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 |
|---|---|---|---|---|
| Tc-99m sestamibi p study dose HCPCS A9500 | $67.60 | $104.00 | not published | 0 |
| Tc-99m succimer (dmsa) HCPCS A9551 | not published | not published | $635.39 – $719.30 | 2 |
| Tc-99m sulfur colloid HCPCS A9541 | $922.89 | $1,419.83 | $283.41 – $739.84 | 3 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $101.34 | $155.90 | $102.33 – $103.31 | 2 |
| Tc-99m tilmanocept diag HCPCS A9520 | $1,685.00 | $2,592.30 | $497.99 – $563.76 | 2 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $295.59 – $446.09 | 2 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $96.40 – $250.02 | 3 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $96.40 – $202.19 | 3 |
| Tcd vasoreactivity study CPT 93890 | not published | not published | $96.40 – $96.40 | 1 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $92.77 – $92.77 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $170.05 | $261.61 | $31.31 – $105.70 | 10 |
| T cells absolute cd 4 count CPT 86361 | $96.91 | $149.09 | $17.85 – $52.65 | 10 |
| T cells total count CPT 86359 | $136.54 | $210.06 | $23.40 – $52.65 | 10 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $243.48 – $243.48 | 1 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $418.95 – $418.95 | 1 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $351.16 – $351.16 | 1 |
| Tdh sdrl/ventr pnxr CPT 61105 | not published | not published | $398.95 – $505.56 | 2 |
| Teaec w/wo patch graft iliofemoral CPT 35355 | $10,013.41 | $15,405.24 | $754.72 – $1,140.73 | 2 |
| Team conf without pat by hc pro CPT 99368 | not published | not published | $46.26 – $46.26 | 1 |
| Team conf without pat by phys CPT 99367 | not published | not published | $70.29 – $70.29 | 1 |
| Team conf w/pat by hc prof CPT 99366 | not published | not published | $53.95 – $53.95 | 1 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | not published | not published | $214.76 – $228.01 | 4 |
| Tee w or without fol w/cont,cong HCPCS C8926 | not published | not published | $334.12 – $334.12 | 1 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $228.32 – $228.32 | 1 |
| Teflon or equal cable lining HCPCS L6665 | not published | not published | $65.29 – $65.29 | 5 |
| Telavancin injection HCPCS J3095 | not published | not published | $5.82 – $9.54 | 4 |
| Telehealth original site facility fee HCPCS Q3014 | $73.28 | $112.74 | $25.53 – $25.53 | 1 |
| Telethx isodose plan cplx CPT 77307 | $880.61 | $1,354.79 | $112.69 – $151.79 | 3 |
| Telethx isodose plan simple CPT 77306 | $880.61 | $1,354.79 | $62.35 – $84.02 | 3 |
| Temozolomide HCPCS J8700 | not published | not published | $0.38 – $3.19 | 4 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | not published | not published | $7.41 – $12.04 | 4 |
| Temperature gradient studies CPT 93740 | not published | not published | $1.57 – $6.15 | 2 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | not published | not published | $20.32 – $61.91 | 4 |
| Tendon lengthening CPT 26476 | not published | not published | $529.22 – $681.04 | 2 |
| Tendon lngth upr a/e ea tdn CPT 24305 | not published | not published | $442.47 – $643.81 | 2 |
| Tendon shortening CPT 26477 | not published | not published | $501.99 – $662.67 | 2 |
| Tendon transfer with graft CPT 26492 | not published | not published | $736.56 – $981.50 | 2 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | not published | not published | $103.32 – $217.42 | 4 |
| Teniposide, 50 mg HCPCS Q2017 | not published | not published | $1,872.00 – $2,995.14 | 2 |
| Tenodesis biceps tdn at elbw CPT 24340 | not published | not published | $476.55 – $681.11 | 2 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | $494.54 – $651.48 | 2 |
| Tenolysis triceps CPT 24332 | not published | not published | $481.35 – $681.95 | 2 |
| Tenoplasty elbow to sho 1 CPT 24320 | not published | not published | $595.23 – $863.58 | 2 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $398.37 – $571.56 | 2 |
| Tenotomy hip flexor open CPT 27005 | not published | not published | $550.53 – $805.15 | 2 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | not published | not published | $229.38 – $338.07 | 2 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $191.33 – $275.29 | 2 |
| Tension based scoliosis orth HCPCS L1005 | not published | not published | $3,839.20 – $3,839.20 | 5 |
| Tens suppl 2 lead per month HCPCS A4595 | not published | not published | $12.88 – $12.88 | 5 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | not published | not published | $0.93 – $4.80 | 4 |
| Teriparatide injection HCPCS J3110 | not published | not published | $32.34 – $59.88 | 3 |
| Term dev auto grasp feature HCPCS L6881 | not published | not published | $4,913.43 – $4,913.43 | 5 |
| Term device, multi art digit HCPCS L6715 | not published | not published | $3,794.37 – $3,794.37 | 5 |
| Term dev mech hand vol close HCPCS L6709 | not published | not published | $1,505.63 – $1,505.63 | 5 |
| Term dev mech hand vol open HCPCS L6708 | not published | not published | $1,124.65 – $1,124.65 | 5 |
| Term dev mech hook vol close HCPCS L6707 | not published | not published | $1,678.25 – $1,678.25 | 5 |
| Term dev mech hook vol open HCPCS L6706 | not published | not published | $427.16 – $427.16 | 5 |
| Term dev modifier wrist unit HCPCS L6805 | not published | not published | $488.94 – $488.94 | 5 |
| Term dev, passive hand mitt HCPCS L6703 | not published | not published | $530.65 – $530.65 | 5 |
| Term dev precision pinch dev HCPCS L6810 | not published | not published | $228.36 – $228.36 | 5 |
| Term dev, sport/rec/work att HCPCS L6704 | not published | not published | $718.32 – $718.32 | 5 |
| Tert gene targeted seq alys CPT 81345 | $492.40 | $757.54 | $94.17 – $222.24 | 10 |
| Test for chlorohydrocarbons CPT 82441 | $12.51 | $19.25 | $2.90 – $7.21 | 8 |
| Test for porphobilinogen CPT 84106 | not published | not published | $3.88 – $11.07 | 10 |
| Test for urine cystines CPT 82615 | not published | not published | $6.35 – $15.91 | 10 |
| Testicular imaging w/vasc flow CPT 78761 | not published | not published | $128.24 – $197.46 | 3 |
| Testosterone pellet 75 mg HCPCS S0189 | not published | not published | $100.93 – $126.16 | 2 |
| Testosterone response panel CPT 80414 | not published | not published | $34.41 – $116.19 | 10 |
| Testosterone undecanoate 1mg HCPCS J3145 | not published | not published | $1.09 – $2.49 | 4 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $103.27 | $158.88 | $10.89 – $10.89 | 1 |
| Test sock elbw disart/above HCPCS L6682 | not published | not published | $383.88 – $383.88 | 5 |
| Test socket above knee HCPCS L5624 | not published | not published | $514.24 – $514.24 | 5 |
| Test socket below knee HCPCS L5620 | not published | not published | $402.69 – $402.69 | 5 |
| Test socket hemipelvectomy HCPCS L5628 | not published | not published | $610.31 – $610.31 | 5 |
| Test socket hip disarticulat HCPCS L5626 | not published | not published | $583.70 – $583.70 | 5 |
| Test socket knee disarticula HCPCS L5622 | not published | not published | $591.76 – $591.76 | 5 |
| Test socket shldr disart/tho HCPCS L6684 | not published | not published | $544.94 – $544.94 | 5 |
| Test socket symes HCPCS L5618 | not published | not published | $362.87 – $362.87 | 5 |
| Test sock wrist disart/bel e HCPCS L6680 | not published | not published | $357.93 – $357.93 | 5 |
| Test stress cardiovascular tracing only CPT 93017 | $577.26 | $888.10 | $31.79 – $53.99 | 3 |
| Test urine for lactose CPT 83633 | not published | not published | $3.89 – $13.50 | 8 |
| Test urine for porphyrins CPT 84119 | not published | not published | $4.99 – $16.03 | 10 |
| Test urine urobilinogen CPT 84578 | $13.09 | $20.14 | $2.98 – $5.36 | 8 |
| Tetanus ig im CPT 90389 | not published | not published | $649.17 – $734.28 | 2 |
| Tetanus immune globulin inj HCPCS J1670 | not published | not published | $443.10 – $734.28 | 4 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $17.77 – $20.76 | 4 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $83.02 – $164.40 | 8 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $460.28 – $911.44 | 8 |
| Tgsap so/hl 51/< rna alys CPT 81456 | $7,305.90 | $11,239.84 | $1,769.28 – $3,503.52 | 8 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $362.33 – $717.49 | 8 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $7.41 – $51.82 | 2 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $310.93 – $310.93 | 1 |
| Thawing cryopresrved oocyte CPT 89356 | not published | not published | $6.60 – $240.97 | 2 |
| Thawing cryopresrved sperm CPT 89353 | not published | not published | $3.50 – $12.44 | 2 |
| Thaw preserved stem cells CPT 38208 | not published | not published | $33.30 – $33.30 | 1 |
| Theophylline therapeutic drug level CPT 80198 | $51.18 | $78.74 | $8.08 – $18.18 | 10 |
| Therapeutic procd strg endur HCPCS G0237 | $86.78 | $133.51 | $10.30 – $12.01 | 2 |
| Therapeutic pulpotomy HCPCS D3220 | $71.50 | $110.00 | not published | 0 |
| Therapy activation ipnss CPT 93150 | not published | not published | $30.44 – $61.95 | 3 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $120.82 | $185.87 | $16.89 – $32.67 | 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.