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 |
|---|---|---|---|---|
| Urinary suspensory HCPCS A5105 | not published | not published | $58.11 – $58.11 | 5 |
| Urine Culture Test CPT 87086 | $29.19 | $44.91 | $5.38 – $18.16 | 10 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $4.84 – $23.00 | 3 |
| Urine ost pouch w faucet/tap HCPCS A4428 | not published | not published | $7.35 – $9.29 | 6 |
| Urine pregnancy test CPT 81025 | $25.23 | $38.82 | $2.02 – $10.33 | 10 |
| Urine screen for bacteria CPT 81007 | not published | not published | $2.02 – $35.98 | 10 |
| Urine shunt to intestine CPT 50815 | not published | not published | $907.87 – $1,390.73 | 2 |
| Urine specimen collect mult HCPCS P9615 | not published | not published | $2.00 – $11.21 | 8 |
| Urofollitropin, 75 iu HCPCS J3355 | not published | not published | $120.14 – $120.14 | 1 |
| Urography, antegrade CPT 74425 | $732.28 | $1,126.58 | $89.98 – $166.11 | 3 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $85.87 – $123.13 | 3 |
| Urokinase 250,000 iu inj HCPCS J3365 | not published | not published | $414.54 – $414.54 | 1 |
| Urokinase 5000 iu injection HCPCS J3364 | not published | not published | $8.29 – $8.29 | 1 |
| Use 1st target lesion CPT 76982 | not published | not published | $52.60 – $107.03 | 3 |
| User adjustable heel height HCPCS L5990 | not published | not published | $2,180.41 – $2,180.41 | 5 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $34.43 | $52.97 | $11.36 – $17.11 | 4 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $663.04 | $1,020.06 | $85.84 – $339.96 | 3 |
| Vaccine Administration (one shot) CPT 90471 | $67.74 | $104.21 | $18.18 – $22.51 | 2 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $239.41 | $368.32 | $134.40 – $161.65 | 2 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $236.64 | $364.06 | $134.40 – $147.06 | 2 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $196.27 | $301.96 | $120.75 – $168.37 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $243.53 | $374.66 | $80.85 – $94.80 | 2 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $219.55 | $337.77 | $60.38 – $60.38 | 1 |
| Vaccine dtap < 7 years im CPT 90700 | $57.91 | $89.09 | $30.23 – $31.99 | 2 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $135.58 | $208.58 | $102.87 – $107.30 | 2 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $122.60 | $188.62 | $64.13 – $68.06 | 2 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | $211.02 | $324.64 | $153.67 – $166.88 | 2 |
| Vaccine dtap-ipv/hib im CPT 90698 | $226.53 | $348.51 | $120.25 – $126.66 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $59.05 | $90.84 | $31.19 – $34.49 | 2 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $26.03 | $40.04 | $13.44 – $14.25 | 2 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $142.10 | $218.61 | $75.74 – $91.86 | 3 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $208.36 | $320.56 | $132.51 – $139.85 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $59.94 | $92.22 | $39.62 – $41.67 | 2 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im CPT 90634 | $47.20 | $72.61 | not published | 0 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | $43.41 | $66.78 | $70.17 – $75.49 | 3 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $78.97 | $121.49 | $70.17 – $75.14 | 3 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $271.43 | $417.59 | $147.63 – $188.21 | 3 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $45.38 | $69.81 | $28.47 – $33.22 | 3 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $641.57 | $987.03 | $301.91 – $322.38 | 2 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $434.17 | $667.96 | not published | 0 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $169.88 | $261.36 | $67.74 – $98.16 | 3 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | not published | not published | $54.96 – $98.16 | 3 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $38.47 | $59.18 | $22.07 – $22.07 | 1 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $40.94 | $62.98 | $23.22 – $23.22 | 1 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $36.51 | $56.17 | $19.36 – $21.56 | 2 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | not published | not published | $71.38 – $75.46 | 2 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $37.99 | $58.44 | $20.06 – $22.78 | 2 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $39.11 | $60.17 | $20.72 – $22.65 | 2 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | not published | not published | $9.68 – $10.78 | 2 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | $45.34 | $69.75 | $25.73 – $27.54 | 2 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | $127.48 | $196.13 | $67.74 – $73.62 | 2 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $68.98 | $106.13 | $49.50 – $49.50 | 1 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | not published | not published | $11.03 – $11.03 | 1 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $330.07 | $507.80 | $234.93 – $241.40 | 2 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $343.22 | $528.03 | $199.78 – $201.63 | 2 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $315.15 | $484.85 | $175.33 – $178.30 | 2 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $330.07 | $507.80 | $156.19 – $169.89 | 2 |
| Vaccine mmr live subcutaneous CPT 90707 | $183.83 | $282.81 | $97.12 – $104.33 | 2 |
| Vaccine mmrv live subcutaneous CPT 90710 | $568.55 | $874.69 | $283.66 – $314.24 | 2 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $208.94 | $321.45 | $122.94 – $140.50 | 3 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $462.57 | $711.65 | $237.75 – $271.57 | 2 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | $439.52 | $676.19 | $233.67 – $269.31 | 3 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $462.57 | $711.65 | $274.64 – $341.00 | 3 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $87.84 | $135.14 | $44.77 – $46.34 | 2 |
| Vaccine rabies im CPT 90675 | $791.49 | $1,217.68 | $331.98 – $454.85 | 3 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $531.55 | $817.77 | $309.75 – $309.75 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $1,031.86 | $1,587.47 | $519.75 – $519.75 | 1 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | $1,031.86 | $1,587.47 | $519.75 – $519.75 | 1 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | $508.64 | $782.53 | $294.00 – $294.00 | 1 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | $174.28 | $268.12 | $145.68 – $156.83 | 2 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $174.28 | $268.12 | $100.76 – $108.45 | 2 |
| Vaccine tdap >=7 years im CPT 90715 | $97.06 | $149.33 | $40.29 – $53.31 | 3 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $83.37 | $128.26 | $29.38 – $40.66 | 3 |
| Vaccine typhoid vicps im CPT 90691 | not published | not published | $96.35 – $96.49 | 2 |
| Vaccine varicella live subcutaneous CPT 90716 | $385.63 | $593.28 | $183.04 – $191.84 | 2 |
| Vaccine yellow fever live subcutaneous CPT 90717 | not published | not published | $147.69 – $168.79 | 2 |
| Vacuum drain bottle/tube kit HCPCS A7048 | not published | not published | $58.86 – $58.86 | 5 |
| Vad battery clip set hmii 14-v li-ion HCPCS Q0497 | not published | not published | $562.64 – $562.64 | 5 |
| Vad cable power module dc input HCPCS Q0478 | not published | not published | $220.87 – $220.87 | 5 |
| Vad univ batt charger hm 1440 HCPCS Q0495 | not published | not published | $5,020.16 – $5,020.16 | 5 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $720.28 – $1,052.24 | 2 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $896.76 – $1,319.52 | 2 |
| Vag hyst including t/o CPT 58262 | not published | not published | $672.15 – $980.53 | 2 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $944.49 – $1,390.88 | 2 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $877.84 – $1,290.89 | 2 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $651.00 – $945.76 | 2 |
| Vaginal bx CPT 58999 | $199.89 | $307.53 | not published | 0 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $659.23 – $939.15 | 2 |
| Vaginal Delivery (full care) CPT 59400 | not published | not published | $1,787.59 – $2,229.77 | 2 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $608.87 – $887.01 | 2 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $1,321.80 – $1,814.99 | 2 |
| Vag inser rectal control sys HCPCS A4563 | not published | not published | $1,640.30 – $1,640.30 | 5 |
| Vagnc compl rmvl paravag tis CPT 57111 | not published | not published | $1,321.80 – $1,814.99 | 2 |
| Vagnc compl rmvl vag wall CPT 57110 | not published | not published | $655.50 – $957.15 | 2 |
| Vagotomy pfrmd w/prtl dstl gstrct 43635 CPT 43635 | not published | not published | $81.54 – $141.46 | 2 |
| Vagotomy & pylorus repair CPT 43641 | not published | not published | $917.37 – $1,507.96 | 2 |
| Vagotomy & pylorus repair 43640 CPT 43640 | not published | not published | $907.63 – $1,485.93 | 2 |
| Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr HCPCS J3379 | not published | not published | $0.01 – $0.05 | 2 |
| Valproic acid total therapeutic drug level CPT 80164 | $49.02 | $75.41 | $9.02 – $23.87 | 10 |
| Valrubicin injection HCPCS J9357 | $2,820.82 | $4,339.73 | $1,225.58 – $1,687.20 | 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.