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 |
|---|---|---|---|---|
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $105.96 – $168.00 | 2 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $79.95 – $119.23 | 2 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $124.76 – $194.25 | 2 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $68.68 – $107.31 | 2 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $553.62 – $890.19 | 2 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $136.16 – $194.73 | 2 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $86.50 – $114.16 | 2 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $71.71 – $105.22 | 2 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $20.01 – $36.04 | 8 |
| Detect agnt mult dna direc CPT 87800 | $145.18 | $223.36 | $25.26 – $63.43 | 10 |
| Determination venous press CPT 93770 | $194.12 | $298.64 | $0.69 – $6.15 | 2 |
| Determine refractive state CPT 92015 | not published | not published | $23.02 – $23.02 | 1 |
| Developmental screen/score/document 96110 CPT 96110 | $141.93 | $218.36 | $11.94 – $11.94 | 1 |
| Devel tst phys/qhp 1st hr CPT 96112 | $324.94 | $499.91 | $90.01 – $169.46 | 3 |
| Device intraute mirena HCPCS J7298 | $2,565.91 | $3,947.55 | $810.51 – $1,287.51 | 3 |
| Dev interrog remote 1/2/mlt CPT 93295 | not published | not published | $30.15 – $61.36 | 3 |
| Devise bowel pouch CPT 44316 | not published | not published | $1,071.32 – $1,782.55 | 2 |
| Devlopment test interpt&rep HCPCS G0451 | not published | not published | $10.03 – $11.02 | 2 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $162.48 | $249.97 | $38.30 – $75.58 | 3 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $201.75 | $310.38 | $17.82 – $24.72 | 3 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | not published | not published | $90.02 – $166.50 | 4 |
| Dexamethasone 0.4 mg/0.1 ml intraocular injection - cnr HCPCS J1095 | not published | not published | $1.10 – $1.38 | 3 |
| Dexamethasone 4 mg tablet HCPCS J8540 | not published | not published | $0.03 – $0.09 | 3 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $0.32 | $0.49 | $0.08 – $0.25 | 4 |
| Dexamethasone intra implant HCPCS J7312 | $414.35 | $637.46 | $203.66 – $228.51 | 4 |
| Dexamethasone panel CPT 80420 | not published | not published | $65.45 – $194.26 | 10 |
| Dexmedetomidine film, 1 mcg HCPCS J1105 | not published | not published | $0.62 – $0.62 | 1 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | not published | not published | $41.44 – $329.11 | 4 |
| Dextran 40 infusion HCPCS J7100 | not published | not published | $21.80 – $66.56 | 3 |
| Dextran 75 infusion HCPCS J7110 | not published | not published | $11.62 – $11.62 | 1 |
| Dextroamphetamine HCPCS S0160 | not published | not published | $0.66 – $1.38 | 3 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | not published | not published | $0.65 – $3.15 | 4 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | not published | not published | $0.94 – $8.46 | 3 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $7.40 | $11.39 | $1.65 – $4.94 | 4 |
| Dextrose 5 % IV bolus HCPCS J7070 | not published | not published | $2.85 – $6.20 | 4 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $80.47 | $123.80 | $14.82 – $50.02 | 10 |
| Diabetes (HbA1c) Test CPT 83036 | $35.15 | $54.07 | $6.46 – $21.85 | 10 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | not published | not published | $6.73 – $14.44 | 2 |
| Diabetic custom molded shoe HCPCS A5501 | not published | not published | $271.80 – $271.80 | 5 |
| Diabetic shoe with wedge HCPCS A5504 | not published | not published | $45.79 – $45.79 | 5 |
| Diabetic shoe w/off set heel HCPCS A5506 | not published | not published | $45.79 – $45.79 | 5 |
| Diabetic shoe w/roller/rockr HCPCS A5503 | not published | not published | $45.79 – $45.79 | 5 |
| Diab manage trn ind/group HCPCS G0109 | $44.10 | $67.84 | $13.39 – $20.95 | 2 |
| Diab shoe for density insert HCPCS A5500 | not published | not published | $90.63 – $90.63 | 5 |
| Diab shoe w/metatarsal bar HCPCS A5505 | not published | not published | $45.79 – $45.79 | 5 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $127.33 – $199.95 | 2 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $256.89 – $363.19 | 2 |
| Diagnostic anoscopy CPT 46601 | not published | not published | $70.61 – $120.51 | 2 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $93.46 – $162.11 | 2 |
| Diagnostic anoscopy spx 46600 CPT 46600 | not published | not published | $33.23 – $52.13 | 2 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $80.17 | $123.34 | $81.50 – $87.02 | 2 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $80.17 | $123.34 | $81.50 – $110.86 | 2 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $36.92 – $54.35 | 2 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $429.03 | $660.04 | $50.34 – $74.58 | 3 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $334.81 | $515.09 | $90.18 – $183.50 | 4 |
| Diagnostic Mammogram (one breast) CPT 77065 | $261.55 | $402.39 | $70.33 – $143.12 | 4 |
| Diagnostic radio unlisted proc CPT 76499 | not published | not published | $42.53 – $42.53 | 1 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | not published | not published | $144.56 – $227.52 | 2 |
| Dialysis one evaluation CPT 90945 | not published | not published | $64.58 – $95.71 | 3 |
| Dialysis repeated eval CPT 90947 | not published | not published | $89.10 – $138.04 | 3 |
| Dialysis training incompl CPT 90993 | not published | not published | $77.90 – $98.59 | 2 |
| Diathermy eg microwave CPT 97024 | not published | not published | $3.11 – $6.14 | 3 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.18 | $0.28 | $0.07 – $0.13 | 4 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | not published | not published | $5.79 – $14.77 | 4 |
| Dicyclomine injection HCPCS J0500 | not published | not published | $8.52 – $46.80 | 4 |
| Difelikefalin, esrd on dialy HCPCS J0879 | not published | not published | $0.22 – $0.28 | 3 |
| Diffusing capacity CPT 94729 | $157.27 | $241.95 | $44.08 – $59.82 | 3 |
| Digital analysis of eeg CPT 95957 | not published | not published | $168.36 – $238.96 | 3 |
| Digit nerve surgery add-on CPT 64778 | not published | not published | $126.43 – $204.07 | 2 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | not published | not published | $3.91 – $9.57 | 4 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $2,906.98 – $5,383.32 | 4 |
| Digoxin total therapeutic drug level CPT 80162 | $48.04 | $73.91 | $8.85 – $23.87 | 10 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $164.78 | $253.50 | $54.98 – $101.05 | 4 |
| Dilate biliary duct/ampulla CPT 47542 | not published | not published | $97.44 – $156.00 | 2 |
| Dilate esophagus CPT 43453 | not published | not published | $64.00 – $111.04 | 2 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $60.49 – $102.64 | 2 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | not published | not published | $384.67 – $384.67 | 1 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | not published | not published | $192.32 – $192.32 | 1 |
| Dilate ic vasospasm init CPT 61640 | not published | not published | $547.50 – $547.50 | 1 |
| Dilate tear duct opening CPT 68801 | not published | not published | $59.46 – $91.60 | 2 |
| Dilate urethra stricture CPT 53600 | $324.29 | $498.91 | $46.47 – $72.41 | 2 |
| Dilate urethra stricture CPT 53601 | not published | not published | $39.55 – $60.91 | 2 |
| Dilate urethra stricture CPT 53605 | not published | not published | $46.23 – $73.57 | 2 |
| Dilate urethra stricture CPT 53621 | not published | not published | $52.81 – $82.16 | 2 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $30.99 – $47.12 | 2 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $138.39 – $214.54 | 2 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $35.56 – $50.46 | 2 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $154.22 – $244.14 | 2 |
| Dilation of salivary duct CPT 42660 | not published | not published | $57.75 – $97.82 | 2 |
| Dilation of urethra CPT 53661 | not published | not published | $29.91 – $45.98 | 2 |
| Dilation of urethra CPT 53665 | not published | not published | $27.44 – $43.97 | 2 |
| Dilation of vagina CPT 57400 | not published | not published | $94.82 – $138.18 | 2 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $43.95 – $64.76 | 2 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | not published | not published | $63.89 – $99.06 | 2 |
| Dilat xst trc ndurlgc px CPT 50436 | $4,335.25 | $6,669.61 | $112.75 – $172.35 | 2 |
| Dilat xst trc new access rcs CPT 50437 | $7,428.10 | $11,427.84 | $185.85 – $287.95 | 2 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | not published | not published | $0.03 – $0.03 | 2 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $42.58 – $64.18 | 3 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $0.92 – $12.04 | 4 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $1,121.44 | $1,725.30 | $239.30 – $749.23 | 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.