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 iodine CPT 83789 | $60.97 | $93.80 | $23.39 – $313.58 | 3 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $57.28 | $88.13 | $26.30 – $352.60 | 3 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $100.37 | $154.42 | $10.61 – $352.60 | 4 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $212.84 | $327.44 | $10.61 – $172.33 | 4 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $17.61 | $27.09 | $9.49 – $166.35 | 4 |
| Mayo legionella antibody CPT 86713 | not published | not published | $14.84 – $198.99 | 4 |
| Mayo leptospira antibody igm CPT 86720 | not published | not published | $8.11 – $210.70 | 4 |
| Mayo lipoprotein electrophoresis CPT 83700 | $35.84 | $55.14 | $10.92 – $146.45 | 3 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $264.85 | $407.46 | $15.03 – $201.47 | 4 |
| Mayo manganese CPT 83785 | $56.32 | $86.64 | $25.85 – $346.62 | 4 |
| Mayo metanephrines plasma CPT 83835 | $342.48 | $526.89 | $16.43 – $220.33 | 4 |
| Mayo methadone definitive assay confirmation urine CPT 80358 | $162.73 | $250.36 | $5.05 – $5.05 | 1 |
| Mayo mgle voltage-gated calcium channel antibody each CPT 86596 | $38.88 | $59.82 | $11.15 – $156.72 | 4 |
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | $35.88 | $55.20 | $11.40 – $239.31 | 4 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $43.96 | $67.63 | $14.11 – $189.24 | 4 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $580.95 | $893.77 | $18.08 – $242.44 | 3 |
| Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 | $267.15 | $411.00 | $132.89 – $1,781.85 | 3 |
| Mayo mpl sequence analysis exon 10 CPT 81339 | $391.36 | $602.09 | $112.23 – $2,408.75 | 4 |
| Mayo muramidase CPT 85549 | $157.27 | $241.96 | $18.19 – $243.87 | 4 |
| Mayo muscle-specific kinase (musk) antibody CPT 86366 | $35.88 | $55.20 | $11.40 – $239.31 | 4 |
| Mayo mycophenolic acid therapeutic drug level CPT 80180 | $35.20 | $54.15 | $10.61 – $234.76 | 4 |
| Mayo myoglobin CPT 83874 | $170.71 | $262.63 | $12.53 – $168.04 | 3 |
| Mayo nickel CPT 83885 | not published | not published | $23.77 – $318.78 | 3 |
| Mayo opatu opiates definitive assay >=1 CPT 80361 | $170.71 | $262.63 | $5.05 – $5.05 | 1 |
| Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 | $192.26 | $295.79 | $5.05 – $5.05 | 1 |
| Mayo opatu oxycodone definitive assay CPT 80365 | $54.14 | $83.30 | $5.05 – $5.05 | 1 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $367.41 | $565.24 | $20.57 – $275.86 | 4 |
| Mayo organic acids qualitative each specimen CPT 83919 | not published | not published | $15.96 – $213.95 | 4 |
| Mayo oxalate 24 hour urine CPT 83945 | $38.87 | $59.80 | $12.02 – $187.94 | 4 |
| Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 | $113.55 | $174.69 | $5.25 – $149.96 | 4 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $39.20 | $60.31 | $14.58 – $195.48 | 4 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $580.95 | $893.77 | $5.25 – $156.72 | 4 |
| Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) CPT 87476 | $245.06 | $377.02 | $21.64 – $456.39 | 4 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $200.01 | $307.71 | $17.44 – $233.85 | 3 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $29.07 | $44.73 | $10.61 – $178.97 | 4 |
| Mayo pqnu porphobilinogen urine quantitative 24 hour urine CPT 84110 | $28.61 | $44.01 | $8.19 – $109.77 | 4 |
| Mayo pregnenolone CPT 84140 | $42.00 | $64.61 | $20.05 – $268.84 | 4 |
| Mayo prmb primidone therapeutic drug level CPT 80188 | $127.11 | $195.55 | $10.61 – $215.77 | 4 |
| Mayo proinsulin CPT 84206 | $313.92 | $482.95 | $25.89 – $347.14 | 3 |
| Mayo psaft prostate specific antigen free CPT 84154 | $91.57 | $140.88 | $17.84 – $239.18 | 4 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $309.51 | $476.17 | $17.85 – $239.31 | 3 |
| Mayo rbcme osmotic fragility rbc incubated CPT 85557 | not published | not published | $9.52 – $173.76 | 4 |
| Mayo receptor assay transferrin soluble CPT 84238 | $116.39 | $179.06 | $35.47 – $475.64 | 3 |
| Mayo renin CPT 84244 | $194.52 | $299.26 | $21.33 – $286.01 | 3 |
| Mayo repu protein electrophoresis urine CPT 84166 | $108.06 | $166.24 | $11.36 – $231.90 | 4 |
| Mayo selenium CPT 84255 | $199.28 | $306.58 | $24.76 – $332.05 | 3 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | $32.75 | $50.39 | $15.04 – $201.60 | 3 |
| Mayo serotonin CPT 84260 | $71.81 | $110.48 | $30.05 – $402.93 | 3 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $61.63 | $94.81 | $18.77 – $251.67 | 4 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $208.79 | $321.21 | $10.61 – $178.58 | 4 |
| Mayo streptococcus pneumoniae antibody igg 23 serotypes multiplex immunoassay quantitative CPT 86581 | $32.37 | $49.80 | $89.27 – $1,196.96 | 3 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $13.58 | $20.90 | $3.30 – $55.54 | 4 |
| Mayo tau phosphorylated 217 each CPT 84393 | $37.30 | $57.38 | $125.05 – $1,676.76 | 3 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | $441.49 | $679.21 | $202.65 – $2,717.26 | 3 |
| Mayo tgrp testosterone free CPT 84402 | $135.92 | $209.10 | $24.71 – $331.27 | 4 |
| Mayo tgrp testosterone total CPT 84403 | $135.92 | $209.10 | $25.04 – $335.69 | 4 |
| Mayo thiopurine s-methyltransferase CPT 84433 | not published | not published | $13.30 – $288.35 | 4 |
| Mayo thyroglobulin CPT 84432 | $68.50 | $105.39 | $15.58 – $208.88 | 3 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $76.22 | $117.26 | $8.11 – $132.40 | 4 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $163.00 | $250.77 | $12.02 – $161.15 | 3 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $92.85 | $142.84 | not published | 0 |
| Mayo ttfb testosterone bioavailable direct CPT 84410 | $44.69 | $68.76 | $49.74 – $666.96 | 4 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | $34.64 | $53.29 | $11.62 – $184.17 | 4 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $46.17 | $71.03 | $10.61 – $176.10 | 4 |
| Mayo vasoactive intestinal peptide CPT 84586 | $280.94 | $432.22 | $34.27 – $459.51 | 3 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $175.46 | $269.94 | $19.63 – $263.25 | 3 |
| Mayo vitamin b3 (niacin) CPT 84591 | $46.85 | $72.07 | $16.55 – $221.89 | 3 |
| Mayo vitamin k CPT 84597 | $43.67 | $67.19 | $13.31 – $178.45 | 4 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $169.97 | $261.49 | $10.61 – $172.33 | 4 |
| Mcoln1 gene CPT 81290 | not published | not published | $38.13 – $511.27 | 3 |
| Measurement post void urine by ultrasound CPT 51798 | $162.58 | $250.12 | not published | 0 |
| Mecasermin injection HCPCS J2170 | not published | not published | $168.87 – $352.92 | 2 |
| Mechlorethamine hcl inj HCPCS J9230 | not published | not published | $297.32 – $297.32 | 1 |
| #mec-opiates CPT 80356 | $6.33 | $9.74 | $5.05 – $5.05 | 1 |
| Mecp2 gene dup/delet variant CPT 81304 | not published | not published | $145.50 – $1,950.93 | 3 |
| Mecp2 gene full seq CPT 81302 | not published | not published | $512.03 – $6,865.58 | 3 |
| Mecp2 gene known variant CPT 81303 | not published | not published | $116.40 – $1,560.74 | 3 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | not published | not published | $0.52 – $0.65 | 2 |
| Med serv eve/wkend/holiday CPT 99051 | $23.41 | $36.02 | not published | 0 |
| Megestrol 20 mg tabs 100 each bottle HCPCS S0179 | not published | not published | $0.23 – $0.26 | 2 |
| Melphalan oral 2 mg HCPCS J8600 | not published | not published | $8.79 – $10.99 | 2 |
| Membrane affinity fresh amniotic 2.5x2.5cm -cost per sq cm HCPCS Q4159 | not published | not published | $1,266.67 – $1,266.67 | 1 |
| Membrane amnio clarix 4x3cm 1k -cost per sq cm HCPCS Q4155 | not published | not published | $38.40 – $38.40 | 1 |
| Membrane amniotic barrier 4x4cm-q4163-cost per sq cm HCPCS Q4163 | not published | not published | $447.50 – $447.50 | 1 |
| Membrane collgn porcine maci w/autologous cult chondrocytes HCPCS J7330 | not published | not published | $62,702.40 – $63,189.12 | 2 |
| Membrane placenta tiss biodfence g3 2x2cm-4sqcm-q4116-cost per sq cm HCPCS Q4140 | not published | not published | $357.19 – $357.19 | 1 |
| Membrane placenta tiss enverse sheet 2x3cm-cost per sq cm HCPCS Q4258 | not published | not published | $275.20 – $275.20 | 1 |
| Memoderm/derma/tranz/integup HCPCS Q4126 | not published | not published | $97.50 – $97.50 | 1 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | not published | not published | $3.48 – $10.14 | 2 |
| Meperidine/promethazine inj HCPCS J2180 | not published | not published | $7.58 – $7.58 | 1 |
| Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 | not published | not published | $30.54 – $39.15 | 2 |
| Mercaptopurine 50 mg HCPCS S0108 | not published | not published | $2.74 – $3.61 | 2 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | not published | not published | $0.43 – $2.20 | 2 |
| Mesh tiss ovitex lpr 15x15x25cm 6mm oval HCPCS C9364 | not published | not published | $21.63 – $21.63 | 1 |
| Mesna 100 mg/ml intravenous solution HCPCS J9209 | not published | not published | $1.36 – $6.00 | 2 |
| Metabolic Blood Panel (Basic) CPT 80048 | $120.17 | $184.87 | $7.32 – $110.03 | 4 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $254.57 | $391.65 | $10.10 – $137.35 | 4 |
| Metabolic panel ionized ca CPT 80047 | not published | not published | $7.32 – $178.58 | 4 |
| Methacholine chloride 0.0625 mg/ml nebulization soln HCPCS J7674 | not published | not published | $1.00 – $1.63 | 2 |
| Methadone injection HCPCS J1230 | not published | not published | $20.91 – $21.00 | 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.