Gouverneur Hospital
Gouverneur, NY · Critical Access Hospital
Posts prices for 44 of the 66 common shoppable procedures we track. Price file retrieved 2026-09-11.
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| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Transforaminal epidural injection, lumbar/sacral (64483) | $2,385.11 | $3,669.40 | 2.2× |
| CT head/brain without contrast (70450) | $1,597 | $2,456.92 | 12.2× |
| MRI brain without contrast (70551) | $2,253.77 | $3,467.34 | 7.6× |
| MRI brain with contrast (70552) | $3,043.12 | $4,681.72 | 7.0× |
| MRI brain without and with contrast (70553) | $3,681.54 | $5,663.91 | 8.5× |
| X-ray lower spine, 4+ views (72110) | $414.03 | $636.97 | 3.2× |
| MRI lumbar spine without contrast (72148) | $2,642.74 | $4,065.75 | 8.9× |
| CT pelvis with contrast (72193) | $1,309.46 | $2,014.56 | 6.0× |
| MRI lower-extremity joint without contrast (73721) | $3,043.12 | $4,681.72 | 10.2× |
| CT abdomen and pelvis with contrast (74177) | $2,772.77 | $4,265.80 | 6.4× |
| Ultrasound, abdomen complete (76700) | $944.78 | $1,453.51 | 7.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) | $305.96 | $470.71 | 2.3× |
| Ultrasound, transvaginal (76830) | $493.27 | $758.88 | 3.8× |
| Mammography, one breast (diagnostic) (77065) | $407.64 | $627.14 | 4.7× |
| Mammography, both breasts (diagnostic) (77066) | $474.10 | $729.39 | 4.3× |
| Mammography, screening (bilateral) (77067) | $319.04 | $490.83 | 3.5× |
| Basic metabolic panel (80048) | $120.17 | $184.87 | 14.2× |
| Comprehensive metabolic panel (80053) | $254.57 | $391.65 | 24.1× |
| Lipid panel (80061) | $118.34 | $182.06 | 8.8× |
| Renal function panel (80069) | $184.97 | $284.57 | 21.3× |
| Hepatic function panel (80076) | $149.47 | $229.96 | 18.3× |
| Urinalysis, non-automated, without microscopy (81002) | $43.96 | $67.63 | 12.6× |
| PSA, total (84153) | $58.56 | $90.10 | 3.2× |
| Thyroid stimulating hormone (TSH) (84443) | $135.17 | $207.96 | 8.0× |
| CBC with automated differential (85025) | $77.30 | $118.93 | 9.9× |
| CBC, automated (85027) | $77.30 | $118.93 | 11.9× |
| Prothrombin time (PT) (85610) | $52.02 | $80.03 | 12.1× |
| Partial thromboplastin time (PTT) (85730) | $52.02 | $80.03 | 8.7× |
| Psychotherapy, 30 minutes (90832) | $209.24 | $321.91 | 0.9× |
| Psychotherapy, 45 minutes (90834) range across 4 matching MRF lines |
$188.60–$196.14 | $290.16–$301.76 | varies |
| Psychotherapy, 60 minutes (90837) range across 2 matching MRF lines |
$196.14–$349.25 | $301.76–$537.31 | varies |
| Family psychotherapy, without patient (50 min) (90846) | $209.24 | $321.91 | 0.9× |
| Family psychotherapy, with patient (50 min) (90847) | $279.24 | $429.60 | 1.3× |
| Group psychotherapy (90853) range across 3 matching MRF lines |
$108.47–$206.48 | $166.88–$317.66 | varies |
| Electrocardiogram (ECG), complete (93000) | $61.23 | $94.20 | 0.8× |
| Sleep study (attended polysomnography) (95810) | $3,340.24 | $5,138.83 | 3.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) | $61.54 | $94.67 | 2.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) range across 4 matching MRF lines |
$113.86–$313.92 | $175.17–$482.95 | varies |
| Office visit, new patient (moderate complexity, ~45 min) (99204) range across 3 matching MRF lines |
$20.98–$390.13 | $32.27–$600.20 | varies |
| Office visit, new patient (high complexity, ~60 min) (99205) range across 4 matching MRF lines |
$236.93–$514.76 | $364.51–$791.94 | varies |
| Office consultation (low complexity, ~30 min) (99243) | $158.91 | $244.47 | 1.0× |
| Office consultation (moderate complexity, ~40 min) (99244) | $298.91 | $459.86 | 1.8× |
| Preventive visit, new patient (age 18–39) (99385) | $112.46 | $173.02 | — |
| Preventive visit, new patient (age 40–64) (99386) | $131.23 | $201.89 | — |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
More prices at this hospital
- Imaging: 207 codes with posted prices and Medicare benchmarks
- Lab & pathology: 688 codes with posted prices and Medicare benchmarks
- Visits & medical services: 161 codes with posted prices and Medicare benchmarks
- Procedures & surgery: 309 codes with posted prices and Medicare benchmarks
- Supplies, drugs & other: 36 codes with posted prices and Medicare benchmarks
Get the raw price file
Download the machine-readable file (CSV, 9.0 MB) ↓ — captured 2026-09-11
File links point at the hospital's own hosting and sometimes rotate — if the download fails, use the hospital's transparency page.