticaria - sendout CPT 86343 | $26.33 | $40.51 | $12.09 – $162.06 | 3 |
| Chylomicron screen, bf - sendout CPT 82664 | not published | not published | $59.66 – $799.88 | 3 |
| Cidofovir injection HCPCS J0740 | not published | not published | $521.83 – $1,037.23 | 2 |
| Cilastatin sodium injection HCPCS J0743 | not published | not published | $7.34 – $12.11 | 2 |
| Ciltacabtagene car-pos t HCPCS Q2056 | not published | not published | $558,000.00 – $558,000.00 | 1 |
| Cinacalcet 30 mg tablet HCPCS J0604 | not published | not published | $0.02 – $0.06 | 2 |
| Cine/video x-rays CPT 76120 | not published | not published | $58.88 – $58.88 | 1 |
| Cine/video x-rays add-on CPT 76125 | not published | not published | $35.65 – $35.65 | 1 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | not published | not published | $2.10 – $2.91 | 2 |
| Ciprofloxacin otic susp 6 mg HCPCS J7342 | not published | not published | $27.18 – $33.98 | 2 |
| Cisplatin 1 mg/ml desensitization HCPCS J9060 | not published | not published | $2.86 – $4.33 | 2 |
| C-kit mutation liquid tumor - sendout CPT 81272 | not published | not published | $319.62 – $4,285.67 | 3 |
| Cladribine 10 mg/10 ml intravenous solution HCPCS J9065 | not published | not published | $10.20 – $42.00 | 2 |
| Clearance of airways CPT 31720 | $316.98 | $487.66 | not published | 0 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | not published | not published | $1.61 – $1.61 | 1 |
| Clofarabine 1 mg/ml intravenous solution HCPCS J9027 | not published | not published | $16.01 – $120.31 | 2 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | not published | not published | $16.20 – $31.75 | 2 |
| Closed carpo/metacarpal fx disl thumb w/manip CPT 26645 | $1,243.18 | $1,912.59 | not published | 0 |
| Closed tx/acetabululm without manip 27220 CPT 27220 | $514.01 | $790.78 | not published | 0 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $4,283.02 | $6,589.26 | not published | 0 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $1,320.06 | $2,030.86 | not published | 0 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $530.65 | $816.39 | not published | 0 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $2,888.33 | $4,443.59 | not published | 0 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | $637.35 | $980.54 | not published | 0 |
| Clostridium toxin a w/optic CPT 87803 | not published | not published | $9.49 – $208.10 | 4 |
| Clos txnose fx without stablz 21315 CPT 21315 | $2,703.41 | $4,159.09 | not published | 0 |
| Closure of windpipe lesion 31820 CPT 31820 | $8,876.49 | $13,656.14 | not published | 0 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $18.36 – $246.21 | 4 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $9.49 – $265.59 | 4 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $18.36 – $246.21 | 4 |
| Clot factor xii hageman CPT 85280 | not published | not published | $18.77 – $251.67 | 4 |
| Clot factor xiii fibrin scrn CPT 85291 | $19.25 | $29.61 | $7.17 – $118.49 | 4 |
| Clot factor xiii fibrin stab CPT 85290 | $49.35 | $75.92 | $8.01 – $212.52 | 4 |
| Clozapine, 25 mg HCPCS S0136 | not published | not published | $0.62 – $0.78 | 2 |
| Clsd ostomy pouch w/flange HCPCS A5054 | not published | not published | $1.67 – $1.67 | 1 |
| Clsd ostomy pouch without barr HCPCS A5052 | not published | not published | $3.43 – $3.43 | 1 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $546.61 | $840.94 | not published | 0 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $671.50 | $1,033.08 | not published | 0 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $710.51 | $1,093.09 | not published | 0 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $442.01 | $680.02 | not published | 0 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $507.97 | $781.49 | not published | 0 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $390.23 | $600.36 | not published | 0 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $433.91 | $667.55 | not published | 0 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $521.61 | $802.47 | not published | 0 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $1,895.91 | $2,916.78 | not published | 0 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $1,525.96 | $2,347.63 | not published | 0 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $442.01 | $680.02 | 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.