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 fensolvi 0.25 mg HCPCS J1951 | not published | not published | $134.26 – $158.80 | 2 |
| Inj ferric pyrophosphate cit HCPCS J1443 | not published | not published | $0.03 – $0.04 | 2 |
| Inj., fibryga, 1 mg HCPCS J7177 | not published | not published | $1.10 – $1.32 | 3 |
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | not published | not published | $7.15 – $7.15 | 1 |
| Inj, focinvez, 1mg HCPCS J1434 | not published | not published | $3.02 – $3.02 | 1 |
| Inj follitropin alfa 75 iu HCPCS S0126 | not published | not published | $231.85 – $270.22 | 2 |
| Inj follitropin beta 75 iu HCPCS S0128 | not published | not published | $208.80 – $261.00 | 2 |
| Inj, fosaprepitant (teva) HCPCS J1456 | not published | not published | $1.21 – $2.41 | 2 |
| Inj fosnetupitant, palonoset HCPCS J1454 | not published | not published | $632.88 – $819.82 | 2 |
| Inj., fremanezumab-vfrm 1 mg HCPCS J3031 | not published | not published | $3.22 – $3.38 | 2 |
| Inj, fulvestrant (fresenius) HCPCS J9394 | not published | not published | $3.32 – $60.00 | 2 |
| Inj, fulvestrant (teva) HCPCS J9393 | not published | not published | $19.20 – $24.00 | 2 |
| Inj, gadopiclenol, 1 ml HCPCS A9573 | $6.34 | $9.75 | not published | 0 |
| Inj, ganciclovir (exela) HCPCS J1574 | not published | not published | $48.00 – $60.00 | 2 |
| Inj ganirelix acetat 250 mcg HCPCS S0132 | not published | not published | $180.34 – $220.82 | 2 |
| Inj gemcitabine hcl (accord) HCPCS J9196 | not published | not published | $8.65 – $8.65 | 1 |
| Inj givosiran 0.5 mg HCPCS J0223 | not published | not published | $116.47 – $127.52 | 2 |
| Inj glofitamab gxbm, 2.5 mg HCPCS J9286 | not published | not published | $2,772.80 – $2,772.80 | 1 |
| Inj glycopyrrolate fres kabi HCPCS J1598 | not published | not published | $1.66 – $1.66 | 1 |
| Inj glycopyrrolate, glyrx-pf HCPCS J1597 | not published | not published | $1.54 – $1.54 | 1 |
| Inj golodirsen 10 mg HCPCS J1429 | not published | not published | $153.60 – $192.00 | 2 |
| Inj, granisetron, xr, 0.1 mg HCPCS J1627 | not published | not published | $5.29 – $8.39 | 2 |
| Inj., guselkumab, 1 mg HCPCS J1628 | not published | not published | $70.43 – $151.00 | 2 |
| Inj., haegarda 10 units HCPCS J0599 | not published | not published | $11.62 – $12.33 | 2 |
| Inj heparin, pfizer, 1000u HCPCS J1643 | not published | not published | $0.40 – $2.94 | 2 |
| Inj. herceptin hylecta, 10mg HCPCS J9356 | not published | not published | $62.92 – $93.50 | 2 |
| Inj herzuma 10 mg HCPCS Q5113 | not published | not published | $73.91 – $112.20 | 2 |
| Inj human fibrinogen con nos HCPCS J7178 | not published | not published | $1.48 – $1.64 | 3 |
| Inj hydroxocobalamin IV 25mg HCPCS J3424 | not published | not published | $4.79 – $4.79 | 1 |
| Inj hydroxyprogst capoat nos HCPCS J1729 | not published | not published | $13.10 – $16.37 | 2 |
| Inj., ibalizumab-uiyk, 10 mg HCPCS J1746 | not published | not published | $76.95 – $80.28 | 2 |
| Inj imip 4 cilas 4 releb 2mg HCPCS J0742 | not published | not published | $2.50 – $2.72 | 2 |
| Inj, imm glob bivigam, 500mg HCPCS J1556 | not published | not published | $77.30 – $82.60 | 2 |
| Inj, immphentiv, 20 mcg HCPCS J2373 | not published | not published | $0.14 – $0.14 | 1 |
| Inj. inebilizumab-cdon, 1 mg HCPCS J1823 | not published | not published | $484.40 – $524.00 | 2 |
| Inj. infugem, 100 mg HCPCS J9198 | not published | not published | $36.48 – $45.60 | 2 |
| Inj. insulin (fiasp) HCPCS J1812 | not published | not published | $1.39 – $1.39 | 1 |
| Inj, invega hafyera/trinza HCPCS J2427 | not published | not published | $12.67 – $12.67 | 1 |
| Inj ivig privigen 500 mg HCPCS J1459 | not published | not published | $49.18 – $97.55 | 2 |
| Inj, ixinity, 1 i.u HCPCS J7213 | not published | not published | $1.91 – $1.92 | 2 |
| Inj. jivi 1 iu HCPCS J7208 | not published | not published | $2.45 – $2.88 | 3 |
| Inj, kovaltry, 1 i.u HCPCS J7211 | not published | not published | $1.49 – $2.29 | 3 |
| Inj labetalol hcl hikma, 5mg HCPCS J1921 | not published | not published | $1.38 – $1.38 | 1 |
| Inj., lanadelumab-flyo, 1 mg HCPCS J0593 | not published | not published | $84.80 – $96.47 | 2 |
| Inj, lanreotide, (cipla) 1mg HCPCS J1932 | not published | not published | $25.42 – $88.93 | 2 |
| Inj, lecanemab-irmb, 1 mg HCPCS J0174 | $1.03 | $1.59 | $1.33 – $1.33 | 1 |
| Inj lefamulin 1 mg HCPCS J0691 | not published | not published | $0.66 – $0.82 | 2 |
| Inj, lenacapavir, 1 mg HCPCS J1961 | not published | not published | $22.03 – $22.03 | 1 |
| Inj levocarnitine per 1 gm HCPCS J1955 | not published | not published | $24.38 – $44.13 | 2 |
| Inj levoleucovorin nos 0.5mg HCPCS J0641 | not published | not published | $0.02 – $0.42 | 2 |
| Inj, levothyroxine, freskabi HCPCS J0651 | not published | not published | $6.40 – $6.40 | 1 |
| Inj, levothyroxine, hikma HCPCS J0652 | not published | not published | $5.14 – $5.14 | 1 |
| Inj, lidocaine w epinephrine HCPCS J2004 | not published | not published | $0.01 – $0.01 | 1 |
| Inj, linezolid (hospira) HCPCS J2021 | not published | not published | $6.34 – $25.38 | 2 |
| Inj. lumasiran, 0.5 mg HCPCS J0224 | not published | not published | $318.85 – $359.68 | 2 |
| Inj., lumoxiti, 0.01 mg HCPCS J9313 | not published | not published | $21.18 – $26.48 | 2 |
| Inj luxturna 1 billion vec g HCPCS J3398 | not published | not published | $2,924.00 – $3,400.00 | 2 |
| Inj. meloxicam 1 mg HCPCS J1738 | not published | not published | $3.01 – $3.76 | 2 |
| Inj melpha hydroch nos 50 mg HCPCS J9245 | not published | not published | $157.10 – $354.00 | 2 |
| Inj, melphalan flufenami 1mg HCPCS J9247 | not published | not published | $570.00 – $570.00 | 1 |
| Inj melphalan (hepzato) 1 mg HCPCS J9248 | not published | not published | $773.80 – $773.80 | 1 |
| Inj menotropins 75 iu HCPCS S0122 | not published | not published | $233.04 – $269.32 | 2 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $5.41 | $8.32 | $2.51 – $3.63 | 2 |
| Inj, meropenem (b. braun) HCPCS J2184 | not published | not published | $2.09 – $4.26 | 2 |
| Inj., meropenem, vaborbactam HCPCS J2186 | not published | not published | $2.14 – $2.47 | 2 |
| Inj meropenem (wg crit care) HCPCS J2183 | not published | not published | $1.60 – $1.60 | 1 |
| Inj metaraminol bitartrate HCPCS J0380 | not published | not published | $1.07 – $1.07 | 1 |
| Inj, micafungin (par pharm) HCPCS J2247 | not published | not published | $0.31 – $1.80 | 2 |
| Inj, mirikizumab-mrkz, 1 mg HCPCS J2267 | not published | not published | $47.57 – $47.57 | 1 |
| Inj mogamulizumab-kpkc, 1 mg HCPCS J9204 | not published | not published | $243.63 – $249.87 | 2 |
| Inj, motixafortide, 0.25 mg HCPCS J2277 | not published | not published | $25.22 – $25.22 | 1 |
| Inj, moxifloxacin 100 mg HCPCS J2280 | not published | not published | $8.57 – $13.79 | 2 |
| Inj moxifloxacin (fres kabi) HCPCS J2281 | not published | not published | $7.10 – $13.80 | 2 |
| Inj multihance HCPCS A9577 | $3.16 | $4.86 | $6.31 – $6.31 | 1 |
| Inj multihance multipack HCPCS A9578 | not published | not published | $6.63 – $6.63 | 1 |
| Inj. mycophenolate mofetil HCPCS J7519 | not published | not published | $0.31 – $0.31 | 1 |
| Inj naloxone hydrochloride HCPCS J2310 | not published | not published | $9.21 – $18.81 | 2 |
| Inj. naxitamab-gqgk, 1 mg HCPCS J9348 | not published | not published | $641.83 – $658.17 | 2 |
| Inj nephrosto/ureterogram w/img exstng access CPT 50431 | $581.00 | $893.84 | not published | 0 |
| Inj, nithiodote, 3mg / 125mg HCPCS J0211 | not published | not published | $1.88 – $1.88 | 1 |
| Inj, nogapendekin pmln, 1mcg HCPCS J9028 | not published | not published | $94.58 – $94.58 | 1 |
| Inj, ocriplasmin, 0.125 mg HCPCS J7316 | not published | not published | $948.16 – $1,185.20 | 2 |
| Inj octafluoropropane mic,ml HCPCS Q9956 | not published | not published | $41.88 – $56.16 | 2 |
| Inj ogivri 10 mg HCPCS Q5114 | not published | not published | $46.82 – $105.64 | 2 |
| Inj, olaratumab, 10 mg HCPCS J9285 | not published | not published | $47.15 – $58.94 | 2 |
| Inj, oliceridine 0.1 mg HCPCS C9101 | not published | not published | $1.24 – $1.55 | 2 |
| Inj olipudase alfa-rpcp 1mg HCPCS J0218 | not published | not published | $381.24 – $381.24 | 1 |
| Inj, omacetaxine mep, 0.01mg HCPCS J9262 | not published | not published | $3.65 – $4.17 | 2 |
| Inj., omadacycline, 1 mg HCPCS J0121 | not published | not published | $3.87 – $4.80 | 2 |
| Inj onase abepar-xioi treat HCPCS J3399 | not published | not published | $2,550,000.00 – $2,550,000.00 | 1 |
| Inj ontruzant 10 mg HCPCS Q5112 | not published | not published | $28.74 – $105.97 | 2 |
| Inj, palonosetron (posfrea) HCPCS J2468 | not published | not published | $59.91 – $59.91 | 1 |
| Inj pantoprazole(hikma) 40mg HCPCS J2471 | not published | not published | $6.24 – $6.24 | 1 |
| Inj, panzyga, 500 mg HCPCS J1576 | not published | not published | $70.43 – $70.43 | 1 |
| Inj, pasireotide long acting HCPCS J2502 | not published | not published | $526.94 – $607.47 | 2 |
| Inj., patisiran, 0.1 mg HCPCS J0222 | not published | not published | $99.04 – $117.42 | 2 |
| Inj, pedmark, 100 mg HCPCS J0208 | not published | not published | $87.68 – $87.68 | 1 |
| Inj, pegcetacoplan, 1mg HCPCS J2781 | not published | not published | $143.99 – $143.99 | 1 |
| Inj pegfilgrastim-bmez 0.5mg HCPCS Q5120 | not published | not published | $24.71 – $392.55 | 2 |
| Inj, pegulicianine, 1 mg HCPCS A9615 | not published | not published | $33.97 – $33.97 | 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.