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 |
|---|---|---|---|---|
| Hrdtry perph neurphy panel CPT 81448 | $1,140.56 | $1,754.70 | $567.35 – $7,607.33 | 3 |
| Hsv dna dir probe CPT 87528 | not published | not published | $19.45 – $260.77 | 3 |
| Htt gene charac alleles CPT 81274 | not published | not published | $166.55 – $3,574.49 | 4 |
| Htt gene detc abnor alleles CPT 81271 | $341.32 | $525.10 | $83.83 – $1,781.85 | 4 |
| Human epididymis protein 4 (he4) CPT 86305 | $150.92 | $232.18 | $20.19 – $270.66 | 4 |
| Human ig IV CPT 90283 | not published | not published | $63.53 – $63.53 | 1 |
| Human ig sc CPT 90284 | not published | not published | $16.01 – $16.01 | 1 |
| Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution HCPCS J7165 | not published | not published | $3.02 – $3.02 | 1 |
| Hyaluronidase 150 unit/ml injection solution HCPCS J3470 | not published | not published | $32.17 – $66.96 | 2 |
| Hyaluronidase 200 units/ml inj HCPCS J3471 | not published | not published | $0.50 – $0.57 | 2 |
| Hyaluronidase, human recombinant 150 unit/ml injection solution HCPCS J3473 | not published | not published | $0.36 – $0.45 | 2 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $4.86 | $7.47 | $4.40 – $18.00 | 2 |
| Hydrocolld drg >16<=48 w/bdr HCPCS A6238 | not published | not published | $11.25 – $11.25 | 1 |
| Hydrocolld drg <=16 in w/bdr HCPCS A6237 | not published | not published | $6.01 – $6.01 | 1 |
| Hydrocolld drg <=16 without bdr HCPCS A6234 | not published | not published | $4.68 – $4.68 | 1 |
| Hydrocortisone acetate inj HCPCS J1700 | not published | not published | $1.03 – $1.03 | 1 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | not published | not published | $16.43 – $20.58 | 2 |
| Hydrocortisone sodium ph inj HCPCS J1710 | not published | not published | $4.69 – $4.69 | 1 |
| Hydrogel drsg gel filler HCPCS A6248 | not published | not published | $14.06 – $14.06 | 1 |
| Hydrogel dsg<=16 sq in HCPCS A6231 | not published | not published | $1.97 – $1.97 | 1 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | not published | not published | $0.14 – $0.14 | 1 |
| Hydromorphone 250 mg HCPCS S0092 | not published | not published | $80.08 – $83.40 | 2 |
| Hydromorphone injection HCPCS J1170 | not published | not published | $3.80 – $3.80 | 1 |
| Hydroxocobalamin im 10mcg HCPCS J3425 | not published | not published | $0.01 – $0.01 | 1 |
| Hydroxyurea 500 mg HCPCS S0176 | not published | not published | $0.38 – $0.67 | 2 |
| Hydroxyzine hcl 50 mg/ml intramuscular solution HCPCS J3410 | not published | not published | $17.76 – $27.86 | 2 |
| Hydroxyzine pamoate 25 mg capsule HCPCS Q0177 | not published | not published | $0.09 – $0.10 | 2 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | not published | not published | $17.36 – $232.81 | 3 |
| Hymovis injection 1 mg HCPCS J7322 | $48.55 | $74.69 | $17.50 – $35.85 | 2 |
| Hyoscyamine sulfate inj HCPCS J1980 | not published | not published | $35.60 – $51.84 | 2 |
| #hypersens-actinomyces ab CPT 86602 | not published | not published | $8.11 – $132.40 | 4 |
| Hypnotherapy CPT 90880 | not published | not published | $141.68 – $141.68 | 1 |
| Hyqvia 100mg immuneglobulin HCPCS J1575 | not published | not published | $17.57 – $26.65 | 2 |
| Hysterosalpingography s&i CPT 74740 | not published | not published | $50.71 – $50.71 | 1 |
| Hzv zoster vacc recombinant adjuvanted im inj CPT 90750 | not published | not published | $205.88 – $205.88 | 1 |
| I-123 iobenguane diag HCPCS A9582 | not published | not published | $4,723.22 – $4,723.22 | 1 |
| I-123 ioflupane diag HCPCS A9584 | not published | not published | $2,961.60 – $2,961.60 | 1 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | not published | not published | $100.49 – $100.49 | 1 |
| I125 iothalamate, dx HCPCS A9554 | not published | not published | $42.00 – $42.00 | 1 |
| I131 iodide cap, rx HCPCS A9517 | not published | not published | $59.96 – $59.96 | 1 |
| I131 serum albumin, dx HCPCS A9524 | not published | not published | $95.00 – $95.00 | 1 |
| Iaadi respiratory synctial virus CPT 87280 | not published | not published | $8.11 – $174.54 | 4 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | not published | not published | $34.04 – $456.39 | 3 |
| Ia infect ag ab qual/semiquant sgl step CPT 86318 | not published | not published | $3.79 – $235.28 | 4 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | not published | not published | $27.14 – $588.92 | 4 |
| Ibandronate 3 mg/3 ml intravenous syringe HCPCS J1740 | not published | not published | $22.22 – $97.00 | 2 |
| Ibmfs seq alys pnl 30 genes CPT 81441 | not published | not published | $2,375.10 – $31,846.46 | 3 |
| Ibuprofen injection HCPCS J1741 | not published | not published | $2.98 – $3.32 | 2 |
| Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 | not published | not published | $292.34 – $357.96 | 2 |
| Icatibant injection HCPCS J1744 | not published | not published | $125.32 – $162.66 | 2 |
| Idarubicin hcl injection HCPCS J9211 | not published | not published | $43.51 – $62.08 | 2 |
| Idecabtagene vicleucel car HCPCS Q2055 | not published | not published | $503,400.00 – $503,400.00 | 1 |
| Idh1 common variants CPT 81120 | not published | not published | $187.45 – $2,513.45 | 3 |
| Idh2 common variants CPT 81121 | not published | not published | $286.92 – $3,847.10 | 3 |
| Idursulfase injection HCPCS J1743 | not published | not published | $542.57 – $627.17 | 2 |
| Ifnl3 gene CPT 81283 | not published | not published | $71.17 – $954.26 | 3 |
| Ifosfamide 1 gram intravenous solution HCPCS J9208 | not published | not published | $24.62 – $44.09 | 2 |
| Igh@/bcl2 translocation alys CPT 81278 | not published | not published | $125.63 – $2,696.32 | 4 |
| Igh gene rearrang dir probe CPT 81262 | not published | not published | $66.49 – $891.58 | 3 |
| Igh gene rearrange amp meth CPT 81261 | not published | not published | $192.05 – $2,575.10 | 3 |
| Igh@ var region somatic mutation analy CPT 81263 | $574.31 | $883.56 | $285.68 – $3,830.59 | 3 |
| Igk rearrangeabn clonal pop CPT 81264 | $475.33 | $731.27 | $167.55 – $2,246.56 | 3 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $187.20 | $288.00 | $25.62 – $25.62 | 1 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $524.16 | $806.40 | $25.62 – $25.62 | 1 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $241.40 | $371.38 | $25.62 – $25.62 | 1 |
| Iiv3 vacc no prsv 0.25 ml im CPT 90655 | $37.44 | $57.60 | not published | 0 |
| Ikbkap gene CPT 81260 | not published | not published | $38.13 – $511.27 | 3 |
| Iloprost non-comp unit dose HCPCS Q4074 | not published | not published | $161.64 – $161.64 | 1 |
| Imatinib 100 mg tab HCPCS S0088 | not published | not published | $2.85 – $3.93 | 2 |
| Imetelstat 188 mg intravenous solution HCPCS J0870 | not published | not published | $55.51 – $55.51 | 1 |
| Immune complex assay CPT 86332 | $51.49 | $79.22 | $23.64 – $316.96 | 3 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | not published | not published | $45.13 – $93.14 | 2 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | not published | not published | $81.01 – $124.40 | 2 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | $7.13 | $10.97 | $48.06 – $107.76 | 2 |
| Immune globulin ig human im use 90281 CPT 90281 | not published | not published | $100.72 – $100.72 | 1 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $235.55 | $362.39 | $20.19 – $270.66 | 4 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $235.55 | $362.39 | $20.19 – $270.66 | 4 |
| Immunoassay tumor qual CPT 86294 | not published | not published | $8.11 – $332.57 | 4 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $24.34 | $37.45 | $11.62 – $155.81 | 3 |
| Immunodiffusion nes CPT 86329 | not published | not published | $12.63 – $182.74 | 4 |
| Immunofixation electrophoresis serum CPT 86334 | $148.34 | $228.22 | $21.67 – $290.56 | 4 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | not published | not published | $16.41 – $16.41 | 1 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | not published | not published | $19.44 – $19.44 | 1 |
| Immunoglobulin assay CPT 86023 | $37.62 | $57.88 | $12.09 – $162.06 | 3 |
| Imuglucerase injection HCPCS J1786 | not published | not published | $43.14 – $51.51 | 2 |
| In-111 autologous plt stdy dx HCPCS A9571 | not published | not published | $4,291.50 – $4,291.50 | 1 |
| In-111 autol wbc diag per dose HCPCS A9570 | not published | not published | $4,291.50 – $4,291.50 | 1 |
| In-111 oxyquinolin per 0.5 mci HCPCS A9547 | not published | not published | $2,145.75 – $2,145.75 | 1 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | not published | not published | $743.74 – $743.74 | 1 |
| Inactivated je vacc im CPT 90738 | not published | not published | $325.58 – $325.58 | 1 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $3,332.03 | $5,126.20 | not published | 0 |
| Incision of eardrum CPT 69420 | $527.74 | $811.91 | not published | 0 |
| Incision of toe tendons 28011 CPT 28011 | $3,312.43 | $5,096.04 | not published | 0 |
| Incobotulinumtoxin a HCPCS J0588 | not published | not published | $5.33 – $6.24 | 2 |
| Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s) CPT 87626 | $151.61 | $233.24 | $42.12 – $913.04 | 4 |
| Infect ag drug suscept pheno predict CPT 87900 | $414.91 | $638.32 | $80.80 – $1,695.36 | 4 |
| Infect ag eia chlamydia trachomatis CPT 87320 | not published | not published | $8.11 – $195.09 | 4 |
| Infect ag eia influenza a or b ea CPT 87400 | not published | not published | $13.71 – $183.78 | 3 |
| Infect ag genotype na cytomegalovirus CPT 87910 | not published | not published | $249.73 – $3,348.45 | 3 |
| Infect ag genotype na dna hepatitis b CPT 87912 | not published | not published | $249.73 – $3,348.45 | 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.