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 |
|---|---|---|---|---|
| Hepatitis b immune globulin greater than 1,560 units/5 ml im solution CPT 90371 | not published | not published | $170.28 – $170.28 | 1 |
| Hepatitis b surface ag quan CPT 87467 | not published | not published | $24.56 – $329.32 | 3 |
| Hepatitis b surface antibody CPT 86706 | $34.18 | $52.59 | $10.20 – $139.69 | 4 |
| Hepatitis b vaccine 40 mcg/ml inj-adult CPT 90747 | not published | not published | $148.16 – $164.42 | 5 |
| Hepatitis c antibody CPT 86803 | $45.40 | $69.85 | $10.10 – $185.60 | 4 |
| Hepatitis c rna dir probe CPT 87520 | not published | not published | $30.28 – $406.05 | 3 |
| Hepatitis d quantification CPT 87523 | $92.52 | $142.34 | $41.55 – $557.19 | 4 |
| Hepatitis g dna amp probe CPT 87526 | not published | not published | $38.08 – $510.62 | 3 |
| Hepatitis g dna dir probe CPT 87525 | not published | not published | $28.91 – $387.58 | 3 |
| Hepatitis g dna quant CPT 87527 | not published | not published | $40.51 – $543.14 | 3 |
| Hep b vac 3ag 10mcg 3 dos im CPT 90759 | not published | not published | $73.82 – $73.82 | 5 |
| Hepb vacc 3 dose immunsup im CPT 90740 | not published | not published | $164.42 – $164.42 | 5 |
| Hereditary colon ca dsordrs CPT 81435 | not published | not published | $1,264.83 – $16,959.43 | 3 |
| Hered neuroend tum-rlt do 5+ CPT 81437 | not published | not published | $1,264.83 – $16,959.43 | 3 |
| Hered rta do gen seq 15 CPT 81434 | not published | not published | $579.97 – $7,776.54 | 3 |
| Herpes simplex 1 ag if CPT 87274 | not published | not published | $11.62 – $155.81 | 4 |
| Herpes simplex 2 ag if CPT 87273 | not published | not published | $11.62 – $155.81 | 4 |
| Herpes simplex type 1 antibody igg CPT 86695 | $39.20 | $60.31 | $12.79 – $171.55 | 3 |
| Herpes simplex type 2 antibody igg CPT 86696 | $39.20 | $60.31 | $14.65 – $251.67 | 4 |
| Herpes simplex virus isolation CPT 87255 | $68.80 | $105.85 | $6.83 – $440.39 | 4 |
| Heterophile antibodies screening CPT 86308 | $49.45 | $76.08 | $4.78 – $67.37 | 4 |
| Heterophile antibodies titer CPT 86309 | not published | not published | $6.28 – $84.15 | 4 |
| Heterophile antibody absrbj CPT 86310 | not published | not published | $7.15 – $95.86 | 3 |
| Hexa gene CPT 81255 | not published | not published | $49.91 – $669.17 | 3 |
| Hgb methemoglobin qual CPT 83045 | not published | not published | $6.30 – $84.41 | 3 |
| Hhv-6 dna dir probe CPT 87531 | not published | not published | $56.26 – $754.36 | 3 |
| Hhv-6 dna quant CPT 87533 | not published | not published | $40.51 – $543.14 | 3 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $261.96 | $403.01 | $32.17 – $32.17 | 1 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $511.99 | $787.68 | $39.37 – $39.37 | 1 |
| Hip and Pelvis X-ray (single view, left side) CPT 73501 | $199.93 | $307.59 | $24.15 – $24.15 | 1 |
| Hip X-ray CPT 73502 | $265.80 | $408.92 | $33.32 – $33.32 | 1 |
| Histamine CPT 83088 | not published | not published | $28.64 – $384.07 | 3 |
| Hiv-1 ag ia CPT 87390 | not published | not published | $22.12 – $312.93 | 4 |
| Hiv-1 dna dir probe CPT 87534 | not published | not published | $21.26 – $285.10 | 3 |
| Hiv-2 ag ia CPT 87391 | not published | not published | $21.24 – $284.84 | 3 |
| HIV 2 pcr qual - sendout CPT 87537 | not published | not published | $21.26 – $285.10 | 3 |
| Hiv-2 quant&revrse trnscripj CPT 87539 | not published | not published | $56.86 – $762.42 | 3 |
| HIV prep, ftc/taf 200/25mg HCPCS J0751 | not published | not published | $71.27 – $71.27 | 1 |
| HIV prep, ftc/tdf 200/300mg HCPCS J0750 | not published | not published | $1.28 – $1.28 | 1 |
| HIV prep, inj, cabotegravir HCPCS J0739 | not published | not published | $6.89 – $7.40 | 2 |
| Hizentra injection HCPCS J1559 | not published | not published | $13.64 – $24.75 | 2 |
| Hla class i high defin qual CPT 86832 | $834.74 | $1,284.21 | $314.04 – $4,210.76 | 3 |
| Hla class ii high defin qual CPT 86833 | $840.02 | $1,292.34 | $316.03 – $4,237.42 | 3 |
| Hla class i&ii antibody qual CPT 86828 | not published | not published | $62.26 – $834.87 | 3 |
| Hla class i/ii antibody qual CPT 86829 | not published | not published | $62.26 – $834.87 | 3 |
| Hla class ii phenotype qual CPT 86831 | $220.30 | $338.92 | $79.42 – $1,064.95 | 3 |
| Hla class ii semiquant panel CPT 86835 | not published | not published | $313.27 – $4,200.48 | 3 |
| Hla class i phenotype qual CPT 86830 | $257.00 | $395.39 | $92.65 – $1,242.35 | 3 |
| Hla class i semiquant panel CPT 86834 | not published | not published | $346.83 – $4,650.50 | 3 |
| Hla i & ii type verify lr CPT 81371 | not published | not published | $392.38 – $5,261.27 | 3 |
| Hla i & ii typing hr CPT 81378 | $942.83 | $1,450.51 | $335.20 – $4,494.55 | 3 |
| Hla i & ii typing lr CPT 81370 | not published | not published | $390.06 – $5,230.05 | 3 |
| Hla ii typing 1 loc hr CPT 81382 | $27.90 | $42.92 | $119.97 – $1,608.61 | 3 |
| Hla ii typing ag equiv lr CPT 81375 | not published | not published | $214.12 – $2,870.99 | 3 |
| Hla i low res one antigen equiv ea CPT 81374 | $231.56 | $356.25 | $72.10 – $966.75 | 3 |
| Hla i typing 1 locus hr CPT 81380 | not published | not published | $171.93 – $2,305.35 | 3 |
| Hla i typing complete hr CPT 81379 | not published | not published | $325.32 – $4,362.02 | 3 |
| Hla i typing complete lr CPT 81372 | not published | not published | $391.48 – $5,249.17 | 3 |
| Hla i typing high res 1 allele grp ea CPT 81381 | not published | not published | $164.80 – $2,209.75 | 3 |
| Hla i typing low res one locus ea CPT 81373 | not published | not published | $123.61 – $1,657.38 | 3 |
| Hla typing a b or c CPT 86813 | $181.05 | $278.54 | $56.26 – $754.36 | 3 |
| Hla typing dr/dq CPT 86816 | not published | not published | $29.26 – $392.40 | 3 |
| Hla x-match noncytotoxc addl CPT 86826 | not published | not published | $35.43 – $475.12 | 3 |
| Hla x-math non-cytotoxic CPT 86825 | not published | not published | $106.21 – $1,424.05 | 3 |
| Hlth bhv assmt/reassessment CPT 96156 | not published | not published | $22.47 – $22.47 | 1 |
| Hlth bhv ivntj fam 1st 30 CPT 96167 | not published | not published | $53.51 – $53.51 | 1 |
| Hlth bhv ivntj fam without pt ea CPT 96171 | not published | not published | $22.15 – $22.15 | 1 |
| Hlth bhv ivntj fam wo pt 1st CPT 96170 | not published | not published | $60.63 – $60.63 | 1 |
| Hlth bhv ivntj grp 1st 30 CPT 96164 | not published | not published | $3.02 – $3.02 | 1 |
| Hlth bhv ivntj indiv 1st 30 CPT 96158 | not published | not published | $22.47 – $22.47 | 1 |
| Hocm 200-249mg/ml iodine,1ml HCPCS Q9960 | not published | not published | $0.18 – $0.18 | 1 |
| Hocm 250-299mg/ml iodine,1ml HCPCS Q9961 | not published | not published | $0.31 – $0.31 | 1 |
| Hocm 350-399mg/ml iodine,1ml HCPCS Q9963 | not published | not published | $0.70 – $0.70 | 1 |
| Home/res vst est mod mdm 40 CPT 99349 | not published | not published | $131.20 – $131.20 | 1 |
| Home/res vst est sf mdm 20 CPT 99347 | not published | not published | $87.46 – $87.46 | 1 |
| Home/res vst new low mdm 30 CPT 99342 | not published | not published | $104.96 – $104.96 | 1 |
| Home/res vst new sf mdm 15 CPT 99341 | not published | not published | $87.46 – $87.46 | 1 |
| Home sleep test/type 3 porta HCPCS G0399 | $464.35 | $714.38 | $0.01 – $0.01 | 1 |
| Home visit est patient 99348 CPT 99348 | not published | not published | $104.74 – $104.74 | 1 |
| Home visit new patient CPT 99343 | not published | not published | $130.98 – $130.98 | 1 |
| Homocysteine CPT 83090 | $182.79 | $281.21 | $17.38 – $233.07 | 4 |
| Homogenization tissue CPT 87176 | not published | not published | $5.70 – $76.48 | 3 |
| Homovanillic acid (hva) CPT 83150 | not published | not published | $6.31 – $291.47 | 4 |
| Hpa-15 genotyping CPT 81112 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-1 genotyping CPT 81105 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-2 genotyping CPT 81106 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-3 genotyping CPT 81107 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-4 genotyping CPT 81108 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-5 genotyping CPT 81109 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-6 genotyping CPT 81110 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpa-9 genotyping CPT 81111 | not published | not published | $118.55 – $1,589.62 | 3 |
| Hpv combo assay ca screen HCPCS G0476 | not published | not published | $34.04 – $456.39 | 3 |
| Hpv low-risk types CPT 87623 | not published | not published | $28.13 – $456.39 | 4 |
| Hpv types 16 & 18 only CPT 87625 | not published | not published | $28.13 – $527.40 | 4 |
| H pylori ag ia CPT 87339 | not published | not published | $15.52 – $208.10 | 3 |
| H pylori (c-13) blood CPT 83009 | not published | not published | $65.34 – $876.10 | 4 |
| H pylori (c-13) breath CPT 83013 | $214.41 | $329.86 | $65.34 – $876.10 | 4 |
| H pylori drug admin CPT 83014 | $16.61 | $25.55 | $7.62 – $102.23 | 3 |
| Hrdtry brst ca-rlatd do 5+ CPT 81432 | not published | not published | $1,264.83 – $16,959.43 | 3 |
| Hrdtry cardmypy gene panel CPT 81439 | not published | not published | $567.35 – $7,607.33 | 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.