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 |
|---|---|---|---|---|
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $169.33 | $260.51 | $42.50 – $58.41 | 3 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | not published | not published | $17.12 – $24.06 | 3 |
| Ultrasound dx ophth b-scan CPT 76512 | not published | not published | $14.94 – $30.40 | 3 |
| Ultrasound elastography ea l target les CPT 76983 | not published | not published | $29.95 – $60.94 | 3 |
| Ultrasound elastography parenchyma CPT 76981 | not published | not published | $68.15 – $138.67 | 3 |
| Ultrasound encephalogram CPT 76506 | $297.18 | $457.20 | $58.90 – $91.59 | 3 |
| Ultrasound exam follow-up CPT 76970 | not published | not published | $58.58 – $58.58 | 1 |
| Ultrasound exam k transpl w/doppler CPT 76776 | not published | not published | $88.55 – $128.65 | 3 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | not published | not published | $41.61 – $54.49 | 3 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $219.91 | $338.32 | $26.67 – $54.27 | 3 |
| Ultrasound guidance for vascular access CPT 76937 | $218.23 | $335.74 | $18.46 – $25.85 | 3 |
| Ultrasound guide intraoperative CPT 76998 | $240.12 | $369.42 | $99.04 – $99.04 | 1 |
| Ultrasound guide tissue ablation CPT 76940 | not published | not published | $59.74 – $86.00 | 2 |
| Ultrasound hips infant dynamic CPT 76885 | not published | not published | $58.90 – $83.26 | 3 |
| Ultrasound infant hips ltd without stress CPT 76886 | not published | not published | $55.87 – $78.60 | 3 |
| Ultrasound joint complete left CPT 76881 | $323.71 | $498.02 | $8.94 – $41.26 | 3 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | $251.07 | $386.26 | $13.30 – $27.07 | 3 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | not published | not published | $33.76 – $47.03 | 3 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | not published | not published | $17.19 – $27.45 | 3 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | not published | not published | $74.56 – $94.53 | 3 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $323.71 | $498.02 | $57.51 – $77.52 | 3 |
| Ultrasound prostate/transrectal CPT 76872 | $251.07 | $386.26 | $72.17 – $112.35 | 3 |
| Ultrasound spinal canal and contents CPT 76800 | $323.71 | $498.02 | $74.31 – $102.80 | 3 |
| Ultrasound transabd ea addl gest CPT 76812 | not published | not published | $58.90 – $120.85 | 3 |
| Ultrasound trgt dyn mbubb 1st les CPT 76978 | not published | not published | $78.99 – $268.39 | 3 |
| Ultrasound trgt dyn mbubb ea addl CPT 76979 | not published | not published | $55.05 – $195.95 | 3 |
| Ultraviolet therapy CPT 97028 | not published | not published | $3.48 – $6.98 | 3 |
| Umbilical artery cath newborn 36660 CPT 36660 | not published | not published | $48.41 – $78.85 | 2 |
| Umbilical cord occlud w/us CPT 59072 | not published | not published | $370.88 – $503.57 | 2 |
| Umbilicoplasty 15847 CPT 15847 | not published | not published | $314.86 – $314.86 | 1 |
| Unit mobile power mpu HCPCS Q0479 | not published | not published | $14,418.01 – $14,418.01 | 5 |
| Unlisted chemotherapy px CPT 96549 | $99.79 | $153.52 | not published | 0 |
| Unlisted CT procedure CPT 76497 | not published | not published | $63.86 – $108.14 | 2 |
| Unlisted cytogenetic study CPT 88299 | $4,244.69 | $6,530.29 | $109.12 – $109.12 | 1 |
| Unlisted cytopathology px CPT 88199 | not published | not published | $20.29 – $20.29 | 1 |
| Unlisted fluoroscopic px CPT 76496 | not published | not published | $78.80 – $171.73 | 2 |
| Unlisted hematology&coagj px CPT 85999 | not published | not published | $8.04 – $8.04 | 1 |
| Unlisted maaa CPT 81599 | not published | not published | $103.65 – $103.65 | 1 |
| Unlisted misc path test CPT 89240 | $73.70 | $113.38 | $4.30 – $4.30 | 1 |
| Unlisted mr procedure CPT 76498 | not published | not published | $262.50 – $336.53 | 2 |
| Unlisted procedure microbiology CPT 87999 | $1,043.48 | $1,605.35 | $14.58 – $14.58 | 1 |
| Unlisted procedure urinary 58750 CPT 58750 | not published | not published | $658.16 – $963.74 | 2 |
| Unlisted px casting/strpg CPT 29799 | $368.32 | $566.65 | not published | 0 |
| Unlisted px foot/toes CPT 28899 | $654.26 | $1,006.56 | not published | 0 |
| Unlisted px hands/fingers CPT 26989 | $3,251.90 | $5,002.93 | not published | 0 |
| Unlisted px pelvis/hip joint CPT 27299 | $3,251.90 | $5,002.93 | not published | 0 |
| Unlisted px small intestine CPT 44799 | $2,195.76 | $3,378.09 | not published | 0 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $10.44 – $10.44 | 1 |
| Unlisted surgical path px CPT 88399 | not published | not published | $67.11 – $67.11 | 1 |
| Unlisted transfusion med px CPT 86999 | not published | not published | $4.87 – $4.87 | 1 |
| Unlisted ultrasound procedure CPT 76999 | $206.02 | $316.95 | not published | 0 |
| Unlisted urinalysis px CPT 81099 | not published | not published | $2.67 – $6.61 | 2 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $1,159.66 | $1,784.09 | not published | 0 |
| Upgrade pm system CPT 33214 | not published | not published | $346.15 – $532.77 | 2 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $201.75 | $310.38 | $19.42 – $25.07 | 3 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $343.73 | $528.82 | $92.36 – $187.95 | 3 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $499.36 | $768.24 | $68.42 – $139.23 | 3 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $1,510.60 | $2,324.00 | $173.89 – $310.53 | 3 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $1,510.60 | $2,324.00 | $154.24 – $273.90 | 3 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $956.04 | $1,470.83 | $99.73 – $202.95 | 3 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $275.16 | $423.33 | $19.03 – $24.83 | 3 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $275.16 | $423.33 | $23.13 – $29.38 | 3 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $91.56 – $159.03 | 2 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $1,670.68 | $2,570.28 | $102.40 – $179.91 | 2 |
| Upper ext fx orthosis rad/ul HCPCS L3982 | not published | not published | $559.71 – $559.71 | 5 |
| Upper ext harvest for cabg1 seg 35600 CPT 35600 | not published | not published | $137.01 – $283.82 | 2 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $336.54 | $517.76 | $75.79 – $111.48 | 3 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $336.54 | $517.76 | $68.70 – $95.88 | 3 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $102.40 – $179.91 | 2 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $479.75 – $723.39 | 2 |
| Urea nitrogen CPT 84520 | $14.31 | $22.01 | $2.64 – $8.89 | 10 |
| Urea nitrogen 24 hour urine CPT 84540 | $17.18 | $26.43 | $3.70 – $11.43 | 10 |
| Urea nitrogen clearance CPT 84545 | $23.92 | $36.80 | $3.65 – $8.64 | 8 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $3.41 – $6.16 | 8 |
| Ureteral embolization/occl CPT 50705 | not published | not published | $132.60 – $204.45 | 2 |
| Ureteral reflux study CPT 78740 | not published | not published | $157.99 – $214.64 | 3 |
| Ureter endoscopy CPT 50970 | not published | not published | $269.11 – $421.85 | 2 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $256.37 – $401.20 | 2 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $342.50 – $538.44 | 2 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $260.25 – $407.81 | 2 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $257.79 – $403.46 | 2 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $231.20 – $360.70 | 2 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $337.75 – $531.29 | 2 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $258.63 – $405.53 | 2 |
| Ureteroneocystostomy 50780 CPT 50780 | not published | not published | $828.77 – $1,252.05 | 2 |
| Ureteroureterostomy 50760 CPT 50760 | not published | not published | $843.68 – $1,272.37 | 2 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $579.34 | $891.29 | $65.59 – $166.11 | 2 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $554.11 – $845.73 | 2 |
| Urethrocystography void s&i CPT 74455 | $579.34 | $891.29 | $69.50 – $94.75 | 3 |
| Uric acid blood CPT 84550 | $16.35 | $25.16 | $3.01 – $10.17 | 10 |
| Uric acid urine CPT 84560 | $17.18 | $26.43 | $3.38 – $11.43 | 10 |
| Urinalysis glass test CPT 81020 | not published | not published | $3.05 – $5.64 | 8 |
| Urinalysis microscopic only CPT 81015 | $11.02 | $16.95 | $2.02 – $4.54 | 10 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $7.83 | $12.04 | $1.44 – $2.60 | 8 |
| Urinalysis (with microscopy) CPT 81001 | $11.50 | $17.69 | $2.11 – $7.13 | 10 |
| Urinalysis (without microscopy) CPT 81003 | $8.13 | $12.51 | $1.49 – $4.54 | 10 |
| Urinary bldr retent nuc study CPT 78730 | not published | not published | $53.41 – $77.52 | 3 |
| Urinary pouch on barr w/flng HCPCS A5073 | not published | not published | $3.42 – $4.37 | 6 |
| Urinary pouch w/barrier HCPCS A5071 | not published | not published | $4.64 – $8.57 | 6 |
| Urinary reflex study CPT 51792 | not published | not published | $155.88 – $227.93 | 3 |
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.