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 |
|---|---|---|---|---|
| Epstein barr early antigen antibody CPT 86663 | $61.42 | $94.50 | $12.73 – $170.64 | 4 |
| Epstein barr nuclear antigen antibody CPT 86664 | $60.82 | $93.57 | $14.83 – $198.86 | 4 |
| Epstein barr viral capsid antigen antibody igm CPT 86665 | $60.82 | $93.57 | $17.60 – $235.93 | 4 |
| Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 | not published | not published | $10.20 – $27.00 | 2 |
| Eptinezumab-jjmr 100 mg/ml intravenous solution HCPCS J3032 | $26.82 | $41.26 | $19.32 – $19.32 | 2 |
| Ercp biliary & pancreas CPT 74330 | not published | not published | $112.66 – $112.66 | 1 |
| Ergonovine 0.2 mg/ml inj HCPCS J1330 | not published | not published | $4.58 – $4.58 | 1 |
| Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution HCPCS J9179 | not published | not published | $118.75 – $155.52 | 2 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | not published | not published | $9.18 – $63.68 | 2 |
| ER Visit (level 1, minor) CPT 99281 | $206.39 | $317.52 | $87.03 – $87.03 | 1 |
| ER Visit (level 2) CPT 99282 | $332.48 | $511.50 | $90.09 – $90.09 | 1 |
| ER Visit (level 3) CPT 99283 | $369.10 | $567.85 | $144.32 – $144.32 | 1 |
| ER Visit (level 4) CPT 99284 | $663.54 | $1,020.83 | $144.32 – $144.32 | 1 |
| ER Visit (level 5, high severity) CPT 99285 | $927.69 | $1,427.21 | $144.32 – $144.32 | 1 |
| Erwinaze injection HCPCS J9019 | not published | not published | $386.96 – $483.70 | 2 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | not published | not published | $65.96 – $99.14 | 2 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln HCPCS J1806 | not published | not published | $0.41 – $0.41 | 1 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | not published | not published | $0.28 – $0.28 | 1 |
| Esophageal dilat s&i CPT 74360 | not published | not published | $102.18 – $102.18 | 1 |
| Esophageal motility CPT 78258 | not published | not published | $156.81 – $156.81 | 1 |
| Established Patient Office Visit (level 1) CPT 99211 | $234.61 | $360.94 | $19.90 – $33.00 | 2 |
| Established Patient Office Visit (level 2) CPT 99212 | $254.61 | $391.71 | $31.71 – $63.00 | 2 |
| Established Patient Office Visit (level 3) CPT 99213 | $288.41 | $443.71 | $31.71 – $101.00 | 2 |
| Established Patient Office Visit (level 4) CPT 99214 | $358.44 | $551.44 | $45.92 – $149.00 | 2 |
| Established Patient Office Visit (level 5) CPT 99215 | $472.92 | $727.57 | $64.50 – $199.00 | 2 |
| Estradiol total CPT 82670 | $303.66 | $467.17 | $27.10 – $363.39 | 4 |
| Estradiol valerate 10 mg inj HCPCS J1380 | not published | not published | $7.30 – $31.86 | 2 |
| Estrogens total-sendout CPT 82672 | $140.67 | $216.41 | $21.05 – $282.23 | 4 |
| Etanercept injection HCPCS J1438 | not published | not published | $978.91 – $984.55 | 2 |
| Ethanolamine oleate 100 mg HCPCS J1430 | not published | not published | $497.70 – $528.40 | 2 |
| Eth estr and eton monthly HCPCS J7295 | not published | not published | $117.81 – $168.62 | 2 |
| Ethylene glycol -sendout CPT 82693 | $31.49 | $48.44 | $14.45 – $193.79 | 3 |
| Etonogestrel implant system HCPCS J7307 | $1,432.95 | $2,204.54 | $1,214.63 – $1,310.98 | 3 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | not published | not published | $0.91 – $1.07 | 2 |
| Etoposide 50 mg cap HCPCS J8560 | not published | not published | $76.46 – $90.40 | 2 |
| Euflexxa inj per dose HCPCS J7323 | not published | not published | $128.71 – $420.15 | 2 |
| Euglobulin lysis CPT 85360 | $16.40 | $25.23 | $6.67 – $109.38 | 4 |
| Eval/fit voice prosthesis iii, st CPT 92607 | not published | not published | $254.16 – $254.16 | 1 |
| Evaluation cervical mucus CPT 89330 | not published | not published | $10.07 – $135.00 | 3 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $175.70 | $270.31 | $71.91 – $1,276.04 | 4 |
| Evaluation of speech fluency 92521 CPT 92521 | not published | not published | $223.15 – $223.15 | 1 |
| Evaluation psychiatric diagnostic CPT 90791 | $349.99 | $538.44 | $65.16 – $110.00 | 2 |
| Event monitor CPT 93270 | $225.34 | $346.68 | not published | 0 |
| Exam of vagina w/scope 57420 CPT 57420 | $693.11 | $1,066.33 | not published | 0 |
| Exam pelvic add-on CPT 99459 | $47.92 | $73.72 | not published | 0 |
| Exc benign feenlm 3.1-4.0cm 11444 CPT 11444 | $4,753.85 | $7,313.62 | not published | 0 |
| Exc ben+marg excep skin tag tal 0.6-1cm 11401 CPT 11401 | $859.90 | $1,322.92 | not published | 0 |
| Excise subq tumor/abd wall <3 cm 22902 CPT 22902 | $3,307.66 | $5,088.70 | not published | 0 |
| Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm CPT 11441 | $1,389.90 | $2,138.31 | not published | 0 |
| Excision benign lesion trunk/arms/legs > 4.0 cm CPT 11406 | $3,679.56 | $5,660.86 | not published | 0 |
| Excision breast lesion CPT 19125 | $9,974.41 | $15,345.24 | not published | 0 |
| Exc les conjunctiva <1 cm CPT 68110 | $4,544.49 | $6,991.53 | not published | 0 |
| Exc malig feenl >4cm 11646 CPT 11646 | $7,435.50 | $11,439.23 | not published | 0 |
| Exc malig snhfg 0.5cm or less 11620 CPT 11620 | $5,173.82 | $7,959.72 | not published | 0 |
| Exc mal+marg tal 1.1-2 cm 11602 CPT 11602 | $915.44 | $1,408.37 | not published | 0 |
| Exc mal+marg tal 2.1-3 cm 11603 CPT 11603 | $1,592.44 | $2,449.91 | not published | 0 |
| Exc snhfg mal+mrg >4 cm 11626 CPT 11626 | $6,338.72 | $9,751.87 | not published | 0 |
| Exc sq tum/neck/ant thorax 3cm/> 21552 CPT 21552 | $5,584.64 | $8,591.75 | not published | 0 |
| Exc thrombosed hemorrhoid 46320 CPT 46320 | $2,192.50 | $3,373.08 | not published | 0 |
| Exemestane, 25 mg HCPCS S0156 | not published | not published | $1.60 – $4.00 | 2 |
| Exhaled breath condensate CPT 83987 | not published | not published | $3.47 – $46.56 | 3 |
| Exome re-evaluation CPT 81417 | not published | not published | $310.40 – $4,161.98 | 3 |
| Exome sequence analysis CPT 81415 | $9,321.00 | $14,340.00 | $4,636.60 – $62,169.64 | 3 |
| Exome sequence analysis CPT 81416 | not published | not published | $11,640.00 – $156,074.40 | 3 |
| Explore/irrigate tear ducts CPT 68840 | $619.03 | $952.36 | not published | 0 |
| Ex sq tumor/face or scalp < 2 cm 21011 CPT 21011 | $3,502.88 | $5,389.05 | not published | 0 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | $253.70 | $390.31 | not published | 0 |
| Ext ecg>7d<15d scan a/r CPT 93247 | $253.70 | $390.31 | not published | 0 |
| Extension drainage tubing HCPCS A4331 | not published | not published | $5.16 – $5.16 | 1 |
| External chromosome analysis 20-25 cells CPT 88264 | not published | not published | $140.27 – $1,880.83 | 3 |
| External profiling gene expression oncology (breast) mrna 21 genes CPT 81519 | not published | not published | $2,069.49 – $50,373.01 | 4 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | not published | not published | $101.03 – $1,869.64 | 4 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $230.41 | $354.47 | $5.25 – $233.20 | 4 |
| Eye Socket (Orbit) X-ray CPT 70200 | $245.78 | $378.12 | $28.28 – $28.28 | 1 |
| Eye Socket, Pituitary or Ear CT Scan (with and without contrast) CPT 70482 | $1,009.89 | $1,553.67 | $315.96 – $315.96 | 1 |
| Eye Socket, Pituitary or Ear CT Scan (with contrast) CPT 70481 | $1,580.90 | $2,432.15 | $234.50 – $234.50 | 1 |
| Eye Socket, Pituitary or Ear CT Scan (without contrast) CPT 70480 | $1,363.32 | $2,097.41 | $202.19 – $202.19 | 1 |
| Ezh2 gene common variants CPT 81237 | not published | not published | $106.29 – $2,281.29 | 4 |
| Ezh2 gene full gene sequence CPT 81236 | not published | not published | $171.43 – $3,679.19 | 4 |
| F-18 florbetapir less than or equal to 10 mci HCPCS A9586 | not published | not published | $3,428.88 – $3,428.88 | 1 |
| F-18 fluciclovine per mci HCPCS A9588 | not published | not published | $576.00 – $576.00 | 1 |
| F9 full gene sequence CPT 81238 | not published | not published | $582.00 – $7,803.72 | 3 |
| Face, Eye Socket and Neck MRI (with and without contrast) CPT 70543 | $2,642.74 | $4,065.75 | $502.55 – $502.55 | 1 |
| Face, Eye Socket and Neck MRI (without contrast) CPT 70540 | $1,639.12 | $2,521.72 | $326.77 – $326.77 | 1 |
| Facial Bones X-ray (1 to 2 views) CPT 70140 | not published | not published | $19.42 – $19.42 | 1 |
| Facial Bones X-ray (complete) CPT 70150 | $184.47 | $283.80 | $27.43 – $27.43 | 1 |
| Factor ix CPT 85250 | $60.62 | $93.26 | $18.47 – $247.64 | 4 |
| Factor ix alprolix recomb HCPCS J7201 | not published | not published | $3.55 – $4.14 | 3 |
| Factor ix complex HCPCS J7194 | not published | not published | $1.62 – $1.70 | 3 |
| Factor ix idelvion inj HCPCS J7202 | not published | not published | $5.18 – $5.98 | 3 |
| Factor ix non-recombinant HCPCS J7193 | not published | not published | $1.34 – $1.66 | 3 |
| Factor ix recomb gly rebinyn HCPCS J7203 | not published | not published | $4.32 – $5.41 | 3 |
| Factor ix recombinan rixubis HCPCS J7200 | not published | not published | $1.57 – $2.04 | 3 |
| Factor ix recombinant nos HCPCS J7195 | not published | not published | $1.79 – $1.88 | 3 |
| Factor viia recomb sevenfact HCPCS J7212 | not published | not published | $2.39 – $2.82 | 3 |
| Factor viii CPT 85240 | $98.55 | $151.61 | $9.49 – $232.81 | 4 |
| Factor viii HCPCS J7190 | not published | not published | $1.12 – $1.73 | 3 |
| Factor viii fc fusion recomb HCPCS J7205 | not published | not published | $2.32 – $2.86 | 3 |
| Factor viii nuwiq recomb 1iu HCPCS J7209 | not published | not published | $1.18 – $2.28 | 3 |
| Factor viii pegylated recomb HCPCS J7207 | not published | not published | $2.10 – $2.75 | 3 |
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.