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 |
|---|---|---|---|---|
| Clsd tx humerus fract without manip 24500 CPT 24500 | $442.01 | $680.02 | not published | 0 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $797.02 | $1,226.19 | not published | 0 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $530.65 | $816.39 | not published | 0 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $463.22 | $712.65 | not published | 0 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $442.01 | $680.02 | not published | 0 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $594.51 | $914.63 | not published | 0 |
| Clsd tx pelvic ring fx CPT 27197 | $509.51 | $783.86 | not published | 0 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $465.60 | $716.31 | not published | 0 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $715.15 | $1,100.23 | not published | 0 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $2,986.09 | $4,593.99 | not published | 0 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | $656.57 | $1,010.11 | not published | 0 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $1,663.67 | $2,559.49 | not published | 0 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $2,383.66 | $3,667.17 | not published | 0 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,970.18 | $3,031.05 | not published | 0 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | $442.01 | $680.02 | not published | 0 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $619.10 | $952.46 | not published | 0 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $586.79 | $902.76 | not published | 0 |
| Cltx gr hmrl tbrs fx w/mnpj CPT 23625 | $2,987.24 | $4,595.76 | not published | 0 |
| Cltx mndblr fx w/mnpj CPT 21451 | $2,833.45 | $4,359.15 | not published | 0 |
| #cms hgb-carboxyhemoglobin CPT 82376 | not published | not published | $13.65 – $183.00 | 3 |
| #cms hgb-sulfhemoglobin CPT 83060 | not published | not published | $8.54 – $114.45 | 3 |
| #cmvcul-virus inoculation shell CPT 87254 | not published | not published | $6.83 – $254.40 | 4 |
| Cmv ig IV CPT 90291 | not published | not published | $2,108.22 – $2,108.22 | 1 |
| Cmv pcr-sendout CPT 87496 | not published | not published | $23.62 – $456.39 | 4 |
| Cnbp gene detc abnor allele CPT 81187 | not published | not published | $83.83 – $1,781.85 | 4 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | not published | not published | $2.53 – $2.98 | 3 |
| Coagulation time activated teg CPT 85347 | not published | not published | $4.15 – $55.67 | 4 |
| Coagulation time lee & white CPT 85345 | not published | not published | $4.55 – $61.00 | 3 |
| Coagulation time otr method CPT 85348 | not published | not published | $4.36 – $58.40 | 4 |
| Cocaine 4 % nasal solution HCPCS C9046 | not published | not published | $1.62 – $1.65 | 2 |
| Cocaine hcl nasal (numbrino) HCPCS C9143 | not published | not published | $1.65 – $1.65 | 1 |
| Codeine 15 mg/ml inj 2 ml HCPCS J0745 | not published | not published | $0.79 – $0.79 | 1 |
| Cogenex amnio memb per sq cm HCPCS Q4229 | not published | not published | $372.26 – $372.26 | 1 |
| Cold agglutinin screen (arc) CPT 86156 | not published | not published | $7.83 – $104.96 | 3 |
| Cold agglutinin titer CPT 86157 | $37.37 | $57.49 | $5.25 – $104.83 | 4 |
| Colistimethate sodium inj HCPCS J0770 | not published | not published | $11.94 – $33.59 | 2 |
| Collagenase, clost hist inj HCPCS J0775 | not published | not published | $73.38 – $78.27 | 2 |
| Collagen based wound filler HCPCS A6010 | not published | not published | $18.75 – $18.75 | 1 |
| Collagen gel/paste wound fil HCPCS A6011 | not published | not published | $2.00 – $2.00 | 1 |
| Collarbone (Clavicle) X-ray (both sides) CPT 73000 | $157.19 | $241.83 | $18.36 – $18.36 | 1 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $352.82 | $542.80 | not published | 0 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $352.82 | $542.80 | not published | 0 |
| Colposcopy w/biopsy of cervix 57455 CPT 57455 | $832.58 | $1,280.89 | not published | 0 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $265.65 | $408.69 | not published | 0 |
| Compatibility test each unit immediate spin technique CPT 86920 | $265.65 | $408.69 | not published | 0 |
| Complement antigen each component c3 CPT 86160 | $63.75 | $98.07 | $10.61 – $156.07 | 4 |
| Complement fixation each CPT 86171 | not published | not published | $9.71 – $130.19 | 3 |
| Complex body section x-ray CPT 76101 | not published | not published | $126.77 – $126.77 | 1 |
| Complex body section x-rays CPT 76102 | not published | not published | $158.71 – $158.71 | 1 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $1,713.10 | $2,635.54 | not published | 0 |
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $285.80 | $439.70 | not published | 0 |
| Composite drsg <= 16 sq in HCPCS A6203 | not published | not published | $2.37 – $2.37 | 1 |
| Computed tomographic angiography head and neck with contrast CPT 70471 | $554.00 | $852.30 | not published | 0 |
| Concentration infection agents any type CPT 87015 | $65.93 | $101.43 | $3.28 – $86.88 | 4 |
| Conduit wrap neuomend 3mmx2.5cm HCPCS C9361 | not published | not published | $208.54 – $208.54 | 1 |
| Condylomata destruction 56420 CPT 56420 | $328.95 | $506.08 | not published | 0 |
| Congo red blood test HCPCS P2029 | not published | not published | $4.80 – $64.38 | 3 |
| Conivaptan hcl HCPCS C9488 | not published | not published | $53.48 – $53.48 | 1 |
| Conjugated estrogens 25 mg solution for injection HCPCS J1410 | not published | not published | $382.89 – $408.37 | 2 |
| Connector tis 2x10mm HCPCS C9352 | not published | not published | $548.63 – $548.63 | 1 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $1,934.95 | $2,976.84 | not published | 0 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $159.46 | $245.33 | not published | 0 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $331.81 | $510.48 | not published | 0 |
| Consultation with family CPT 90887 | not published | not published | $95.00 – $95.00 | 1 |
| Contrast baths charges CPT 97034 | $43.16 | $66.40 | $29.82 – $29.82 | 1 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | not published | not published | $137.54 – $137.54 | 1 |
| Contrast exam thoracic aorta CPT 75600 | not published | not published | $327.23 – $327.23 | 1 |
| Contrast exam thoracic aorta 75605-26 CPT 75605 | not published | not published | $137.40 – $137.40 | 1 |
| Contrast x-ray gallbladder CPT 74290 | not published | not published | $47.02 – $47.02 | 1 |
| Contrast x-ray of ankle CPT 73615 | not published | not published | $83.96 – $83.96 | 1 |
| Contrast x-ray of brain CPT 70010 | not published | not published | $153.98 – $153.98 | 1 |
| Contrast x-ray of brain CPT 70015 | not published | not published | $106.59 – $106.59 | 1 |
| Contrast x-ray of elbow CPT 73085 | not published | not published | $62.50 – $62.50 | 1 |
| Contrast x-ray of hip CPT 73525 | $753.38 | $1,159.04 | $64.22 – $64.22 | 1 |
| Contrast x-ray of knee joint CPT 73580 | not published | not published | $84.56 – $84.56 | 1 |
| Contrast x-ray of wrist CPT 73115 | $725.86 | $1,116.71 | $69.92 – $69.92 | 1 |
| Control nosebleed pack+caut 30905 CPT 30905 | $311.34 | $478.99 | not published | 0 |
| Control of nosebleed ant comp 30903 CPT 30903 | $221.88 | $341.36 | not published | 0 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $236.68 | $364.12 | not published | 0 |
| Contrst x-ray uppr gi tract CPT 74249 | not published | not published | $139.29 – $139.29 | 1 |
| Coombs direct CPT 86880 | $47.61 | $73.25 | $4.74 – $70.10 | 4 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | not published | not published | $5.55 – $74.40 | 3 |
| Coombs indirect titer reference CPT 86886 | $331.81 | $510.48 | $5.02 – $67.37 | 3 |
| Copper cu 64 dotatate diag HCPCS A9592 | not published | not published | $1,110.00 – $1,110.00 | 1 |
| Copper intrauterine device HCPCS J7300 | $430.07 | $661.65 | $1,124.40 – $1,195.95 | 3 |
| Cor artery disease mrna CPT 81493 | not published | not published | $1,018.50 – $13,656.51 | 3 |
| Corticorelin ovine triflutal HCPCS J0795 | not published | not published | $8.76 – $10.95 | 2 |
| Cortisol acth stimulation test - sendout CPT 80400 | not published | not published | $31.64 – $424.26 | 4 |
| Cortisol total am CPT 82533 | $135.17 | $207.96 | $15.81 – $212.00 | 4 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | not published | not published | $33.40 – $101.02 | 2 |
| Co-treatment - group 15 mins, st CPT 92508 | not published | not published | $47.26 – $47.26 | 1 |
| Counseling smoke cess interm >10mins CPT 99407 | $72.82 | $112.03 | $20.60 – $20.60 | 1 |
| Counseling visit to discuss need for ldct g0296 HCPCS G0296 | $264.56 | $407.02 | not published | 0 |
| Covid-19 administration immunization im inj 1st/only component CPT 90480 | $106.68 | $164.13 | $44.95 – $44.95 | 5 |
| Covid-19 lab test non-cdc HCPCS U0002 | not published | not published | $30.79 – $667.35 | 4 |
| #covid19rsv-rsv CPT 87634 | $203.45 | $313.00 | $21.64 – $913.04 | 4 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $27.53 | $42.36 | $8.11 – $169.47 | 4 |
| CPAP or BiPAP Setup (first day) CPT 94660 | $187.93 | $289.12 | not published | 0 |
| C-peptide CPT 84681 | $70.33 | $108.20 | $20.19 – $270.66 | 4 |
| CPR (Cardiopulmonary Resuscitation) CPT 92950 | $687.49 | $1,057.67 | 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.