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 |
|---|---|---|---|---|
| Bacterial meningitis antigen CPT 86403 | $24.38 | $37.51 | $3.79 – $150.09 | 4 |
| Bacterial vaginosis pcr CPT 87801 | $387.91 | $596.78 | $40.40 – $913.04 | 4 |
| Bactericidal level serum CPT 87197 | not published | not published | $14.57 – $195.35 | 3 |
| #bac vag cand-c. albicans naa CPT 87481 | not published | not published | $21.05 – $456.39 | 4 |
| Balance and Coordination Retraining (each 15 minutes) CPT 97112 | $56.18 | $86.43 | $69.45 – $69.45 | 1 |
| Barium Enema (Colon X-ray, barium and air) CPT 74280 | not published | not published | $145.34 – $145.34 | 1 |
| Barium Enema (Colon X-ray, barium only) CPT 74270 | not published | not published | $97.00 – $97.00 | 1 |
| Barium Swallow (Esophagus X-ray) CPT 74220 | not published | not published | $57.78 – $57.78 | 1 |
| Barrier film 1.0ml wipe HCPCS A5120 | not published | not published | $0.20 – $0.20 | 1 |
| Barrier film 28ml spray no stng cavilon HCPCS A4369 | not published | not published | $15.35 – $15.35 | 1 |
| Barrier skin flat ctf 2.75in HCPCS A4408 | not published | not published | $9.38 – $9.38 | 1 |
| Barrier skin flextend 2.25in floating flang new image HCPCS A4409 | not published | not published | $6.85 – $6.85 | 1 |
| Barrier skin flxtnd ctf 3.5in flt flang 4in w/tape cut to ft HCPCS A4414 | not published | not published | $4.98 – $4.98 | 1 |
| Barrier skn ft cx ff red 2.25 ctf new image w/tape HCPCS A4407 | not published | not published | $9.22 – $9.22 | 1 |
| Bartonella dna pcr-sendout CPT 87471 | not published | not published | $34.04 – $456.39 | 3 |
| Bartonella dna quant CPT 87472 | not published | not published | $41.55 – $557.19 | 3 |
| Basiliximab HCPCS J0480 | not published | not published | $4,687.66 – $4,955.26 | 2 |
| B cells total count CPT 86355 | $84.04 | $129.29 | $23.40 – $490.72 | 4 |
| Bcg live 50 mg intravesical suspension HCPCS J9030 | $5.35 | $8.23 | $3.14 – $3.77 | 2 |
| Bcg vaccine intravesical CPT 90586 | not published | not published | $188.48 – $188.48 | 1 |
| Bcg vaccine percut CPT 90585 | not published | not published | $188.48 – $188.48 | 1 |
| Bckdhb gene CPT 81205 | not published | not published | $92.14 – $1,235.46 | 3 |
| Becaplermin 0.01% gel 15 gm HCPCS S0157 | not published | not published | $43.51 – $51.80 | 2 |
| Bedside drainage bag HCPCS A4357 | not published | not published | $4.47 – $4.47 | 1 |
| Belatacept 250 mg intravenous solution HCPCS J0485 | $6.98 | $10.74 | $3.89 – $4.54 | 2 |
| Belimumab 120 mg intravenous solution HCPCS J0490 | not published | not published | $54.97 – $58.08 | 2 |
| Belt ostomy lg 34-65in HCPCS A4367 | not published | not published | $7.90 – $7.90 | 1 |
| Bendamustine 100 mg intravenous powder for solution HCPCS J9033 | not published | not published | $1.24 – $35.66 | 2 |
| Bendamustine 25 mg/ml intravenous solution (belrapzo) HCPCS J9036 | not published | not published | $14.20 – $31.20 | 2 |
| Bendamustine 25 mg/ml intravenous solution (bendeka) HCPCS J9034 | not published | not published | $13.58 – $29.69 | 2 |
| Bendamustine 25 mg/ml intravenous solution (vivimusta) HCPCS J9056 | not published | not published | $27.24 – $27.24 | 1 |
| Benign lesion paring 2-4 CPT 11056 | $443.10 | $681.70 | not published | 0 |
| #_benzodiazconfur CPT 80346 | $156.41 | $240.63 | $5.05 – $5.05 | 1 |
| Benztropine 1 mg/ml injection solution HCPCS J0515 | not published | not published | $16.77 – $29.38 | 2 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $118.34 | $182.06 | $7.90 – $331.01 | 4 |
| Beta-2 microglobulin CPT 82232 | $82.06 | $126.25 | $12.63 – $210.44 | 4 |
| Beta-amyloid 1-40 CPT 82233 | not published | not published | $125.05 – $1,676.76 | 3 |
| Beta-amyloid 1-42 CPT 82234 | $37.30 | $57.38 | $125.05 – $1,676.76 | 3 |
| Betamethasone acetate and sodium phos 6 mg/ml suspension for injection HCPCS J0702 | not published | not published | $6.85 – $9.42 | 2 |
| Bethanechol chloride inject HCPCS J0520 | not published | not published | $4.50 – $4.50 | 1 |
| Bevacizumab 25 mg/ml intravenous solution HCPCS J9035 | not published | not published | $72.73 – $95.63 | 2 |
| Bevacizumab-awwb 25 mg/ml intravenous solution HCPCS Q5107 | not published | not published | $29.82 – $83.73 | 2 |
| Bevacizumab-bvzr 25 mg/ml intravenous solution HCPCS Q5118 | not published | not published | $73.61 – $73.61 | 1 |
| Bevacizumab injection HCPCS C9257 | $92.30 | $142.00 | $2.39 – $2.39 | 1 |
| B-hexosaminidase ea assay CPT 83080 | not published | not published | $16.36 – $219.41 | 4 |
| Bhv id assmt by phys/qhp CPT 97151 | not published | not published | $29.88 – $29.88 | 1 |
| Bhv id suprt assmt by 1 tech CPT 97152 | not published | not published | $29.88 – $29.88 | 1 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $667.15 | $1,026.39 | not published | 0 |
| Bile acids cholylglycine CPT 82240 | not published | not published | $16.41 – $345.70 | 4 |
| Bilicheck CPT 88720 | not published | not published | $4.87 – $65.29 | 3 |
| Bilirubin direct CPT 82248 | $46.17 | $71.03 | $4.87 – $65.29 | 4 |
| Bilirubin total CPT 82247 | $46.17 | $71.03 | $4.87 – $65.29 | 4 |
| Bio-connekt per square cm HCPCS Q4161 | not published | not published | $525.60 – $525.60 | 1 |
| Biodfence dryflex, 1cm HCPCS Q4138 | not published | not published | $235.33 – $235.33 | 1 |
| Biopsy bone trocar/needle superficial CPT 20220 | $3,679.56 | $5,660.86 | not published | 0 |
| Biopsy cervixsingle/multiple 57500 CPT 57500 | $1,629.30 | $2,506.62 | not published | 0 |
| Biopsy of prostate CPT 55700 | $4,551.46 | $7,002.24 | not published | 0 |
| Biopsy of salivary gland 42400 CPT 42400 | $1,451.96 | $2,233.78 | not published | 0 |
| Biopsy skin incisional single lesion CPT 11106 | $1,425.53 | $2,193.13 | not published | 0 |
| Biotinidase - quest CPT 82261 | not published | not published | $16.09 – $219.41 | 4 |
| Biovance 1 square cm HCPCS Q4154 | not published | not published | $450.00 – $450.00 | 1 |
| Bivalirudin HCPCS J0583 | not published | not published | $0.15 – $0.60 | 2 |
| Bladder calculi irrig sol HCPCS Q2004 | not published | not published | $94.77 – $114.75 | 2 |
| Bladder Catheter Insertion (simple) CPT 51702 | $284.91 | $438.33 | not published | 0 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $272.77 | $419.64 | not published | 0 |
| Bleomycin 15 unit solution for injection HCPCS J9040 | not published | not published | $21.56 – $53.80 | 2 |
| Blinatumomab 35 mcg intravenous solution HCPCS J9039 | not published | not published | $152.28 – $158.65 | 2 |
| Blm gene CPT 81209 | not published | not published | $38.13 – $511.27 | 3 |
| Blood clot lysis time CPT 85175 | not published | not published | $19.76 – $264.94 | 3 |
| Blood clot retraction CPT 85170 | not published | not published | $15.81 – $212.00 | 3 |
| Blood Clotting (PT/INR) Test CPT 85610 | $52.02 | $80.03 | $3.95 – $55.80 | 4 |
| Blood Clotting (PTT) Test CPT 85730 | $52.02 | $80.03 | $5.83 – $78.17 | 4 |
| Blood Count (CBC) Test CPT 85025 | $77.30 | $118.93 | $3.20 – $101.06 | 4 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $77.30 | $118.93 | $3.20 – $84.15 | 4 |
| Blood count spun microhematocrit CPT 85013 | $16.98 | $26.13 | $2.02 – $91.04 | 4 |
| Blood Culture Test CPT 87040 | $109.88 | $169.05 | $8.23 – $134.22 | 4 |
| Blood Draw (Venipuncture) CPT 36415 | $20.14 | $30.99 | $9.06 – $121.48 | 3 |
| Blood gases o2 saturation direct measurement CPT 82805 | not published | not published | $24.13 – $1,024.50 | 4 |
| Blood gases ph venous CPT 82800 | $23.24 | $35.76 | $10.67 – $143.07 | 3 |
| Blood mucoprotein HCPCS P2038 | not published | not published | $4.80 – $64.38 | 3 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $50.64 | $77.91 | $3.43 – $207.06 | 4 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $112.85 | $173.61 | $4.10 – $55.02 | 3 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $112.85 | $173.61 | $3.43 – $56.97 | 4 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $25.64 | $39.45 | $5.16 – $69.19 | 3 |
| Blood smear interpretation CPT 85060 | not published | not published | $20.42 – $20.42 | 1 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $51.28 | $78.89 | $1.44 – $49.42 | 4 |
| Blood split unit HCPCS P9011 | $370.30 | $569.70 | not published | 0 |
| Blood thymol turbidity HCPCS P2033 | not published | not published | $4.80 – $64.38 | 3 |
| Blood Transfusion CPT 36430 | $966.08 | $1,486.28 | not published | 0 |
| Blood typing abo CPT 86900 | $59.73 | $91.89 | $2.90 – $38.89 | 4 |
| Blood typing ag donor ea ag CPT 86902 | $497.31 | $765.09 | $6.16 – $82.59 | 3 |
| Blood typing patient serum CPT 86904 | $71.66 | $110.25 | $15.85 – $212.52 | 3 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $604.39 | $929.83 | $3.72 – $49.81 | 4 |
| Blood typing rh (d) CPT 86901 | $59.73 | $91.89 | $2.90 – $38.89 | 4 |
| Blood typing rh phenotype complete reference CPT 86906 | not published | not published | $7.52 – $100.80 | 3 |
| Blood volume CPT 78122 | not published | not published | $126.87 – $126.87 | 1 |
| Bone Age X-ray (hand and wrist) CPT 77072 | $146.13 | $224.82 | $15.04 – $15.04 | 1 |
| Bone Density Scan (DEXA) CPT 77080 | $493.27 | $758.88 | $62.18 – $62.18 | 1 |
| Bone imaging (3d) CPT 78320 | not published | not published | $155.92 – $155.92 | 1 |
| Bone imaging multiple areas CPT 78305 | not published | not published | $172.51 – $172.51 | 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.