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 |
|---|---|---|---|---|
| Albuterol comp con HCPCS J7610 | not published | not published | $1.16 – $1.16 | 1 |
| Albuterol comp unit HCPCS J7609 | not published | not published | $0.22 – $0.48 | 2 |
| Albuterol ipratrop non-comp HCPCS J7620 | not published | not published | $0.19 – $0.48 | 2 |
| Albuterol non-comp con HCPCS J7611 | not published | not published | $0.18 – $0.38 | 2 |
| Albuterol non-comp unit HCPCS J7613 | not published | not published | $0.08 – $0.10 | 2 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | not published | not published | $16.75 – $224.62 | 3 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | $63.11 | $97.09 | not published | 0 |
| Aldesleukin injection HCPCS J9015 | not published | not published | $5,817.60 – $6,168.30 | 2 |
| Aldosterone suppression eval CPT 80408 | not published | not published | $121.74 – $1,632.28 | 3 |
| Alefacept HCPCS J0215 | not published | not published | $20.62 – $20.62 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $2,441.49 – $2,707.21 | 2 |
| Alginate dressing <=16 sq in HCPCS A6196 | not published | not published | $5.23 – $5.23 | 1 |
| Alginate drsg wound filler HCPCS A6199 | not published | not published | $2.64 – $2.64 | 1 |
| Alglucerase injection HCPCS J0205 | not published | not published | $24.59 – $24.59 | 1 |
| Alglucosidase alfa injection HCPCS J0220 | not published | not published | $187.20 – $187.20 | 1 |
| Alkaline phosphatase CPT 84075 | $62.27 | $95.80 | $5.02 – $67.37 | 4 |
| Allergen alpha lactalbumin ige CPT 86008 | $37.89 | $58.29 | $3.69 – $233.20 | 4 |
| Allergen egg white ige CPT 86003 | $52.76 | $81.17 | $3.69 – $67.89 | 4 |
| Allergen specific ige qual multi scrn ea CPT 86005 | not published | not published | $7.73 – $103.66 | 3 |
| Allergy injections; 2 or more 95117 CPT 95117 | $72.08 | $110.89 | not published | 0 |
| Allergy injection; single 95115 CPT 95115 | $46.69 | $71.83 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | not published | not published | $199.80 – $199.80 | 1 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | not published | not published | $400.80 – $400.80 | 1 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | not published | not published | $101.13 – $101.13 | 1 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | not published | not published | $270.00 – $270.00 | 1 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | not published | not published | $489.50 – $489.50 | 1 |
| Alloskin ac, 1 cm HCPCS Q4141 | not published | not published | $112.05 – $112.05 | 1 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $7.82 | $12.03 | $5.16 – $6.20 | 2 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | not published | not published | $62.48 – $837.73 | 4 |
| Alpha-fetoprotein amniotic CPT 82106 | not published | not published | $10.10 – $221.11 | 4 |
| Alpha-fetoprotein tumor marker CPT 82105 | $318.44 | $489.90 | $6.57 – $218.11 | 4 |
| Alprostadil for injection HCPCS J0270 | not published | not published | $9.86 – $11.38 | 2 |
| Alprostadil urethral suppos HCPCS J0275 | not published | not published | $39.37 – $39.37 | 1 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $127.60 | $196.31 | $91.46 – $96.43 | 2 |
| Alt/sgpt CPT 84460 | $70.33 | $108.20 | $5.08 – $68.93 | 4 |
| Altuviiio per factor viii iu HCPCS J7214 | not published | not published | $4.60 – $4.67 | 2 |
| Aluminum - quest CPT 82108 | $72.80 | $112.00 | $24.72 – $331.40 | 4 |
| Ambl bp mntr w/sw a/r CPT 93788 | $323.00 | $496.92 | not published | 0 |
| Amifostine HCPCS J0207 | not published | not published | $1,028.55 – $1,285.69 | 2 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $2.79 | $4.29 | $0.60 – $1.92 | 2 |
| Amines vaginal fluid qual CPT 82120 | not published | not published | $2.02 – $77.91 | 4 |
| Amino acid screen, urine CPT 82128 | not published | not published | $9.29 – $180.40 | 4 |
| Amino acid single qual CPT 82127 | not published | not published | $9.29 – $184.43 | 4 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $14.14 – $255.05 | 4 |
| Aminolevulinic acid, 10% gel HCPCS J7345 | not published | not published | $1.78 – $1.97 | 2 |
| Aminolevulinic acid delta CPT 82135 | not published | not published | $15.96 – $213.95 | 3 |
| Aminolevulinic acid hcl top HCPCS J7308 | not published | not published | $394.41 – $462.61 | 2 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | not published | not published | $10.90 – $11.05 | 2 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | not published | not published | $2.59 – $4.61 | 2 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | not published | not published | $0.33 – $0.51 | 2 |
| Amitriptyline (elavil) -sendout CPT 80335 | $194.06 | $298.55 | $5.05 – $5.05 | 1 |
| Amitriptyline injection HCPCS J1320 | not published | not published | $2.11 – $2.11 | 1 |
| Amivantamab-vmjw 50 mg/ml intravenous solution HCPCS J9061 | not published | not published | $21.51 – $22.51 | 2 |
| Ammonia CPT 82140 | $116.12 | $178.64 | $14.13 – $189.50 | 4 |
| Amnioarmor 1 sq cm HCPCS Q4188 | not published | not published | $576.00 – $576.00 | 1 |
| Amniocore per sq cm HCPCS Q4227 | not published | not published | $540.00 – $540.00 | 1 |
| Amnio-maxx or lite per sq cm HCPCS Q4239 | not published | not published | $399.74 – $399.74 | 1 |
| Amniotic fluid scan CPT 82143 | not published | not published | $9.07 – $121.61 | 4 |
| Amobarbital 125 mg inj HCPCS J0300 | not published | not published | $175.94 – $219.92 | 2 |
| Amphetamine confirm urine -sendout CPT 80324 | $183.40 | $282.15 | $5.05 – $5.05 | 1 |
| Amphetamines 5 or more CPT 80326 | $162.73 | $250.36 | $5.05 – $5.05 | 1 |
| Ampho b cholesteryl sulfate HCPCS J0288 | not published | not published | $57.90 – $57.90 | 1 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | not published | not published | $50.07 – $52.44 | 2 |
| Amphotericin b lipid complex HCPCS J0287 | not published | not published | $10.30 – $12.60 | 2 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | not published | not published | $23.31 – $61.14 | 2 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | not published | not published | $0.60 – $3.12 | 2 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | not published | not published | $1.57 – $6.16 | 2 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | not published | not published | $255.10 – $3,420.50 | 3 |
| Amylase CPT 82150 | $65.93 | $101.43 | $5.08 – $84.28 | 4 |
| Anacaulase-bcdb 8.8% gel 1 g HCPCS J7353 | not published | not published | $54.98 – $54.98 | 1 |
| Ana ds-dna CPT 86226 | not published | not published | $11.75 – $157.51 | 3 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $121.35 | $186.69 | not published | 0 |
| Analysis complx cranial nerve pulse gen prgrmg 95977 CPT 95977 | $250.63 | $385.58 | not published | 0 |
| Analysis gene f2 20210g>a variant CPT 81240 | $123.83 | $190.51 | $63.72 – $854.38 | 4 |
| Analysis gene f5 leiden variant CPT 81241 | $338.81 | $521.25 | $71.17 – $954.26 | 4 |
| Analysis nerve CPT 88356 | not published | not published | $25.62 – $25.62 | 1 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $71.30 | $109.69 | $21.64 – $456.39 | 4 |
| Anastrozole 1 mg HCPCS S0170 | not published | not published | $0.46 – $0.60 | 2 |
| Anca screen with reflex to titer -quest CPT 86021 | $385.34 | $592.83 | $14.60 – $195.74 | 3 |
| An cholangiogram percutaneous compl CPT 47531 | $6,497.26 | $9,995.79 | not published | 0 |
| Androstanediol CPT 82154 | not published | not published | $27.97 – $374.97 | 4 |
| An fluoro guide for cvp CPT 77001 | not published | not published | $73.43 – $73.43 | 1 |
| Angiotensin ii CPT 82163 | not published | not published | $19.90 – $266.89 | 3 |
| Anidulafungin injection HCPCS J0348 | not published | not published | $0.47 – $2.29 | 2 |
| Ankle X-ray CPT 73610 | $232.59 | $357.83 | $20.75 – $20.75 | 1 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $200.64 | $308.68 | $18.14 – $18.14 | 1 |
| Annual alcohol screen 15 min HCPCS G0442 | $109.58 | $168.58 | not published | 0 |
| Annual nursing fac assessmnt CPT 99318 | not published | not published | $26.02 – $26.02 | 1 |
| Annual Physical, Established Patient (age 18-39) CPT 99395 | $281.98 | $433.82 | not published | 0 |
| Annual Physical, Established Patient (age 40-64) CPT 99396 | $311.23 | $478.82 | not published | 0 |
| Annual Physical, New Patient (age 18-39) CPT 99385 | $112.46 | $173.02 | $91.84 – $91.84 | 1 |
| Annual Physical, New Patient (age 40-64) CPT 99386 | $131.23 | $201.89 | $91.84 – $91.84 | 1 |
| Anodyne therapy charges pt CPT 97026 | $32.32 | $49.73 | $12.27 – $12.27 | 1 |
| Anora (draw only) CPT 99001 | $39.89 | $61.37 | not published | 0 |
| Anoscopy and biopsy CPT 46606 | $2,425.93 | $3,732.20 | not published | 0 |
| Anoscopy control bleeding 46614 CPT 46614 | $2,190.45 | $3,369.93 | not published | 0 |
| Anthrax vaccine sc or im CPT 90581 | not published | not published | $118.80 – $118.80 | 1 |
| Antibody CPT 86744 | not published | not published | $8.11 – $207.97 | 4 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $43.66 | $67.17 | $12.49 – $167.52 | 3 |
| Antibody elution rbc reference CPT 86860 | $279.99 | $430.75 | $11.82 – $11.82 | 1 |
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.