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 |
|---|---|---|---|---|
| Factor viii recombinant nos HCPCS J7192 | not published | not published | $1.54 – $2.15 | 3 |
| Factor viii recomb novoeight HCPCS J7182 | not published | not published | $1.40 – $2.40 | 3 |
| Factor viii recomb obizur HCPCS J7188 | not published | not published | $3.23 – $3.54 | 3 |
| Factor xiii anti-hem factor HCPCS J7180 | not published | not published | $10.48 – $13.76 | 3 |
| Factor xiii recomb a-subunit HCPCS J7181 | not published | not published | $17.34 – $20.22 | 3 |
| Fam adapt bhv tx gdn phy/qhp CPT 97156 | not published | not published | $17.51 – $17.51 | 1 |
| Family therapy without pt 50min 90846 CPT 90846 | $209.24 | $321.91 | $57.51 – $88.00 | 2 |
| Family therapy with patient 50 min 90847 CPT 90847 | $279.24 | $429.60 | $57.51 – $92.00 | 2 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | $1.15 | $1.77 | $0.01 – $0.01 | 1 |
| Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution HCPCS J9358 | not published | not published | $28.90 – $29.68 | 2 |
| Fancc gene CPT 81242 | not published | not published | $35.52 – $476.29 | 3 |
| Fat/lipids feces qualitative CPT 82705 | not published | not published | $4.95 – $66.33 | 4 |
| Fatty acids nonesterified CPT 82725 | $38.89 | $59.83 | $18.21 – $244.13 | 3 |
| Fecal bilirubin test CPT 82252 | not published | not published | $4.42 – $59.31 | 3 |
| Fecal microbiota, live-jslm 150 ml rectal suspension enema HCPCS J1440 | not published | not published | $63.93 – $351.12 | 2 |
| #fecal-sodium CPT 84302 | $78.75 | $121.15 | $4.71 – $63.21 | 4 |
| Feeding tube reposition CPT 74355 | not published | not published | $113.41 – $113.41 | 1 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | not published | not published | $10.61 – $242.44 | 4 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | not published | not published | $0.84 – $1.27 | 2 |
| Fern test HCPCS Q0114 | not published | not published | $9.45 – $126.68 | 3 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $1.93 | $2.97 | $1.13 – $2.05 | 2 |
| Ferritin CPT 82728 | $150.92 | $232.18 | $13.22 – $177.27 | 4 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | $1.29 | $1.98 | $2.13 – $2.13 | 1 |
| Ferumoxytol, esrd use HCPCS Q0139 | not published | not published | $2.13 – $2.13 | 1 |
| Fetal aneuploidy trisom risk CPT 81507 | not published | not published | $750.00 – $795.00 | 3 |
| Fetal biophys profile w/nst 76818 CPT 76818 | not published | not published | $127.70 – $127.70 | 1 |
| Fetal chrmoml microdeltj CPT 81422 | not published | not published | $736.28 – $9,872.36 | 3 |
| Fetal chrom aneuploidy gsa panel CPT 81420 | not published | not published | $736.28 – $9,872.36 | 3 |
| Fetal fibronectin CPT 82731 | not published | not published | $62.48 – $837.73 | 4 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | not published | not published | $7.50 – $100.54 | 4 |
| Fetal hemoglobin rosette CPT 85461 | $22.89 | $35.22 | $9.08 – $121.74 | 4 |
| Fetal lung maturity assess lam body dnst CPT 83664 | not published | not published | $5.27 – $251.28 | 4 |
| #_fet/norfentcnfrmur CPT 80354 | $43.89 | $67.52 | $5.05 – $5.05 | 1 |
| Fiasp for insulin pump use HCPCS J1811 | not published | not published | $6.67 – $6.67 | 1 |
| Fibrin degradation d dimer quantitative CPT 85379 | $205.50 | $316.16 | $9.87 – $132.40 | 4 |
| Fibrin degradation products CPT 85362 | $14.56 | $22.40 | $6.68 – $89.61 | 4 |
| Fibrin degrade semiquant CPT 85378 | not published | not published | $9.43 – $126.42 | 4 |
| Fibrin degradj d-dimer CPT 85380 | not published | not published | $9.87 – $132.40 | 4 |
| Fibrinogen activity CPT 85384 | $85.73 | $131.89 | $6.97 – $126.42 | 4 |
| Fibrinogen test CPT 85370 | not published | not published | $9.09 – $161.67 | 4 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $39.91 | $61.40 | $15.02 – $201.34 | 3 |
| Fibrinolytic antiplasmin CPT 85410 | $15.03 | $23.13 | $7.48 – $100.28 | 3 |
| Fibrinolytic plasmin CPT 85400 | not published | not published | $7.48 – $100.28 | 3 |
| Fibrinolytic plasminogen CPT 85415 | $33.52 | $51.57 | $16.67 – $223.58 | 3 |
| Fibrinolytic plasminogen CPT 85421 | not published | not published | $9.87 – $132.40 | 3 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | not published | not published | $6.33 – $84.93 | 3 |
| Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 | not published | not published | $0.29 – $0.88 | 2 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | not published | not published | $0.98 – $1.25 | 2 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | not published | not published | $0.33 – $1.10 | 2 |
| Finasteride, 5 mg HCPCS S0138 | not published | not published | $0.14 – $0.19 | 2 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $846.29 | $1,301.99 | not published | 0 |
| Finger X-ray (both hands) CPT 73140 | $176.36 | $271.32 | $20.15 – $20.15 | 1 |
| Flebogamma injection HCPCS J1572 | not published | not published | $50.82 – $63.53 | 2 |
| Flecainide (tambocor)-sendout CPT 80181 | $36.35 | $55.92 | $10.61 – $242.44 | 4 |
| Fl exam g/colon tube w contrast CPT 49465 | $908.46 | $1,397.63 | not published | 0 |
| Florbetaben f18 diagnostic HCPCS Q9983 | not published | not published | $3,360.00 – $3,360.00 | 1 |
| Flotufolastat f18 diag 1 mci HCPCS A9608 | not published | not published | $607.90 – $607.90 | 1 |
| Flow cytometry interp 16 or more CPT 88189 | $151.65 | $233.31 | $30.30 – $30.30 | 1 |
| Flow cytometry marker each additional CPT 88185 | $65.22 | $100.34 | $15.60 – $15.60 | 1 |
| Flow cytometry one marker technical component CPT 88184 | $204.03 | $313.89 | $23.40 – $23.40 | 1 |
| Floweramnioflo, 0.1 cc HCPCS Q4177 | not published | not published | $180.00 – $180.00 | 1 |
| Floweramniopatch, per sq cm HCPCS Q4178 | not published | not published | $225.00 – $225.00 | 1 |
| #flow interp 9 - 15 markers CPT 88188 | $150.78 | $231.97 | $25.25 – $25.25 | 1 |
| Floxuridine injection HCPCS J9200 | not published | not published | $142.80 – $3,988.33 | 2 |
| Flt3 gene CPT 81245 | $349.75 | $538.08 | $160.54 – $2,152.66 | 4 |
| Flt3 gene analysis CPT 81246 | $175.40 | $269.84 | $80.51 – $1,079.51 | 4 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | not published | not published | $3.58 – $9.00 | 2 |
| Fludarabine 50 mg intravenous solution HCPCS J9185 | not published | not published | $59.53 – $122.70 | 2 |
| Fluidotherapy charges pt CPT 97022 | not published | not published | $35.13 – $35.13 | 1 |
| Fluocinol acet intravit imp HCPCS J7313 | not published | not published | $490.77 – $555.79 | 2 |
| Fluocinolone acetonide implt HCPCS J7311 | not published | not published | $340.04 – $386.95 | 2 |
| Fluorescent antibody titer dna CPT 86256 | not published | not published | $11.69 – $156.72 | 3 |
| Fluorodopa f-18 diag per mci HCPCS A9602 | not published | not published | $598.64 – $598.64 | 1 |
| Fluoroestradiol f 18 HCPCS A9591 | not published | not published | $766.50 – $766.50 | 1 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | not published | not published | $39.43 – $39.43 | 1 |
| Fluoroguide needle placement CPT 77002 | $315.65 | $485.61 | $48.05 – $48.05 | 1 |
| Fluoro polarize fetal lung CPT 83663 | not published | not published | $10.56 – $245.95 | 4 |
| Fluoroscopy (Live X-ray Guidance, up to 1 hour) CPT 76000 | not published | not published | $49.87 – $49.87 | 1 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | not published | not published | $2.21 – $6.17 | 2 |
| Fluphenazine decanoate 25 mg/ml injection solution HCPCS J2680 | not published | not published | $8.83 – $29.04 | 2 |
| Flutamide 125 mg HCPCS S0175 | not published | not published | $1.88 – $42.76 | 2 |
| Flutemetamol f18 diagnostic HCPCS Q9982 | not published | not published | $3,960.00 – $3,960.00 | 1 |
| Foam stability fetal lung CPT 83662 | not published | not published | $18.34 – $245.95 | 4 |
| Folic acid CPT 82746 | $43.25 | $66.54 | $12.63 – $191.19 | 4 |
| Follow-up angiography CPT 75898 | not published | not published | $79.59 – $79.59 | 1 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | not published | not published | $12.13 – $18.00 | 2 |
| Fondaparinux sodium HCPCS J1652 | not published | not published | $0.86 – $5.76 | 2 |
| Foot X-ray CPT 73630 | $228.74 | $351.91 | $20.32 – $20.32 | 1 |
| Foot X-ray (2 views, both feet) CPT 73620 | $199.37 | $306.73 | $17.48 – $17.48 | 1 |
| Forearm X-ray (both sides) CPT 73090 | $157.19 | $241.83 | $17.92 – $17.92 | 1 |
| Formoterol comp unit HCPCS J7640 | not published | not published | $2.36 – $2.36 | 1 |
| Formoterol fumarate, inh HCPCS J7606 | not published | not published | $1.70 – $19.28 | 2 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | not published | not published | $0.12 – $0.66 | 2 |
| Foscarnet sodium injection HCPCS J1455 | not published | not published | $21.63 – $94.55 | 2 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | not published | not published | $2.62 – $5.76 | 2 |
| Fractionation ketosteroids CPT 83593 | not published | not published | $11.56 – $370.68 | 4 |
| _fragile x methylation-sendout CPT 81244 | not published | not published | $43.54 – $583.85 | 3 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $138.43 | $212.97 | not published | 0 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $221.08 | $340.12 | not published | 0 |
| Frozen cell preparation CPT 88241 | not published | not published | $11.73 – $157.24 | 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.