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 |
|---|---|---|---|---|
| Drug test prsmv instrmnt CPT 80306 | $43.93 | $67.58 | $5.05 – $222.93 | 4 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $121.17 | $186.42 | $7.58 – $808.21 | 4 |
| Drvvt confirm - quest CPT 85597 | not published | not published | $17.44 – $233.85 | 3 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | $1,293.53 | $1,990.04 | not published | 0 |
| Ductogram sgl duct CPT 77053 | not published | not published | $99.98 – $99.98 | 1 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $908.46 | $1,397.63 | not published | 0 |
| Duragen 1x1 5ea/bx HCPCS C9354 | not published | not published | $22.80 – $22.80 | 1 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | $130.88 | $201.36 | $83.87 – $91.98 | 2 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | $335.65 | $516.38 | not published | 0 |
| Dx aly aud oi snd prcsr each CPT 92623 | $167.82 | $258.19 | not published | 0 |
| Ear irrigation 69209 CPT 69209 | $141.04 | $216.98 | not published | 0 |
| Ecallantide injection HCPCS J1290 | not published | not published | $564.64 – $626.68 | 2 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $116.79 | $179.68 | not published | 0 |
| Ecg < 30 days transmission & analysis CPT 93271 | $250.63 | $385.58 | not published | 0 |
| Ecg external < 48 hours recording CPT 93225 | $207.44 | $319.14 | not published | 0 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $207.44 | $319.14 | not published | 0 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $135.81 | $208.94 | not published | 0 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $207.44 | $319.14 | not published | 0 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $1,373.26 | $2,112.70 | not published | 0 |
| Echocardiogram (Limited Follow-Up Heart Ultrasound) CPT 93308 | $1,378.79 | $2,121.21 | not published | 0 |
| Echocardiography doppler color flow mapping CPT 93325 | $325.84 | $501.30 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $1,760.86 | $2,709.02 | not published | 0 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $1,653.52 | $2,543.87 | not published | 0 |
| Echo exam of eye CPT 76516 | not published | not published | $45.69 – $45.69 | 1 |
| Echo exam of eye CPT 76519 | not published | not published | $49.58 – $49.58 | 1 |
| Echo exam of eye CPT 76529 | not published | not published | $56.06 – $56.06 | 1 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $8.71 – $8.71 | 1 |
| Echo exam of fetal heart CPT 76825 | not published | not published | $138.75 – $138.75 | 1 |
| Echo exam of fetal heart CPT 76826 | not published | not published | $79.38 – $79.38 | 1 |
| Echo exam of fetal heart CPT 76827 | not published | not published | $64.85 – $64.85 | 1 |
| Echo exam of fetal heart CPT 76828 | not published | not published | $47.43 – $47.43 | 1 |
| Echo exam uterus 76831- CPT 76831 | not published | not published | $80.23 – $80.23 | 1 |
| Echograp trans r pros study CPT 76873 | not published | not published | $135.05 – $135.05 | 1 |
| Echo guidance radiotherapy CPT 76965 | not published | not published | $74.51 – $74.51 | 1 |
| Echo guide cardiocentesis CPT 76930 | not published | not published | $79.53 – $79.53 | 1 |
| Echo guide for amniocentesis CPT 76946 | not published | not published | $23.99 – $23.99 | 1 |
| Echo guide for artery repair CPT 76936 | not published | not published | $265.40 – $265.40 | 1 |
| Echo guide for heart biopsy CPT 76932 | not published | not published | $76.61 – $76.61 | 1 |
| Echo guide for transfusion CPT 76941 | not published | not published | $101.09 – $101.09 | 1 |
| Echo guide villus sampling CPT 76945 | not published | not published | $61.78 – $61.78 | 1 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $1,977.68 | $3,042.59 | not published | 0 |
| Echo transesophageal CPT 93315 | $1,977.68 | $3,042.59 | not published | 0 |
| Echo transthoracic CPT 93304 | $1,236.10 | $1,901.69 | not published | 0 |
| E coli 0157 ag ia CPT 87335 | not published | not published | $9.14 – $164.66 | 4 |
| Eculizumab 300 mg/30 ml intravenous solution HCPCS J1299 | not published | not published | $44.81 – $44.81 | 1 |
| Eculizumab injection HCPCS J1300 | not published | not published | $260.92 – $260.92 | 1 |
| Edetate calcium disodium inj HCPCS J0600 | not published | not published | $6,460.03 – $6,462.56 | 2 |
| Edetate disodium per 150 mg HCPCS J3520 | not published | not published | $0.26 – $0.26 | 1 |
| E equine encephalitis igg CPT 86652 | $26.80 | $41.23 | $8.11 – $171.55 | 4 |
| Efgartigimod alfa-fcab 20 mg/ml intravenous solution HCPCS J9332 | $34.68 | $53.35 | $32.38 – $35.70 | 2 |
| Egfr gene com variants CPT 81235 | not published | not published | $314.84 – $4,221.55 | 3 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $71.30 | $109.69 | $21.64 – $456.39 | 4 |
| Eia hiv-1/hiv-2 screen HCPCS G0432 | not published | not published | $18.98 – $254.53 | 3 |
| EKG (Electrocardiogram) CPT 93000 | $61.23 | $94.20 | not published | 0 |
| EKG (Tracing Only) CPT 93005 | $250.90 | $386.00 | not published | 0 |
| Elbow X-ray (2 views, both sides) CPT 73070 | $147.81 | $227.40 | $18.15 – $18.15 | 1 |
| Elbow X-ray (3 or more views, both sides) CPT 73080 | $173.82 | $267.42 | $21.85 – $21.85 | 1 |
| Elec stim unattend for press HCPCS G0281 | not published | not published | $26.99 – $26.99 | 1 |
| Electrical Stimulation Therapy (each 15 minutes) CPT 97032 | $24.62 | $37.88 | $29.28 – $29.28 | 1 |
| Electrical stimulation/unattended 97014 CPT 97014 | not published | not published | $28.35 – $28.35 | 1 |
| Electroconvulsive therapy 90870 CPT 90870 | not published | not published | $83.09 – $83.09 | 1 |
| Electrolyte panel CPT 80051 | $154.23 | $237.27 | $6.10 – $91.17 | 4 |
| Electronic analysis with brain program ea add 15 min 95984 CPT 95984 | $134.02 | $206.18 | not published | 0 |
| Elisa hiv-1/hiv-2 screen HCPCS G0433 | not published | not published | $17.74 – $237.88 | 3 |
| Elliotts b solution per ml HCPCS J9175 | not published | not published | $9.79 – $11.64 | 2 |
| Elosulfase alfa, injection HCPCS J1322 | not published | not published | $293.94 – $304.56 | 2 |
| Elotuzumab 300 mg intravenous solution HCPCS J9176 | not published | not published | $7.73 – $8.24 | 2 |
| Elranatamab-bcmm 40 mg/ml subcutaneous solution HCPCS J1323 | not published | not published | $182.98 – $182.98 | 1 |
| Embolization s&i CPT 75894 | not published | not published | $689.78 – $689.78 | 1 |
| Emg needle test 1-extremity CPT 95860 | $334.27 | $514.26 | not published | 0 |
| Encephalitis, california igg/igm CPT 86651 | $26.80 | $41.23 | $8.11 – $171.55 | 4 |
| Encephalitis, st louis igg/igm CPT 86653 | $26.80 | $41.23 | $8.11 – $171.55 | 4 |
| Encephalitis, western equine igg/igm CPT 86654 | $26.80 | $41.23 | $8.11 – $171.55 | 4 |
| Endo abl/incom vein/ext/rad fre/#1 36475 CPT 36475 | $4,902.19 | $7,541.83 | not published | 0 |
| Endo assay seven anal CPT 81506 | not published | not published | $66.85 – $896.39 | 3 |
| Endo cath bile duct s&i CPT 74328 | not published | not published | $106.56 – $106.56 | 1 |
| Endo cath panc duct s&i CPT 74329 | not published | not published | $128.17 – $128.17 | 1 |
| Endocervical curettage 57505 CPT 57505 | $1,557.19 | $2,395.67 | not published | 0 |
| Endoscopy swallow (fees) vid CPT 92612 | not published | not published | $135.64 – $135.64 | 1 |
| Endoscpy nsl/sns w/cntrl nsl hmrrgh CPT 31238 | $3,734.36 | $5,745.17 | not published | 0 |
| Enfortumab vedotin-ejfv 20 mg intravenous solution HCPCS J9177 | not published | not published | $36.64 – $38.28 | 2 |
| Enfuvirtide injection HCPCS J1324 | not published | not published | $0.64 – $0.80 | 2 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | not published | not published | $0.52 – $2.37 | 2 |
| Entamoeba histolytica ag eia - sendout CPT 87337 | not published | not published | $8.11 – $155.81 | 4 |
| Entamoeb hist dispr ag ia CPT 87336 | not published | not published | $8.11 – $208.10 | 4 |
| Enterovirus antibody dfa CPT 87267 | not published | not published | $13.02 – $174.54 | 3 |
| Envrn ivntj med mgmt psyc pt CPT 90882 | $97.70 | $150.31 | $85.00 – $85.00 | 1 |
| Enzyme cell activity ra CPT 82658 | not published | not published | $42.71 – $572.66 | 3 |
| Enzyme histochemistry CPT 88319 | not published | not published | $35.54 – $35.54 | 1 |
| Epcoritamab-bysp 48 mg/0.8 ml subcutaneous solution HCPCS J9321 | not published | not published | $54.86 – $54.86 | 1 |
| Epidural/lumbar/sacral/ea add level64484 CPT 64484 | $986.39 | $1,517.53 | not published | 0 |
| Epidurography CPT 72275 | not published | not published | $71.17 – $71.17 | 1 |
| Epilepsy gen seq alys panel CPT 81419 | $4,854.64 | $7,468.68 | $2,375.10 – $31,846.46 | 3 |
| Epirubicin 200 mg/100 ml intravenous solution HCPCS J9178 | not published | not published | $1.62 – $1.87 | 2 |
| Epoetin alfa, 100 units esrd HCPCS Q4081 | not published | not published | $0.71 – $1.99 | 2 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | not published | not published | $7.07 – $13.24 | 2 |
| Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr HCPCS J0885 | not published | not published | $7.08 – $19.90 | 2 |
| Epoetin beta esrd use HCPCS J0887 | not published | not published | $1.26 – $3.46 | 2 |
| Epoetin beta non esrd HCPCS J0888 | not published | not published | $1.26 – $3.46 | 2 |
| Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr HCPCS J1325 | not published | not published | $16.08 – $22.43 | 2 |
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.