Clifton Springs Hospital and Clinic
2 Coulter Road, Clifton Springs, NY · Rochesterregional · · NPI 1366505463
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 |
|---|---|---|---|---|
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,446.53 | $2,225.43 | $109.81 – $602.19 | 5 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | not published | not published | $1,026.71 – $1,697.37 | 2 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | not published | not published | $1,151.27 – $1,913.65 | 2 |
| Surgical revision intestine CPT 44680 | not published | not published | $816.54 – $1,351.42 | 2 |
| Surgigraft, 1 sq cm HCPCS Q4183 | not published | not published | $85.00 – $100.00 | 2 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $349.31 – $528.40 | 2 |
| Susceptibility agar dilution per agent CPT 87181 | $17.18 | $26.43 | $3.17 – $10.24 | 10 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $17.18 | $26.43 | $3.17 – $10.24 | 10 |
| Susceptibility mic per plate CPT 87186 | $31.27 | $48.11 | $5.76 – $14.98 | 10 |
| Suscept studies macrobroth dilution ea CPT 87188 | not published | not published | $4.42 – $10.24 | 10 |
| Suspend bowel w/prosthesis CPT 44700 | not published | not published | $751.28 – $1,284.49 | 2 |
| Suspension of testis CPT 54620 | not published | not published | $225.36 – $340.41 | 2 |
| Suspension of uterus CPT 58410 | not published | not published | $591.20 – $863.81 | 2 |
| Suspension of uterus 58400 CPT 58400 | not published | not published | $341.72 – $487.62 | 2 |
| Suspension sleeve lower ext HCPCS L2397 | not published | not published | $135.65 – $135.65 | 5 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $791.42 – $1,337.09 | 2 |
| Suture bile duct injury 47900 CPT 47900 | not published | not published | $1,050.35 – $1,520.34 | 2 |
| Svc venogram s&i CPT 75827 | $2,652.99 | $4,081.52 | $53.96 – $109.80 | 3 |
| Swallowing Evaluation (Bedside) CPT 92610 | $266.71 | $410.32 | $49.00 – $84.79 | 3 |
| Swallowing Therapy Session CPT 92526 | $266.90 | $410.62 | $70.62 – $100.88 | 3 |
| Sweat collection by iontophoresis CPT 89230 | not published | not published | $1.52 – $14.49 | 4 |
| Symes ankle without (sach) foot HCPCS L5703 | not published | not published | $2,847.69 – $2,847.69 | 5 |
| Symes met fr leath socket ar HCPCS L5060 | not published | not published | $4,508.51 – $4,508.51 | 5 |
| Symes type medial opening so HCPCS L5636 | not published | not published | $415.91 – $415.91 | 5 |
| Symes type poster opening so HCPCS L5634 | not published | not published | $436.55 – $436.55 | 5 |
| Symes type ptb brim design s HCPCS L5632 | not published | not published | $296.09 – $296.09 | 5 |
| Syme typ expandabl wall sckt HCPCS L5630 | not published | not published | $555.01 – $555.01 | 5 |
| Sympathectomy cervical CPT 64802 | not published | not published | $702.53 – $908.78 | 2 |
| Sympathectomy digital artery CPT 64820 | not published | not published | $571.99 – $801.00 | 2 |
| Sympathectomy lumbar CPT 64818 | not published | not published | $586.67 – $869.79 | 2 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $603.93 – $878.18 | 2 |
| Sympathectomy thoracolumbar CPT 64809 | not published | not published | $871.71 – $1,164.83 | 2 |
| Synch audio-only est high 40 CPT 98015 | $197.76 | $304.24 | $197.71 – $197.71 | 1 |
| Synch audio-only est low 20 CPT 98013 | $152.13 | $234.05 | $90.67 – $90.67 | 1 |
| Synch audio-only est mod 30 CPT 98014 | $187.00 | $287.69 | $133.74 – $133.74 | 1 |
| Synch audio-only est sf 10 CPT 98012 | $131.16 | $201.78 | $49.68 – $49.68 | 1 |
| Synch audio-only new high 60 CPT 98011 | $207.64 | $319.45 | $242.91 – $242.91 | 1 |
| Synch audio-only new low 30 CPT 98009 | $159.74 | $245.75 | $117.37 – $117.37 | 1 |
| Synch audio-only new mod 45 CPT 98010 | $196.35 | $302.07 | $184.50 – $184.50 | 1 |
| Synch audio-only new sf 15 CPT 98008 | $137.72 | $211.87 | $67.68 – $67.68 | 1 |
| Synojoynt, inj., 1 mg HCPCS J7331 | not published | not published | $3.12 – $27.94 | 4 |
| Synthetic sentence id test CPT 92576 | not published | not published | $34.59 – $40.95 | 2 |
| Synvisc or synvisc-one HCPCS J7325 | $28.03 | $43.13 | $6.02 – $34.24 | 4 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $15.95 | $24.54 | $2.93 – $8.41 | 10 |
| T3 (triiodothyronine) free CPT 84481 | $61.33 | $94.35 | $9.09 – $20.45 | 10 |
| T3 (triiodothyronine) total CPT 84480 | $51.34 | $78.98 | $5.76 – $17.02 | 10 |
| T4 (thyroxine) free CPT 84439 | $32.62 | $50.19 | $6.01 – $20.25 | 10 |
| T4 (thyroxine) total CPT 84436 | $24.86 | $38.25 | $4.59 – $12.96 | 10 |
| Tacrol astagraf ex rel oral HCPCS J7508 | not published | not published | $0.43 – $0.62 | 4 |
| Tacrol envarsus ex rel oral HCPCS J7503 | not published | not published | $0.94 – $1.87 | 4 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | not published | not published | $0.19 – $0.99 | 4 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | not published | not published | $180.88 – $272.14 | 4 |
| Tacrolimus therapeutic drug level CPT 80197 | $49.71 | $76.48 | $9.14 – $23.87 | 10 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | not published | not published | $13.93 – $15.06 | 4 |
| Tah rad debulk/lymph remove 58954 CPT 58954 | not published | not published | $1,626.04 – $2,278.48 | 2 |
| Tah rad dissect for debulk 58953 CPT 58953 | not published | not published | $1,504.12 – $2,105.12 | 2 |
| Tah w/mmk 58152 CPT 58152 | not published | not published | $894.77 – $1,312.09 | 2 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $201.75 | $310.38 | $19.31 – $24.71 | 3 |
| Talimogene laherparepvec 10exp6 (1 million) pfu/ml susp for injection HCPCS J9325 | not published | not published | $70.38 – $77.34 | 4 |
| Talquetamab-tgvs 2 mg/ml subcutaneous solution HCPCS J3055 | not published | not published | $70.00 – $76.72 | 3 |
| Talymed HCPCS Q4127 | not published | not published | $60.00 – $68.49 | 2 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | not published | not published | $0.18 – $0.46 | 3 |
| Tap block bilat cont infusion 64489 CPT 64489 | not published | not published | $59.25 – $90.26 | 2 |
| Tap block uni by cont infusion 64487 CPT 64487 | not published | not published | $47.02 – $74.30 | 2 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | not published | not published | $0.50 – $0.50 | 5 |
| Target gsa panel hmtlmph neop CPT 81450 | $4,979.87 | $7,661.34 | $460.28 – $911.44 | 8 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $7,762.52 | $11,942.34 | $1,769.28 – $3,503.52 | 8 |
| Target gsa panel organ neop CPT 81445 | $1,780.75 | $2,739.61 | $362.33 – $717.49 | 8 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | not published | not published | $1,566.59 – $1,612.42 | 3 |
| Tas congenital car anomal CPT 33741 | not published | not published | $527.24 – $808.93 | 2 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $94.91 – $147.91 | 2 |
| Tavr perq femoral CPT 33361 | not published | not published | $875.84 – $1,415.14 | 2 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | not published | not published | $0.24 – $1.00 | 4 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $83.02 – $188.62 | 10 |
| Tbs dxa cal w/i&r fx risk CPT 77089 | not published | not published | $32.55 – $66.24 | 3 |
| Tbs i&r fx rsk qhp CPT 77092 | not published | not published | $8.40 – $17.10 | 3 |
| Tbs techl calculation only CPT 77091 | not published | not published | $21.76 – $44.28 | 3 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $2.38 – $4.85 | 3 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $293.13 | $450.97 | $46.44 – $120.00 | 10 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $224.30 | $345.07 | $41.30 – $113.62 | 10 |
| Tc-99m apcitide diag HCPCS A9504 | not published | not published | $259.11 – $259.11 | 1 |
| Tc-99m arcitumomab HCPCS A9568 | not published | not published | $259.11 – $259.11 | 1 |
| Tc-99m bicisate HCPCS A9557 | $3,383.26 | $5,205.01 | $379.53 – $446.51 | 2 |
| Tc-99m depreotide HCPCS A9536 | not published | not published | $259.11 – $259.11 | 1 |
| Tc-99m disofenin HCPCS A9510 | $138.94 | $213.75 | not published | 0 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | not published | not published | $1,816.81 – $1,834.52 | 2 |
| Tc-99m exametazime diag HCPCS A9521 | not published | not published | $1,816.81 – $1,834.52 | 2 |
| Tc-99m fanolesomab diag HCPCS A9566 | not published | not published | $259.11 – $259.11 | 1 |
| Tc-99m gluceptate HCPCS A9550 | not published | not published | $259.11 – $259.11 | 1 |
| Tc-99m graphite crucible HCPCS A9506 | not published | not published | $328.60 – $328.60 | 1 |
| Tc-99m labeled rbc HCPCS A9560 | $398.04 | $612.37 | $106.00 – $112.08 | 2 |
| Tc-99m maa HCPCS A9540 | $391.76 | $602.71 | $31.80 – $36.00 | 2 |
| Tc-99m mebrofenin HCPCS A9537 | $140.12 | $215.57 | $8.53 – $66.38 | 2 |
| Tc-99m medronate HCPCS A9503 | $110.53 | $170.04 | $13.78 – $15.60 | 2 |
| Tc-99m mertiatide HCPCS A9562 | $752.37 | $1,157.49 | not published | 0 |
| Tc-99m oxidronate HCPCS A9561 | $112.42 | $172.95 | not published | 0 |
| Tc-99m pentetate dtpa HCPCS A9539 | $342.80 | $527.38 | not published | 0 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $385.37 | $592.87 | not published | 0 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $1.37 | $2.11 | $1.34 – $1.92 | 2 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $101.55 | $156.23 | $16.33 – $76.86 | 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.