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 |
|---|---|---|---|---|
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $132.60 | $204.00 | $6.91 – $167.39 | 4 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $52.76 | $81.17 | $1.41 – $50.98 | 4 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.51 – $0.51 | 1 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $10.84 – $10.84 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $10.77 – $47.98 | 2 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $97.06 | $149.33 | $18.02 – $241.66 | 4 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $143.96 – $1,930.25 | 4 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $97.06 | $149.33 | $17.96 – $240.87 | 4 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $705.14 – $940.33 | 2 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $99.03 | $152.36 | $54.41 – $54.41 | 1 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $474.00 – $474.00 | 1 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $100.00 – $100.00 | 1 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $897.50 – $897.50 | 1 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | not published | not published | $75.36 – $75.36 | 1 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | not published | not published | $206.25 – $206.25 | 1 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $266.88 – $266.88 | 1 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $352.00 – $352.00 | 1 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $2.88 – $3.60 | 2 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.26 – $1.14 | 2 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.27 – $204.72 | 3 |
| Growth hormone panel CPT 80428 | not published | not published | $64.70 – $867.51 | 4 |
| Growth hormone panel CPT 80430 | not published | not published | $77.61 – $1,682.09 | 4 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $73.33 – $983.27 | 3 |
| Grp adapt bhv tx by phy/qhp CPT 97158 | not published | not published | $11.58 – $11.58 | 1 |
| Grp adapt bhv tx by tech CPT 97154 | not published | not published | $12.35 – $12.35 | 1 |
| G-tube reposition CPT 43761 | $358.10 | $550.93 | not published | 0 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $70.82 – $70.82 | 1 |
| Guid loc target vol rad tx CPT 77387 | $189.18 | $291.04 | $70.40 – $70.40 | 1 |
| Hair analysis HCPCS P2031 | not published | not published | $4.80 – $64.38 | 3 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $15.88 | $24.43 | $4.61 – $26.68 | 2 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | not published | not published | $0.78 – $3.60 | 2 |
| Hand-held pefr meter a4614 HCPCS A4614 | not published | not published | $24.67 – $24.67 | 1 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $84.52 | $130.03 | $55.59 – $55.59 | 1 |
| Hand X-ray CPT 73130 | $218.54 | $336.21 | $20.54 – $20.54 | 1 |
| Hand X-ray (2 views, both hands) CPT 73120 | $186.59 | $287.06 | $17.70 – $17.70 | 1 |
| Haptoglobin quantitative CPT 83010 | $212.09 | $326.29 | $12.20 – $163.62 | 4 |
| Hba1/hba2 full gene sequence CPT 81259 | not published | not published | $582.00 – $7,803.72 | 3 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $394.68 | $607.20 | $192.59 – $2,632.45 | 4 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $94.17 – $4,880.58 | 4 |
| Hbb full gene sequence CPT 81364 | not published | not published | $314.84 – $4,221.55 | 3 |
| Hbb gene com variants CPT 81361 | not published | not published | $149.48 – $2,273.61 | 4 |
| Hbb gene dup/del variants CPT 81363 | not published | not published | $192.59 – $2,632.45 | 4 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $94.17 – $4,880.58 | 4 |
| Hb glycosylated a1c home dev CPT 83037 | not published | not published | $9.42 – $126.29 | 3 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | not published | not published | $140.21 – $140.21 | 1 |
| Hcg free betachain test CPT 84704 | not published | not published | $12.49 – $198.86 | 4 |
| Hcg qualitative CPT 84703 | $90.86 | $139.79 | $2.02 – $97.81 | 4 |
| Hcg quantitative CPT 84702 | $184.97 | $284.57 | $12.49 – $195.74 | 4 |
| Hc nm cardiac blood pool planar 1 stdy wal motn eject fract CPT 78481 | not published | not published | $134.20 – $134.20 | 1 |
| Hc nm kidney imaging with flow CPT 78701 | not published | not published | $136.51 – $136.51 | 1 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | not published | not published | $164.87 – $164.87 | 1 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | not published | not published | $480.00 – $480.00 | 1 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | not published | not published | $259.15 – $259.15 | 1 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | not published | not published | $482.57 – $482.57 | 1 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | not published | not published | $736.83 – $736.83 | 1 |
| Hdr rdncl skn surf brachytx CPT 77767 | not published | not published | $182.05 – $182.05 | 1 |
| Hdr rdncl skn surf brachytx CPT 77768 | not published | not published | $285.38 – $285.38 | 1 |
| Head CT scan (with and without contrast) CPT 70470 | $2,107.25 | $3,241.93 | $198.76 – $198.76 | 1 |
| Head CT scan (with contrast) CPT 70460 | $2,091.48 | $3,217.66 | $164.18 – $164.18 | 1 |
| Head CT scan (without contrast) CPT 70450 | $1,597.00 | $2,456.92 | $126.02 – $126.02 | 1 |
| Hearing loss dup/del analys CPT 81431 | not published | not published | $659.18 – $8,838.62 | 3 |
| Hearing loss sequence analys CPT 81430 | not published | not published | $1,576.25 – $21,135.08 | 3 |
| Heart first pass add-on CPT 78496 | not published | not published | $51.43 – $51.43 | 1 |
| Heart first pass multiple CPT 78483 | not published | not published | $285.32 – $285.32 | 1 |
| Heart image spect CPT 78494 | not published | not published | $251.29 – $251.29 | 1 |
| Heart infarct image CPT 78466 | not published | not published | $115.46 – $115.46 | 1 |
| Heart infarct image (ef) CPT 78468 | not published | not published | $140.06 – $140.06 | 1 |
| Heavy metal qual any number CPT 83015 | not published | not published | $20.31 – $272.35 | 4 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $276.45 | $425.31 | $17.92 – $17.92 | 1 |
| Heinz bodies direct CPT 85441 | not published | not published | $4.07 – $54.63 | 4 |
| Heinz bodies induced CPT 85445 | not published | not published | $5.25 – $88.70 | 4 |
| Helicobacter pylori antibody igm CPT 86677 | $38.10 | $58.62 | $8.11 – $219.15 | 4 |
| Helicoll, per square cm HCPCS Q4164 | not published | not published | $985.00 – $985.00 | 1 |
| Hemagglutination inhibition CPT 86280 | not published | not published | $7.94 – $106.52 | 3 |
| Hematocrit CPT 85014 | $32.26 | $49.63 | $2.02 – $30.82 | 4 |
| Hematopoietic nuclear tx CPT 79403 | not published | not published | $188.38 – $188.38 | 1 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | not published | not published | $32.19 – $33.07 | 2 |
| Hemoglobin CPT 85018 | $36.63 | $56.35 | $2.02 – $30.82 | 4 |
| Hemoglobin copper sulfate CPT 83026 | not published | not published | $3.89 – $52.15 | 3 |
| Hemoglobin fetal qualitative CPT 83033 | not published | not published | $7.76 – $104.05 | 3 |
| Hemoglobin f (fetal) chemical CPT 83030 | not published | not published | $3.79 – $139.69 | 4 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $54.24 | $83.44 | $3.79 – $106.65 | 4 |
| Hemoglobin-oxygen affinity CPT 82820 | not published | not published | $10.18 – $173.50 | 4 |
| Hemoglobin plasma CPT 83051 | $14.25 | $21.93 | $3.79 – $95.08 | 4 |
| Hemoglobin thermolabile CPT 83065 | not published | not published | $8.73 – $117.06 | 3 |
| Hemoglobin urine CPT 83069 | not published | not published | $3.83 – $51.37 | 3 |
| Hemolysin acid CPT 85475 | not published | not published | $8.60 – $115.36 | 4 |
| Hemolysins/agglutinins auto CPT 86940 | not published | not published | $7.21 – $114.06 | 4 |
| Hemolysins and agglutinins incubated CPT 86941 | not published | not published | $10.37 – $157.51 | 4 |
| Hemophilus influenza antibdy CPT 86684 | $172.54 | $265.45 | $15.36 – $206.02 | 4 |
| Hepagam b im injection HCPCS J1571 | not published | not published | $65.15 – $106.79 | 2 |
| Hepagam b intravenous, inj HCPCS J1573 | not published | not published | $65.15 – $106.79 | 2 |
| Heparin assay CPT 85520 | $25.53 | $39.27 | $12.70 – $170.25 | 4 |
| Heparin bolus from bag HCPCS J1644 | not published | not published | $0.22 – $0.50 | 2 |
| Heparin neutralization CPT 85525 | not published | not published | $11.48 – $153.99 | 3 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $0.16 | $0.25 | $0.02 – $0.40 | 2 |
| Heparin-protamine tolerance CPT 85530 | not published | not published | $12.70 – $170.25 | 3 |
| Hepatitis a antibody igm CPT 86709 | $91.57 | $140.88 | $10.10 – $146.45 | 4 |
| Hepatitis b core antibody igm CPT 86705 | $219.06 | $337.02 | $10.20 – $153.08 | 4 |
| Hepatitis b core antibody total CPT 86704 | $38.36 | $59.02 | $10.20 – $156.72 | 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.