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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | not published | not published | $15.15 – $380.82 | 4 |
| 17-hydroxypregnenolone CPT 84143 | not published | not published | $22.13 – $296.67 | 4 |
| 17-ketosteroids CPT 83586 | not published | not published | $9.49 – $166.48 | 4 |
| 1 pc ost pouch w filter HCPCS A5056 | not published | not published | $6.02 – $6.02 | 1 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $34.84 – $467.18 | 3 |
| 24 hr ambulatory b/p monitor CPT 93786 | $212.56 | $327.01 | not published | 0 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $2,160.39 | $3,323.67 | not published | 0 |
| 3-d radiotherapy plan CPT 77295 | not published | not published | $357.48 – $357.48 | 1 |
| 3d recon without postprocess indpndt CPT 76376 | not published | not published | $46.12 – $46.12 | 1 |
| 5% dextrose and 0.45% saline HCPCS S5010 | not published | not published | $7.58 – $9.48 | 2 |
| 5% dextrose with potassium HCPCS S5012 | not published | not published | $4.56 – $5.62 | 2 |
| 5' nucleotidase - sendout CPT 83915 | $32.96 | $50.71 | $10.82 – $145.02 | 3 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $150.33 | $231.28 | not published | 0 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $111.60 | $171.70 | not published | 0 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $58.97 | $90.73 | $91.84 – $91.84 | 1 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $38.50 | $59.23 | not published | 0 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $42.59 | $65.53 | not published | 0 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $259.83 | $399.74 | not published | 0 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $49.15 | $75.61 | not published | 0 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $310.12 | $477.10 | not published | 0 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | not published | not published | $43.38 – $62.50 | 2 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | not published | not published | $11.65 – $156.20 | 3 |
| Abciximab injection HCPCS J0130 | not published | not published | $1,294.26 – $1,294.26 | 1 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $159.72 – $159.72 | 1 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $574.12 | $883.26 | not published | 0 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $502.61 | $773.25 | not published | 0 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $2,584.13 | $3,975.58 | $314.18 – $314.18 | 1 |
| Abdominal CT scan (with contrast) CPT 74160 | $2,222.99 | $3,419.99 | $214.31 – $214.31 | 1 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,482.01 | $2,280.01 | $158.14 – $158.14 | 1 |
| Abdominal MRI (with and without contrast) CPT 74183 | $3,696.93 | $5,687.59 | $506.57 – $506.57 | 1 |
| Abdominal MRI (with contrast) CPT 74182 | $3,057.03 | $4,703.12 | $384.36 – $384.36 | 1 |
| Abdominal MRI (without contrast) CPT 74181 | $2,282.34 | $3,511.29 | $331.02 – $331.02 | 1 |
| Abdominal paracentesis w/image guidance CPT 49083 | $2,641.29 | $4,063.53 | not published | 0 |
| Abdominal Ultrasound (complete) CPT 76700 | $944.78 | $1,453.51 | $105.69 – $105.69 | 1 |
| Abdominal Ultrasound (limited) CPT 76705 | $728.36 | $1,120.56 | $68.35 – $68.35 | 1 |
| Abdominal X-ray (2 views) CPT 74019 | $317.33 | $488.20 | not published | 0 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | not published | not published | $30.86 – $30.86 | 1 |
| Abdominal X-ray (single view) CPT 74018 | $191.26 | $294.25 | not published | 0 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $1,424.47 | $2,191.49 | not published | 0 |
| Abl1 gene CPT 81170 | $633.95 | $975.31 | $199.69 – $3,901.86 | 4 |
| Ablation cryo thigh/knee CPT 27599 | $617.08 | $949.36 | not published | 0 |
| Ablation of upper extremity nerves rf CPT 64999 | $884.14 | $1,360.21 | not published | 0 |
| Abobotulinumtoxina HCPCS J0586 | $13.96 | $21.47 | $9.04 – $10.31 | 2 |
| Abscess imaging ltd area CPT 78805 | not published | not published | $117.79 – $117.79 | 1 |
| Abscess imaging whole body CPT 78806 | not published | not published | $216.82 – $216.82 | 1 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | not published | not published | $0.05 – $0.15 | 2 |
| Acetaminophen level CPT 80143 | $41.36 | $63.63 | $18.08 – $242.44 | 3 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | not published | not published | $19.06 – $47.82 | 2 |
| Acetone qualitative CPT 82009 | $72.55 | $111.62 | $0.51 – $58.79 | 4 |
| Acetylcholine receptor modulating antibody CPT 86043 | $23.50 | $36.15 | $7.23 – $156.72 | 4 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $11.92 – $159.85 | 4 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | not published | not published | $0.45 – $3.00 | 2 |
| Acetylcysteine non-comp unit HCPCS J7608 | not published | not published | $8.44 – $13.59 | 2 |
| Acne surgery 10040 CPT 10040 | $431.61 | $664.02 | not published | 0 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $94.20 | $144.92 | not published | 0 |
| Acth stimulation panel CPT 80402 | not published | not published | $84.35 – $1,131.02 | 4 |
| Acth stimulation panel CPT 80406 | not published | not published | $75.91 – $1,017.87 | 4 |
| Acute hepatitis panel CPT 80074 | $150.92 | $232.18 | $46.20 – $619.49 | 3 |
| Acute venous thrombus image CPT 78456 | not published | not published | $198.59 – $198.59 | 1 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | not published | not published | $0.04 – $0.14 | 2 |
| #acylcarnitineprfl CPT 82017 | $35.65 | $54.84 | $16.36 – $219.41 | 4 |
| Acylcarnitines qual CPT 82016 | not published | not published | $16.00 – $214.47 | 4 |
| Adapt behavior tx phys/qhp CPT 97155 | not published | not published | $19.32 – $19.32 | 1 |
| Adaptive behavior tx by tech CPT 97153 | not published | not published | $16.68 – $16.68 | 1 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | not published | not published | $0.39 – $1.92 | 2 |
| Adenovirus ag ia CPT 87301 | not published | not published | $8.11 – $155.81 | 4 |
| Adenovirus antibody,serum - quest CPT 86603 | not published | not published | $8.11 – $167.39 | 4 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $14.65 – $283.01 | 4 |
| Adhesive, liquid or equal HCPCS A4364 | not published | not published | $7.56 – $7.56 | 1 |
| Adh-sendout CPT 84588 | $108.04 | $166.21 | $32.92 – $441.43 | 4 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | not published | not published | $0.22 – $0.59 | 2 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $184.33 | $283.59 | not published | 0 |
| Administration immunization each additional vaccine CPT 90472 | $21.30 | $32.77 | $15.40 – $15.40 | 5 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $50.30 | $77.38 | not published | 0 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $52.84 | $81.29 | not published | 0 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $69.28 | $106.59 | not published | 0 |
| Administration vaccine hepatitis b HCPCS G0010 | $43.45 | $66.85 | $33.41 – $33.41 | 5 |
| Administration vaccine influenza virus HCPCS G0008 | $21.30 | $32.77 | $33.41 – $33.41 | 5 |
| Administration vaccine pneumococcal HCPCS G0009 | $21.30 | $32.77 | $33.41 – $33.41 | 5 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $69.28 | $106.59 | not published | 0 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | not published | not published | $41.11 – $42.16 | 2 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $293.93 – $293.93 | 1 |
| Adrenalin epinephrine inject HCPCS J0171 | not published | not published | $0.73 – $0.76 | 2 |
| Afamelanotide implant, 1 mg HCPCS J7352 | not published | not published | $3,024.55 – $3,524.94 | 2 |
| _afb id by dna probe rflx ast CPT 87149 | not published | not published | $19.45 – $260.77 | 3 |
| #afb mycobacteria suscep. #1 CPT 87190 | $15.45 | $23.77 | $7.09 – $95.08 | 4 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $234.40 | $360.62 | $111.90 – $1,500.40 | 3 |
| Aff2 gen aly detc abnl allel CPT 81171 | not published | not published | $132.89 – $1,781.85 | 3 |
| Aff2 gen alys charac alleles CPT 81172 | not published | not published | $266.59 – $3,574.49 | 3 |
| Aflibercept injection HCPCS J0178 | $1,272.91 | $1,958.32 | $795.86 – $1,110.00 | 2 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $222.84 – $236.29 | 2 |
| Air conduction bilat CPT 92552 | $61.35 | $94.39 | $60.44 – $60.44 | 1 |
| Albumin body fluid quantitative each specimen CPT 82042 | $12.47 | $19.18 | $5.08 – $101.19 | 4 |
| Albumin (human), 25%, 50ml HCPCS P9047 | not published | not published | $53.08 – $54.00 | 2 |
| Albumin, human 25 % intravenous solution HCPCS P9046 | not published | not published | $21.23 – $33.00 | 2 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | not published | not published | $53.08 – $55.55 | 2 |
| Albumin, human 5 % intravenous solution HCPCS P9041 | not published | not published | $10.62 – $39.12 | 2 |
| Albumin ischemia modified CPT 82045 | not published | not published | $12.06 – $441.43 | 4 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $48.74 | $74.99 | $5.08 – $75.18 | 4 |
| Albumin serum plasma or whole blood CPT 82040 | $52.02 | $80.03 | $4.80 – $64.38 | 4 |
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.