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 |
|---|---|---|---|---|
| Bone/joint imaging ltd area CPT 78300 | not published | not published | $112.70 – $112.70 | 1 |
| Bone marrow imaging body CPT 78104 | not published | not published | $190.04 – $190.04 | 1 |
| Bone marrow imaging ltd CPT 78102 | not published | not published | $106.44 – $106.44 | 1 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $140.32 – $140.32 | 1 |
| Bone marrow interpretation CPT 85097 | not published | not published | $20.42 – $20.42 | 1 |
| Bone mineral dual photon CPT 78351 | not published | not published | $10.58 – $10.58 | 1 |
| Bone mineral single photon CPT 78350 | not published | not published | $27.80 – $27.80 | 1 |
| Bone survey-lead poisoning CPT 77074 | $313.89 | $482.91 | $44.66 – $44.66 | 1 |
| Bone tendon board add on HCPCS C9356 | not published | not published | $96.73 – $96.73 | 1 |
| Borrelia antibody CPT 86619 | $31.74 | $48.83 | $12.98 – $174.02 | 4 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $69.24 | $106.52 | $16.52 – $221.50 | 4 |
| Borrelia miyamotoi amp prb CPT 87478 | $71.30 | $109.69 | $21.64 – $456.39 | 4 |
| Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 | not published | not published | $2.50 – $8.57 | 2 |
| (both sides) smear without diff wbc count CPT 85008 | not published | not published | $3.33 – $44.61 | 3 |
| Bowel imaging CPT 78290 | not published | not published | $204.53 – $204.53 | 1 |
| Brace or Splint Fitting and Training (each 15 minutes) CPT 97760 | $61.54 | $94.67 | $96.71 – $96.71 | 1 |
| Brachytx isodose complex CPT 77318 | not published | not published | $235.76 – $235.76 | 1 |
| Brachytx isodose intermed CPT 77317 | not published | not published | $163.84 – $163.84 | 1 |
| Brachytx isodose plan simple CPT 77316 | not published | not published | $125.06 – $125.06 | 1 |
| Braf gene CPT 81210 | not published | not published | $170.14 – $2,281.29 | 4 |
| Brain flow imaging only CPT 78610 | not published | not published | $113.81 – $113.81 | 1 |
| Brain image < 4 views CPT 78600 | not published | not published | $129.93 – $129.93 | 1 |
| Brain image 4+ views CPT 78605 | not published | not published | $126.39 – $126.39 | 1 |
| Brain image w/flow < 4 views CPT 78601 | not published | not published | $136.70 – $136.70 | 1 |
| Brain image w/flow 4 + views CPT 78606 | not published | not published | $217.09 – $217.09 | 1 |
| Brain imaging (3d) CPT 78607 | not published | not published | $232.09 – $232.09 | 1 |
| Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 | $1,544.71 | $2,376.48 | $490.37 – $490.37 | 1 |
| Brain MRA (blood vessel MRI, with contrast) CPT 70545 | not published | not published | $364.11 – $364.11 | 1 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $2,881.95 | $4,433.77 | $321.20 – $321.20 | 1 |
| Brain MRI (with and without contrast) CPT 70553 | $3,681.54 | $5,663.91 | $509.74 – $509.74 | 1 |
| Brain MRI (with contrast) CPT 70552 | $3,043.12 | $4,681.72 | $386.05 – $386.05 | 1 |
| Brain MRI (without contrast) CPT 70551 | $2,253.77 | $3,467.34 | $331.12 – $331.12 | 1 |
| Brca1&2 gene full seq alys CPT 81163 | not published | not published | $453.96 – $6,086.90 | 3 |
| Brca1&2 gen ful dup/del alys CPT 81164 | not published | not published | $566.70 – $7,598.61 | 3 |
| Brca1 dna gene analy known fam var CPT 81215 | not published | not published | $94.17 – $4,880.58 | 4 |
| Brca1 gene full dup/del alys CPT 81166 | not published | not published | $292.31 – $3,919.42 | 3 |
| Brca1 gene full seq alys CPT 81165 | not published | not published | $274.39 – $3,679.19 | 3 |
| Brca2 dna gene analy full seq analy CPT 81216 | not published | not published | $179.57 – $2,407.71 | 3 |
| Brca2 dna gene analy known fam var CPT 81217 | not published | not published | $94.17 – $4,880.58 | 4 |
| Brca2 gene full dup/del alys CPT 81167 | not published | not published | $274.39 – $3,679.19 | 3 |
| Brcassure ashkenazi panel-sendout CPT 81212 | not published | not published | $149.48 – $5,722.73 | 4 |
| Brcassure comprehensive panel-sendout CPT 81162 | not published | not published | $1,770.13 – $23,734.75 | 3 |
| Breastbone (Sternum) X-ray CPT 71120 | $146.13 | $224.82 | $20.50 – $20.50 | 1 |
| Breath hydrogen test 91065 CPT 91065 | not published | not published | $25.25 – $25.25 | 1 |
| Breath test analysis c-14 CPT 78268 | not published | not published | $91.58 – $1,227.92 | 3 |
| Breath tst attain/anal c-14 CPT 78267 | not published | not published | $10.73 – $143.85 | 3 |
| Brentuximab vedotin 50 mg intravenous solution HCPCS J9042 | not published | not published | $241.87 – $248.93 | 2 |
| Brexucabtagene car pos t HCPCS Q2053 | not published | not published | $508,800.00 – $508,800.00 | 1 |
| Brief alcohol misuse counsel HCPCS G0443 | $259.46 | $399.17 | not published | 0 |
| Brief comunicaj tech-bsd svc CPT 98016 | $33.07 | $50.87 | not published | 0 |
| Brompheniramine maleate inj HCPCS J0945 | not published | not published | $0.74 – $0.74 | 1 |
| Bronch ebus samplng 3/> node CPT 31653 | $7,146.71 | $10,994.94 | not published | 0 |
| Bronchial challenge CPT 94070 | $774.40 | $1,191.39 | not published | 0 |
| Bronchoscopy w/markers CPT 31626 | $18,947.23 | $29,149.59 | not published | 0 |
| Bronch w/debrdmt subgltc & uppr trach CPT 31899 | $470.57 | $723.95 | not published | 0 |
| Btk gene common variants CPT 81233 | not published | not published | $106.29 – $2,281.29 | 4 |
| Budesonide comp unit HCPCS J7627 | not published | not published | $0.29 – $0.36 | 2 |
| Budesonide non-comp con HCPCS J7633 | not published | not published | $6.25 – $6.25 | 1 |
| Budesonide non-comp unit HCPCS J7626 | not published | not published | $1.19 – $4.19 | 2 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | not published | not published | $0.57 – $0.57 | 1 |
| Bundled special stain group 1 microorganisms CPT 88312 | $116.86 | $179.79 | $13.31 – $13.31 | 1 |
| Bundled special stain group 2 CPT 88313 | $92.05 | $141.62 | $9.98 – $9.98 | 1 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | not published | not published | $0.01 – $0.01 | 1 |
| Bupivacaine implant, 1 mg HCPCS C9089 | not published | not published | $0.80 – $1.00 | 2 |
| Bupren/nal 3.1 to 6mg bupren HCPCS J0573 | not published | not published | $7.45 – $7.45 | 1 |
| Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet HCPCS J0572 | not published | not published | $3.76 – $3.76 | 1 |
| Buprenorphine 8 mg-naloxone 2 mg sublingual tablet HCPCS J0574 | not published | not published | $7.45 – $7.45 | 1 |
| Buprenorphine and metabolite - sendout CPT 80348 | $83.54 | $128.52 | $5.05 – $5.05 | 1 |
| Buprenorphine hydrochloride HCPCS J0592 | not published | not published | $4.18 – $5.45 | 2 |
| Buprenorphine oral 1mg HCPCS J0571 | not published | not published | $0.64 – $0.65 | 2 |
| Buprenorphine X-ray over 100 mg HCPCS Q9992 | not published | not published | $1,925.23 – $2,194.86 | 2 |
| Buprenorph X-ray 100 mg or less HCPCS Q9991 | $3,171.86 | $4,879.78 | $1,925.23 – $2,194.86 | 2 |
| Bupropion hcl sr 60 tablets HCPCS S0106 | not published | not published | $14.78 – $19.10 | 2 |
| Busulfan injection HCPCS J0594 | not published | not published | $1.46 – $4.25 | 2 |
| Butorphanol tartrate 1 mg HCPCS J0595 | not published | not published | $4.69 – $6.08 | 2 |
| Butorphanol tartrate, nasal HCPCS S0012 | not published | not published | $58.21 – $67.68 | 2 |
| Bx breast add lesion mr imag CPT 19086 | $2,310.69 | $3,554.91 | not published | 0 |
| Bx pleura pq ndl CPT 32400 | $3,334.87 | $5,130.57 | not published | 0 |
| Bx skin punch ea sep/ addl les CPT 11105 | $248.59 | $382.45 | not published | 0 |
| Bx vulva or perineum/1 lesion 56605 CPT 56605 | $1,557.19 | $2,395.67 | not published | 0 |
| Bypass temp external fem-fem CPT 37799 | $1,100.86 | $1,693.63 | not published | 0 |
| C-1 esterase, berinert HCPCS J0597 | not published | not published | $72.27 – $81.98 | 2 |
| C-1 esterase, cinryze HCPCS J0598 | not published | not published | $63.88 – $70.24 | 2 |
| C1 esterase inhibitor func - sendout CPT 86161 | $25.36 | $39.01 | $11.64 – $156.07 | 4 |
| Cabazitaxel 10 mg/ml (first dilution) intravenous solution HCPCS J9043 | not published | not published | $221.71 – $256.33 | 2 |
| Cabergoline, oral 0.25mg HCPCS J8515 | not published | not published | $1.50 – $2.69 | 2 |
| Cabotegravir ER 400 mg/2 ml-rilpivirine ER 600 mg/2ml im suspension,er HCPCS J0741 | not published | not published | $23.13 – $24.96 | 2 |
| Cacna1a gen detc abnor allel CPT 81184 | $324.97 | $499.95 | $83.83 – $1,781.85 | 4 |
| Cacna1a gene full gene seq CPT 81185 | $1,827.62 | $2,811.73 | $820.88 – $11,006.76 | 3 |
| Cacna1a gen known famil vrnt CPT 81186 | not published | not published | $94.17 – $2,408.75 | 4 |
| Cadd pump refill CPT 96521 | $506.88 | $779.81 | not published | 0 |
| Caffeine citrate 20 mg/ml inj for po HCPCS J0706 | not published | not published | $1.00 – $1.36 | 2 |
| Calaspargase pegol-mknl 750 unit/ml intravenous solution HCPCS J9118 | not published | not published | $76.53 – $80.11 | 2 |
| Calcitonin (salmon) 200 unit/ml injection solution HCPCS J0630 | not published | not published | $1,440.00 – $3,757.20 | 2 |
| Calcitonin stimul panel CPT 80410 | not published | not published | $77.96 – $1,045.31 | 4 |
| Calcium 24 hour urine CPT 82340 | $78.05 | $120.07 | $5.85 – $78.43 | 4 |
| Calcium acetate(phosphate binders) 667 mg tablet HCPCS J0615 | not published | not published | $0.02 – $0.02 | 1 |
| Calcium gluconate 100 mg/ml (10 %) intravenous solution HCPCS J0612 | not published | not published | $0.05 – $0.05 | 1 |
| Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 | not published | not published | $0.08 – $0.08 | 1 |
| Calcium glycer & lact/10 ml HCPCS J0620 | not published | not published | $8.99 – $8.99 | 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.