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 |
|---|---|---|---|---|
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $1.16 | $1.79 | $0.02 – $0.02 | 3 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $1.18 | $1.82 | $0.54 – $2.28 | 4 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | $98.56 | $151.63 | $66.16 – $75.32 | 2 |
| Dipyridamole injection HCPCS J1245 | $1.44 | $2.21 | $0.90 – $8.41 | 4 |
| Direct advanced life support CPT 99288 | not published | not published | $82.91 – $82.91 | 1 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $22.85 – $28.74 | 2 |
| Disability dlco CPT 94727 | $367.00 | $564.61 | $29.12 – $37.82 | 3 |
| Disaccharidases CPT 82657 | $65.34 | $100.53 | $14.78 – $26.60 | 8 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $374.72 – $520.45 | 2 |
| Disarticulation shoulder CPT 23920 | not published | not published | $844.00 – $1,252.89 | 2 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $1,069.96 – $1,673.47 | 2 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $149.34 – $224.60 | 2 |
| Discography cerv/thor spine CPT 72285 | not published | not published | $71.70 – $84.58 | 3 |
| Disconnect insert locking wr HCPCS L6616 | not published | not published | $92.61 – $92.61 | 5 |
| Disconnect locking wrist uni HCPCS L6615 | not published | not published | $224.99 – $224.99 | 5 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $68.95 – $114.96 | 2 |
| Dissect brain w/scope CPT 62161 | not published | not published | $1,196.14 – $1,643.86 | 2 |
| Dis site tele svcs rhc/fqhc HCPCS G2025 | not published | not published | $68.50 – $68.50 | 1 |
| Dissolve clot heart vessel CPT 92975 | not published | not published | $450.67 – $450.67 | 1 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $833.98 – $1,265.71 | 2 |
| Div aberrant vsl w/reanast CPT 33803 | not published | not published | $880.87 – $1,275.27 | 2 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $585.51 – $995.89 | 2 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $247.90 – $355.17 | 2 |
| #d/lmeth-l-methamphetamine CPT 80374 | not published | not published | $11.96 – $11.96 | 1 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | not published | not published | $213.90 – $330.81 | 2 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $168.67 – $379.51 | 10 |
| Dmpk gene charac alleles CPT 81239 | not published | not published | $166.55 – $374.74 | 10 |
| Dmpk gene detc abnor allele CPT 81234 | $364.25 | $560.39 | $83.02 – $188.62 | 10 |
| Dna antibody native/double stranded CPT 86225 | $49.75 | $76.54 | $5.25 – $16.49 | 10 |
| Dna gardnerella CPT 87510 | $72.57 | $111.65 | $13.36 – $31.70 | 10 |
| Dna probe chlamydia CPT 87490 | not published | not published | $8.11 – $27.30 | 10 |
| Dna probe gc CPT 87590 | not published | not published | $8.11 – $32.26 | 10 |
| Dna trichomonas CPT 87660 | $72.57 | $111.65 | $13.36 – $31.70 | 10 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $11.50 | $17.69 | $6.10 – $8.02 | 4 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $0.46 – $2.86 | 4 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $46.29 – $51.62 | 3 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $5.63 – $5.63 | 1 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $57.90 – $72.38 | 3 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | not published | not published | $0.67 – $1.01 | 4 |
| Doppler echo complete CPT 93320 | $177.74 | $273.44 | $27.76 – $44.05 | 3 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | not published | not published | $172.79 – $230.83 | 2 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $367.00 | $564.61 | $91.48 – $148.35 | 3 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $255.27 | $392.73 | $58.26 – $98.28 | 3 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | not published | not published | $0.76 – $0.76 | 1 |
| Dornase alfa non-comp unit HCPCS J7639 | not published | not published | $42.88 – $57.92 | 4 |
| Dornhoffer fixed part w/window HCPCS L8614 | $36,623.70 | $56,344.15 | $23,460.09 – $23,460.09 | 5 |
| Dorsi & plantar flex ass/res HCPCS L2220 | $166.66 | $256.40 | $106.75 – $106.75 | 5 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $240.14 – $258.91 | 4 |
| Double transfer toe-hand CPT 26554 | not published | not published | $2,794.52 – $4,228.41 | 2 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | not published | not published | $2.71 – $8.46 | 4 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $104.01 – $469.61 | 5 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | not published | not published | $0.09 – $0.10 | 2 |
| Dpyd gene common variants CPT 81232 | $488.01 | $750.79 | $105.93 – $209.77 | 8 |
| Drainable plastic pch w fcpl HCPCS A4375 | not published | not published | $24.47 – $24.47 | 5 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $1,496.14 | $2,301.76 | $95.28 – $140.96 | 2 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $1,307.90 | $2,012.16 | $109.25 – $157.24 | 2 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $120.21 – $175.43 | 2 |
| Drainage external ear simple 69000 CPT 69000 | $1,338.47 | $2,059.19 | $96.52 – $133.81 | 2 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $175.53 – $225.03 | 2 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $398.42 – $536.71 | 2 |
| Drainage mouth roof lesion CPT 42000 | $553.14 | $850.99 | $81.56 – $115.94 | 2 |
| Drainage of abdomen CPT 48000 | not published | not published | $1,412.83 – $2,088.17 | 2 |
| Drainage of arm bursa 23931 CPT 23931 | $3,433.44 | $5,282.22 | $129.71 – $173.97 | 2 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $312.89 – $464.12 | 2 |
| Drainage of bone lesion CPT 26992 | not published | not published | $770.50 – $1,078.94 | 2 |
| Drainage of bone lesion CPT 27303 | not published | not published | $493.11 – $712.16 | 2 |
| Drainage of eye CPT 65800 | not published | not published | $59.42 – $107.29 | 2 |
| Drainage of eye CPT 65810 | not published | not published | $332.48 – $545.97 | 2 |
| Drainage of eye CPT 65815 | not published | not published | $341.33 – $560.09 | 2 |
| Drainage of forearm bursa CPT 25031 | not published | not published | $297.09 – $388.13 | 2 |
| Drainage of kidney lesion CPT 50390 | $1,537.43 | $2,365.27 | $67.30 – $110.06 | 2 |
| Drainage of mouth lesion CPT 41005 | $586.66 | $902.56 | $92.12 – $128.90 | 2 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $177.99 – $266.85 | 2 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $170.57 – $258.11 | 2 |
| Drainage of mouth lesion CPT 41008 | $6,603.87 | $10,159.80 | $201.39 – $299.71 | 2 |
| Drainage of mouth lesion CPT 41009 | not published | not published | $217.65 – $328.94 | 2 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $231.20 – $353.56 | 2 |
| Drainage of mouth lesion CPT 41016 | $11,200.30 | $17,231.23 | $267.69 – $391.36 | 2 |
| Drainage of mouth lesion CPT 41017 | not published | not published | $264.48 – $395.49 | 2 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $308.45 – $461.64 | 2 |
| Drainage of nose lesion int 30000 CPT 30000 | not published | not published | $90.90 – $131.37 | 2 |
| Drainage of nose lesion sept 30020 CPT 30020 | not published | not published | $91.72 – $131.52 | 2 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $401.57 – $581.37 | 2 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $538.98 – $711.47 | 2 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $335.17 – $501.33 | 2 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $343.07 – $513.54 | 2 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $451.78 – $675.03 | 2 |
| Drainage of rectal abscess CPT 45005 | $2,377.44 | $3,657.60 | $141.11 – $204.44 | 2 |
| Drainage of rectal abscess 45020 CPT 45020 | not published | not published | $451.23 – $725.39 | 2 |
| Drainage of salivary gland CPT 42305 | not published | not published | $316.82 – $479.74 | 2 |
| Drainage of salivary gland CPT 42320 | not published | not published | $133.23 – $196.93 | 2 |
| Drainage of spinal cyst CPT 63172 | not published | not published | $1,112.84 – $1,514.69 | 2 |
| Drainage of spinal cyst CPT 63173 | not published | not published | $1,349.48 – $1,867.88 | 2 |
| Drainage of throat abscess CPT 42725 | not published | not published | $582.27 – $913.60 | 2 |
| Drainage of urethra abscess CPT 53040 | not published | not published | $299.44 – $445.97 | 2 |
| Drainage of urethra abscess 53060 CPT 53060 | not published | not published | $122.27 – $184.04 | 2 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $321.71 – $477.38 | 2 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $488.45 – $737.93 | 2 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $36.79 – $58.90 | 2 |
| Drain blood from under nail 11740 CPT 11740 | $255.27 | $392.72 | $25.95 – $35.86 | 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.