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 |
|---|---|---|---|---|
| Infect ag genotype na hiv-1 other region CPT 87906 | $409.75 | $630.38 | $124.87 – $1,674.29 | 4 |
| Infect ag genotype na hiv-1 revr trn/prt CPT 87901 | $819.50 | $1,260.77 | $249.73 – $3,348.45 | 4 |
| Infect ag ia direct hiv-1 antgn CPT 87806 | not published | not published | $18.67 – $426.21 | 4 |
| Infect ag ia optc obs chlamydia trach CPT 87810 | not published | not published | $34.23 – $458.99 | 3 |
| Infect ag ia optc obs influenza CPT 87804 | $40.49 | $62.29 | $14.65 – $215.25 | 4 |
| Infect ag if ea plyvlnt antsrm CPT 87300 | not published | not published | $11.62 – $155.81 | 3 |
| Infect ag if hep delta agent CPT 87380 | not published | not published | $10.10 – $238.79 | 4 |
| Infect ag if influenza a CPT 87276 | not published | not published | $14.65 – $209.01 | 4 |
| Infect ag if influenza b CPT 87275 | not published | not published | $11.88 – $159.33 | 4 |
| Infect ag if legionella pneumophila CPT 87278 | $120.87 | $185.96 | $15.13 – $202.90 | 4 |
| Infect ag if nos ea CPT 87299 | not published | not published | $15.62 – $209.40 | 3 |
| Infect ag if pneumocystis carinii CPT 87281 | not published | not published | $8.11 – $155.81 | 4 |
| Infect ag if varicella zoster CPT 87290 | not published | not published | $8.11 – $174.54 | 4 |
| Infect ag na chlamydia trachomatis qnt CPT 87492 | not published | not published | $51.87 – $695.44 | 3 |
| Infect ag na hep b amp CPT 87516 | not published | not published | $21.64 – $456.39 | 4 |
| Infect ag na herpes simplex quant CPT 87530 | not published | not published | $41.55 – $557.19 | 3 |
| Infect ag na hpv high-risk types CPT 87624 | $217.24 | $334.21 | $28.13 – $456.39 | 4 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $260.45 | $400.69 | $53.98 – $1,245.99 | 4 |
| Infect ag na influenza revr/amp ea type CPT 87501 | not published | not published | $49.77 – $667.35 | 4 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | not published | not published | $49.77 – $667.35 | 4 |
| Infect ag na resp virus 12-25 targets CPT 87633 | $468.84 | $721.29 | $404.28 – $5,420.72 | 3 |
| Infect ag phenotype na hiv-1 1-10 drugs CPT 87903 | not published | not published | $474.00 – $6,355.61 | 4 |
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $15.35 – $339.07 | 4 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | not published | not published | $24.83 – $538.20 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $36.21 | $55.71 | $9.49 – $155.81 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | not published | not published | $8.11 – $174.54 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $26.95 | $41.46 | $13.41 – $179.75 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | not published | not published | $11.62 – $155.81 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $405.87 | $624.42 | $8.11 – $187.03 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $32.88 | $50.58 | $10.02 – $134.35 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $32.88 | $50.58 | $10.02 – $134.35 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $76.65 | $117.93 | $18.67 – $313.19 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $136.65 | $210.23 | $5.25 – $155.81 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | not published | not published | $11.62 – $155.81 | 4 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $25.64 | $39.45 | $11.62 – $155.81 | 4 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $106.00 | $163.07 | $34.04 – $456.39 | 3 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $111.72 | $171.88 | $21.64 – $456.39 | 4 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $298.52 | $459.26 | $36.15 – $484.74 | 3 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $435.88 | $670.58 | $404.28 – $5,420.72 | 3 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $110.14 | $169.45 | $32.47 – $456.39 | 4 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $104.78 | $161.20 | $21.64 – $456.39 | 4 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | not published | not published | $40.43 – $542.10 | 4 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $111.72 | $171.88 | $21.64 – $456.39 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $73.26 | $112.70 | $30.79 – $667.35 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | not published | not published | $85.59 – $1,855.07 | 4 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $278.13 | $427.89 | $85.59 – $1,855.07 | 4 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $57.16 | $87.94 | $34.04 – $456.39 | 3 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $74.15 | $114.08 | $21.64 – $456.39 | 4 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | $136.85 | $210.54 | $68.07 – $912.78 | 3 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $41.68 – $998.49 | 4 |
| Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets CPT 87627 | not published | not published | $659.38 – $8,841.22 | 3 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $846.85 | $1,302.85 | $404.28 – $5,420.72 | 3 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | not published | not published | $124.44 – $1,668.57 | 3 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $612.71 | $942.63 | $157.79 – $3,420.50 | 4 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $573.97 | $883.03 | $41.55 – $557.19 | 3 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $223.08 | $343.20 | $41.55 – $557.19 | 3 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $136.34 | $209.76 | $41.55 – $557.19 | 4 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $165.94 | $255.30 | $82.55 – $1,106.83 | 4 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $278.13 | $427.89 | $97.27 – $1,855.07 | 4 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | not published | not published | $30.52 – $57.00 | 2 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | $77.16 | $118.70 | $30.52 – $60.00 | 2 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | not published | not published | $30.52 – $113.55 | 2 |
| Influenza dna amp prob addl CPT 87503 | not published | not published | $21.64 – $380.04 | 4 |
| Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 | $111.51 | $171.55 | $98.16 – $98.16 | 5 |
| Influenza virus vaccine, live trivalent intranasal CPT 90660 | $38.74 | $59.60 | $29.71 – $29.71 | 5 |
| Infuse radioactive materials CPT 77750 | not published | not published | $249.74 – $249.74 | 1 |
| Initial nursing facility care/day 35 minutes CPT 99305 | not published | not published | $96.21 – $96.21 | 1 |
| Initial nursing facility care/day 45 minutes CPT 99306 | not published | not published | $131.20 – $131.20 | 1 |
| Initial nursing facility care/day low severity 99304 CPT 99304 | not published | not published | $65.60 – $65.60 | 1 |
| Inj, abilify asimtufii, 1 mg HCPCS J0402 | $11.05 | $17.00 | $5.87 – $5.87 | 1 |
| Inj, abilify maintena, 1 mg HCPCS J0401 | $12.88 | $19.82 | $7.03 – $7.66 | 2 |
| Inj acetaminoph 10mg/ibu 3mg HCPCS J0138 | not published | not published | $0.22 – $0.22 | 1 |
| Inj, acetaminophen (b braun) HCPCS J0136 | not published | not published | $0.05 – $0.15 | 2 |
| Inj acetaminophen -fresenius HCPCS J0134 | not published | not published | $0.05 – $0.25 | 2 |
| Inj, acetaminophen (hikma) HCPCS J0137 | not published | not published | $0.03 – $0.03 | 1 |
| Inj. acthar gel to 40 units HCPCS J0801 | not published | not published | $3,893.43 – $3,893.43 | 1 |
| Inj, adstiladrin, per tx dos HCPCS J9029 | not published | not published | $63,235.61 – $63,235.61 | 1 |
| Inj, aducanumab-avwa, 2 mg HCPCS J0172 | not published | not published | $5.98 – $6.77 | 2 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $34.52 – $34.52 | 1 |
| Inj, aflibercept hd, 1 mg HCPCS J0177 | not published | not published | $321.18 – $321.18 | 1 |
| Inj, afstyla, 1 i.u HCPCS J7210 | not published | not published | $1.51 – $2.15 | 3 |
| Inj, alfentanil hcl, 500mcg HCPCS J0216 | not published | not published | $2.05 – $2.05 | 1 |
| Inj allopurinol sodium 1 mg HCPCS J0206 | not published | not published | $4.45 – $4.45 | 1 |
| Inj, alyglo, 500 mg HCPCS J1552 | not published | not published | $138.11 – $138.11 | 1 |
| Inj alymsys 10 mg HCPCS Q5126 | not published | not published | $86.23 – $86.23 | 1 |
| Inj, amisulpride, 1 mg HCPCS J0184 | not published | not published | $9.16 – $9.16 | 1 |
| Inj andexxa, 10 mg HCPCS J7169 | not published | not published | $120.00 – $150.00 | 2 |
| Inj anifrolumab-fnia 1mg HCPCS J0491 | $35.75 | $55.00 | $17.78 – $18.68 | 2 |
| Inj. (ani), up to 40 units HCPCS J0802 | not published | not published | $3,445.58 – $3,445.58 | 1 |
| Inj., aristada initio, 1 mg HCPCS J1943 | not published | not published | $3.14 – $3.96 | 2 |
| Inj, artesunate, 1mg HCPCS J0391 | not published | not published | $46.94 – $46.94 | 1 |
| Inj. asceniv HCPCS J1554 | not published | not published | $496.68 – $556.31 | 2 |
| Inj, aspara, rylaze, 0.1 mg HCPCS J9021 | not published | not published | $54.38 – $54.60 | 2 |
| Inj avacincaptad pegol 0.1mg HCPCS J2782 | not published | not published | $107.44 – $107.44 | 1 |
| Inj aval alfa-nqpt 4mg HCPCS J0219 | not published | not published | $77.82 – $82.32 | 2 |
| Inj belantamab mafodot blmf HCPCS J9037 | not published | not published | $52.96 – $52.96 | 1 |
| Inj., benralizumab, 1 mg HCPCS J0517 | not published | not published | $163.30 – $214.04 | 2 |
| Inj beta interferon sq 1 mcg HCPCS Q3028 | not published | not published | $39.96 – $41.95 | 2 |
| Inj, bezlotoxumab, 10 mg HCPCS J0565 | $86.17 | $132.57 | $39.87 – $45.60 | 2 |
| Inj bimatoprost itc imp1mcg HCPCS J7351 | not published | not published | $209.91 – $234.00 | 2 |
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.