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 |
|---|---|---|---|---|
| Inj, biorphen, 20 micrograms HCPCS J2372 | not published | not published | $0.18 – $0.18 | 1 |
| Inj, bortezomib, dr. reddy's HCPCS J9046 | not published | not published | $43.97 – $54.96 | 2 |
| Inj, bortezomib freseniuskab HCPCS J9048 | not published | not published | $43.97 – $54.96 | 2 |
| Inj, bortezomib, hospira HCPCS J9049 | not published | not published | $1.43 – $9.74 | 2 |
| Inj., brexanolone, 1 mg HCPCS J1632 | not published | not published | $71.52 – $89.40 | 2 |
| Inj, brixadi, 7 days or less HCPCS J0577 | not published | not published | $425.40 – $425.40 | 1 |
| Inj brixadi, more than 7 day HCPCS J0578 | $2,858.76 | $4,398.10 | $1,701.62 – $1,701.62 | 1 |
| Inj, brolucizumab-dbll, 1 mg HCPCS J0179 | not published | not published | $339.99 – $370.00 | 2 |
| Inj bulking agent anal canal HCPCS L8605 | not published | not published | $1,760.93 – $1,760.93 | 1 |
| Inj, bupivacaine liposome HCPCS J0666 | not published | not published | $1.42 – $1.42 | 1 |
| Inj, bupivacaine (posimir) HCPCS C9144 | not published | not published | $0.58 – $0.58 | 1 |
| Inj. byooviz, 0.1 mg HCPCS Q5124 | not published | not published | $85.57 – $271.20 | 2 |
| Inj calcitriol per 0.1 mcg HCPCS J0636 | not published | not published | $0.90 – $0.95 | 2 |
| Inj, carmustine (accord) HCPCS J9052 | not published | not published | $235.20 – $235.20 | 1 |
| Inj cefazolin sodium, baxter HCPCS J0689 | not published | not published | $1.25 – $2.78 | 2 |
| Inj cefazolin sodium, hikma HCPCS J0688 | not published | not published | $0.98 – $0.98 | 1 |
| Inj cefazolin (wg crit care) HCPCS J0687 | not published | not published | $0.97 – $0.97 | 1 |
| Inj. cefepime hcl (baxter) HCPCS J0701 | not published | not published | $5.80 – $14.48 | 2 |
| Inj, cefepime hcl (b braun) HCPCS J0703 | not published | not published | $5.04 – $8.75 | 2 |
| Inj, cefiderocol, 10 mg HCPCS J0699 | not published | not published | $2.28 – $2.39 | 2 |
| Inj ceftolozane tazobactam HCPCS J0695 | not published | not published | $7.88 – $8.04 | 2 |
| Inj., cerliponase alfa 1 mg HCPCS J0567 | not published | not published | $111.22 – $116.29 | 2 |
| Inj. cetirizine hcl 0.5mg HCPCS J1201 | not published | not published | $15.62 – $18.00 | 2 |
| Inj, cipaglucosidase, 5 mg HCPCS J1203 | not published | not published | $89.85 – $89.85 | 1 |
| Inj, clevidipine butyrate HCPCS C9248 | not published | not published | $3.87 – $3.87 | 1 |
| Inj, clindamycin (baxter) HCPCS J0737 | not published | not published | $2.53 – $2.53 | 1 |
| Inj., copanlisib, 1 mg HCPCS J9057 | not published | not published | $84.06 – $99.01 | 2 |
| Inj crotalidae im f(ab')2 eq HCPCS J0841 | not published | not published | $1,043.55 – $1,464.00 | 2 |
| Inj, crovalimab-akkz, 10 mg HCPCS J1307 | not published | not published | $499.48 – $499.48 | 1 |
| Inj cutaquig 100 mg HCPCS J1551 | not published | not published | $14.34 – $23.67 | 2 |
| Inj cuvitru, 100 mg HCPCS J1555 | not published | not published | $16.68 – $24.20 | 2 |
| Inj, cyclophos (baxter) 5mg HCPCS J9076 | not published | not published | $4.65 – $4.65 | 1 |
| Inj cyclophos dr.reddy's 5mg HCPCS J9072 | not published | not published | $9.05 – $9.05 | 1 |
| Inj cyclophosphamd auromedic HCPCS J9071 | not published | not published | $0.87 – $4.38 | 2 |
| Inj cyclophosphamd (ingenus) HCPCS J9073 | not published | not published | $1.76 – $1.76 | 1 |
| Inj, cyclophosphamd, sandoz HCPCS J9074 | not published | not published | $4.34 – $4.34 | 1 |
| Inj, daptomycin (baxter) HCPCS J0874 | not published | not published | $0.07 – $0.07 | 1 |
| Inj, daptomycin (hospira) HCPCS J0877 | not published | not published | $0.06 – $0.18 | 2 |
| Inj daptomycin (xellia) HCPCS J0873 | not published | not published | $0.03 – $0.03 | 1 |
| Inj daxibotulinumtoxina-lanm HCPCS J0589 | not published | not published | $2.99 – $2.99 | 1 |
| Inj, decitabine (sun pharma) HCPCS J0893 | not published | not published | $0.78 – $6.00 | 2 |
| Inj diclofenac sodium 0.5mg HCPCS J1130 | not published | not published | $0.20 – $0.20 | 1 |
| Inj, donanemab-azbt, 2 mg HCPCS J0175 | not published | not published | $4.18 – $4.18 | 1 |
| Inj, durolane 1 mg HCPCS J7318 | not published | not published | $6.93 – $20.09 | 2 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $176.54 | $271.60 | not published | 0 |
| Injection, belinostat, 10mg HCPCS J9032 | not published | not published | $50.92 – $54.10 | 2 |
| Injection, burosumab-twza 1m HCPCS J0584 | not published | not published | $469.74 – $479.64 | 2 |
| Injection, cangrelor HCPCS C9460 | not published | not published | $19.22 – $20.01 | 2 |
| Injection, caplacizumab-yhdp HCPCS C9047 | not published | not published | $748.07 – $828.22 | 2 |
| Injection, casimersen, 10 mg HCPCS J1426 | not published | not published | $153.60 – $192.00 | 2 |
| Injection, cimetidine hydroc HCPCS S0023 | not published | not published | $1.98 – $1.98 | 1 |
| Injection, daratumumab 10 mg HCPCS J9145 | not published | not published | $67.63 – $76.82 | 2 |
| Injection, delafloxacin HCPCS C9462 | not published | not published | $0.57 – $0.57 | 1 |
| Injection, doxercalciferol HCPCS J1270 | not published | not published | $0.38 – $1.20 | 2 |
| Injection, edaravone, 1 mg HCPCS J1301 | not published | not published | $20.41 – $24.46 | 2 |
| Injection estrone per 1 mg HCPCS J1435 | not published | not published | $0.16 – $0.16 | 1 |
| Injection, famotidine, 20 mg HCPCS S0028 | not published | not published | $1.07 – $1.07 | 1 |
| Injection for hip x-ray CPT 27095 | $514.01 | $790.78 | not published | 0 |
| Injection, fosphenytoin sodi HCPCS S0078 | not published | not published | $38.16 – $86.40 | 2 |
| Injection, fulvestrant HCPCS J9395 | not published | not published | $6.90 – $42.00 | 2 |
| Injection glatiramer acetate HCPCS J1595 | not published | not published | $60.00 – $69.00 | 2 |
| Injection, glucarpidase HCPCS C9293 | not published | not published | $395.27 – $439.78 | 2 |
| Injection, inclisiran, 1 mg HCPCS J1306 | $18.84 | $28.98 | $12.27 – $13.73 | 2 |
| Injection, isavuconazonium HCPCS J1833 | not published | not published | $1.02 – $1.11 | 2 |
| Injection, khapzory, 0.5 mg HCPCS J0642 | not published | not published | $1.18 – $2.42 | 2 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $5.73 – $6.49 | 2 |
| Injection of sinus tract CPT 20500 | $3,143.72 | $4,836.50 | not published | 0 |
| Injection,onabotulinumtoxina HCPCS J0585 | not published | not published | $6.48 – $7.61 | 2 |
| Injection, pentamidine iseth HCPCS S0080 | not published | not published | $93.79 – $117.24 | 2 |
| Injection, peramivir HCPCS J2547 | not published | not published | $1.52 – $1.90 | 2 |
| Injection, piperacillin sodi HCPCS S0081 | not published | not published | $1.32 – $1.32 | 1 |
| Injection, renflexis HCPCS Q5104 | not published | not published | $27.85 – $90.41 | 2 |
| Injection, ruconest HCPCS J0596 | not published | not published | $34.75 – $39.20 | 2 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | $1,895.48 | $2,916.13 | not published | 0 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $1,895.48 | $2,916.13 | not published | 0 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,703.29 | $2,620.44 | not published | 0 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $2,385.11 | $3,669.40 | not published | 0 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $2,006.79 | $3,087.37 | not published | 0 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,581.07 | $2,432.42 | not published | 0 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $159.18 – $163.37 | 2 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $807.96 | $1,243.01 | not published | 0 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $667.15 | $1,026.39 | not published | 0 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $667.15 | $1,026.39 | not published | 0 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $113.85 | $175.16 | not published | 0 |
| Injection, ticarcillin disod HCPCS S0040 | not published | not published | $10.58 – $10.58 | 1 |
| Injection torsemide 10 mg/ml HCPCS J3265 | not published | not published | $2.86 – $2.86 | 1 |
| Inject sacroiliac joint CPT 27096 | $1,522.96 | $2,343.02 | not published | 0 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | not published | not published | $33.37 – $33.37 | 1 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $22.61 – $22.61 | 1 |
| Inj., emapalumab-lzsg, 1 mg HCPCS J9210 | not published | not published | $381.50 – $405.24 | 2 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | not published | not published | $51.98 – $63.16 | 3 |
| Inj, epinephrine (belcher) HCPCS J0173 | not published | not published | $2.25 – $2.25 | 1 |
| Inj., eravacycline, 1 mg HCPCS J0122 | not published | not published | $1.18 – $1.21 | 2 |
| Inj, etelcalcetide, 0.1 mg HCPCS J0606 | not published | not published | $3.96 – $4.24 | 2 |
| Inj, eteplirsen, 10 mg HCPCS J1428 | not published | not published | $153.60 – $192.00 | 2 |
| Inj, evinacumab-dgnb, 5mg HCPCS J1305 | not published | not published | $186.31 – $195.00 | 2 |
| Inj., evomela, 1 mg HCPCS J9246 | not published | not published | $18.50 – $38.38 | 2 |
| Inj, factor x, (human), 1iu HCPCS J7175 | not published | not published | $9.53 – $12.32 | 3 |
| Inj, faricimab-svoa, 0.1mg HCPCS J2777 | $57.53 | $88.51 | $34.72 – $43.80 | 2 |
| Inj. fe derisomaltose 10 mg HCPCS J1437 | not published | not published | $20.83 – $31.37 | 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.