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 |
|---|---|---|---|---|
| Mayo aathr protein s free CPT 85306 | $256.05 | $393.92 | $14.86 – $199.25 | 4 |
| Mayo activated protein c resistance assay CPT 85307 | $101.86 | $156.70 | $14.86 – $199.25 | 4 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $10.61 – $501.65 | 4 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $79.00 | $121.54 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $65.93 | $101.43 | $5.05 – $5.05 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $106.61 | $164.01 | $10.01 – $192.23 | 4 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $210.61 | $324.02 | $5.05 – $5.05 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $72.55 | $111.62 | $12.63 – $174.80 | 4 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $51.10 | $78.62 | $10.61 – $196.13 | 4 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $57.37 | $88.26 | $5.05 – $5.05 | 1 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $72.84 | $112.06 | $5.05 – $5.05 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $257.03 | $395.43 | $117.98 – $1,581.94 | 3 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $583.52 | $897.72 | $88.91 – $1,192.15 | 3 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | not published | not published | $83.83 – $1,781.85 | 4 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | not published | not published | $1,125.20 – $15,087.19 | 3 |
| Mayo androstenedione CPT 82157 | $93.18 | $143.35 | $28.40 – $380.82 | 4 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $78.05 | $120.07 | $14.16 – $189.89 | 3 |
| Mayo antithrombin iii antigen CPT 85301 | $115.38 | $177.50 | $10.49 – $140.60 | 4 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $30.58 | $47.05 | $8.11 – $195.74 | 4 |
| Mayo avwpr vw factor activity CPT 85397 | $62.71 | $96.47 | $9.49 – $401.37 | 4 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $71.30 | $109.69 | $21.64 – $456.39 | 4 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $127.72 | $196.49 | $5.05 – $5.05 | 1 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $52.76 | $81.17 | $8.11 – $132.40 | 4 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $309.51 | $476.17 | $140.49 – $1,883.82 | 4 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $120.17 | $184.87 | $208.18 – $2,791.39 | 4 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $25.16 | $38.70 | $8.11 – $167.78 | 4 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $394.95 | $607.62 | not published | 0 |
| Mayo bordetella pertussis antibody igg CPT 86615 | not published | not published | $8.11 – $171.55 | 4 |
| Mayo brcmg brucella antibody igm CPT 86622 | $117.88 | $181.35 | $8.11 – $116.15 | 4 |
| Mayo c1 esterase inhibitor CPT 83883 | $172.54 | $265.45 | $13.19 – $176.88 | 3 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $70.33 | $108.20 | $5.05 – $5.05 | 1 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $66.32 | $102.03 | $10.61 – $219.41 | 4 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $54.41 | $83.71 | $25.98 – $348.31 | 3 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $238.33 | $366.66 | $118.55 – $1,589.62 | 3 |
| Mayo ceruloplasmin CPT 82390 | $32.96 | $50.71 | $8.18 – $139.69 | 4 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $78.75 | $121.15 | $13.70 – $183.65 | 3 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $253.86 | $390.56 | $12.49 – $167.52 | 3 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $151.65 | $233.31 | $8.11 – $153.73 | 4 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $143.98 | $221.51 | $8.11 – $164.92 | 4 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | not published | not published | $40.40 – $1,515.09 | 4 |
| Mayo chromium CPT 82495 | $132.60 | $204.00 | $19.67 – $263.77 | 4 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $303.78 | $467.36 | $5.05 – $5.05 | 1 |
| Mayo coccidioides antibody CPT 86635 | $179.48 | $276.12 | $8.11 – $149.18 | 4 |
| Mayo cocou cortisone urine CPT 82542 | $25.64 | $39.45 | $23.37 – $313.32 | 3 |
| Mayo cortisol free CPT 82530 | $38.10 | $58.62 | $16.21 – $217.33 | 4 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $73.26 | $112.70 | $25.28 – $547.95 | 4 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $35.22 | $54.18 | $8.11 – $157.64 | 4 |
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | $92.70 | $142.62 | $5.05 – $5.05 | 1 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | not published | not published | $5.05 – $5.05 | 1 |
| Mayo cyanide CPT 82600 | $39.42 | $60.64 | $18.82 – $252.32 | 3 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | $384.34 | $591.30 | $179.38 – $179.38 | 1 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $163.00 | $250.77 | $5.25 – $172.33 | 4 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $224.91 | $346.02 | $24.06 – $328.67 | 4 |
| Mayo dihydrotestosterone CPT 82642 | $61.87 | $95.19 | $28.40 – $380.82 | 3 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | $274.05 | $421.62 | $9.35 – $125.38 | 3 |
| Mayo efpo chloride stool CPT 82438 | $34.45 | $53.00 | $4.85 – $65.03 | 4 |
| Mayo estriol CPT 82677 | $29.69 | $45.68 | $17.68 – $314.49 | 4 |
| Mayo estrone CPT 82679 | $50.69 | $77.99 | $24.20 – $324.50 | 4 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | not published | not published | $10.61 – $212.52 | 4 |
| Mayo everolimus therapeutic drug level CPT 80169 | $27.90 | $42.92 | $10.61 – $178.58 | 4 |
| Mayo factor ii CPT 85210 | $255.31 | $392.78 | $12.59 – $168.82 | 4 |
| Mayo factor v CPT 85220 | $53.31 | $82.01 | $17.12 – $229.56 | 4 |
| Mayo factor vii CPT 85230 | $56.99 | $87.68 | $17.36 – $232.81 | 4 |
| Mayo factor viii vw factor antigen CPT 85246 | $101.86 | $156.70 | $9.49 – $298.36 | 4 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $380.58 | $585.51 | $11.89 – $298.36 | 4 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $48.48 | $74.58 | $9.49 – $298.36 | 4 |
| Mayo factor x CPT 85260 | not published | not published | $17.36 – $232.81 | 4 |
| Mayo factor xi CPT 85270 | $56.99 | $87.68 | $17.36 – $232.81 | 4 |
| Mayo fat/lipids feces quantitative CPT 82710 | $27.12 | $41.72 | $16.30 – $218.50 | 4 |
| Mayo fbl culture fungi blood CPT 87103 | $113.55 | $174.69 | $11.48 – $266.11 | 4 |
| Mayo fdp/fsp paracoagulation CPT 85366 | not published | not published | $7.66 – $1,046.48 | 4 |
| Mayo ffspg allergen clam igg CPT 86001 | not published | not published | $7.59 – $101.71 | 3 |
| Mayo fibrinogen antigen CPT 85385 | $28.20 | $43.38 | $6.97 – $188.07 | 4 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $177.65 | $273.31 | $10.61 – $281.84 | 4 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $8,677.50 | $13,350.00 | not published | 0 |
| Mayo hemosiderin qualitative urine CPT 83070 | not published | not published | $4.61 – $61.78 | 3 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $74.15 | $114.08 | $21.64 – $456.39 | 4 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | not published | not published | $34.04 – $456.39 | 3 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $96.36 | $148.25 | $12.53 – $179.36 | 4 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $77.94 | $119.91 | $25.04 – $335.69 | 3 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $18.89 | $29.06 | $8.62 – $115.63 | 4 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $28.72 | $44.18 | $13.11 – $175.84 | 4 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $224.56 | $345.48 | $26.35 – $353.38 | 4 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $338.81 | $521.25 | $16.75 – $224.62 | 3 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $21.27 | $32.73 | $14.54 – $194.96 | 3 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $219.06 | $337.02 | $20.19 – $270.66 | 4 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $132.60 | $204.00 | $20.19 – $270.66 | 3 |
| Mayo inf agt nucleic acid amp prb helicobacter pylori clarithromycin resistance CPT 87513 | not published | not published | $34.04 – $456.39 | 3 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $60.00 | $92.31 | $8.11 – $209.01 | 4 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $77.30 | $118.93 | $8.11 – $155.81 | 4 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | not published | not published | $21.64 – $456.39 | 4 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $78.16 | $120.24 | $21.64 – $456.39 | 4 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $41.77 | $64.26 | $21.64 – $456.39 | 4 |
| Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii CPT 87594 | $8,614.90 | $13,253.69 | $21.64 – $456.39 | 4 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $453.49 | $697.67 | $28.85 – $557.19 | 4 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $247.24 | $380.37 | $58.33 – $938.92 | 4 |
| Mayo infliximab therapeutic drug level CPT 80230 | $89.15 | $137.15 | $10.61 – $501.65 | 4 |
| Mayo inhab inhibin a CPT 86336 | $84.99 | $130.75 | $6.57 – $202.77 | 4 |
| Mayo insft insulin free CPT 83527 | $27.36 | $42.10 | $12.56 – $168.43 | 4 |
| Mayo insulin antibodies CPT 86337 | $228.57 | $351.65 | $12.63 – $278.46 | 4 |
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.