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 |
|---|---|---|---|---|
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | not published | not published | $149.42 – $239.44 | 2 |
| Drain cath image guided visceral pq CPT 49405 | $3,486.44 | $5,363.76 | $138.80 – $226.39 | 2 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $1,215.65 | $1,870.23 | $68.19 – $92.48 | 2 |
| Drain chest lesion CPT 21502 | not published | not published | $415.51 – $556.74 | 2 |
| Drain chst dry seal exp thorastat HCPCS A7041 | not published | not published | $105.73 – $105.73 | 5 |
| Drain finger abscess;simple 26010 CPT 26010 | $497.06 | $764.71 | $118.67 – $152.29 | 2 |
| Drain lower leg bursa CPT 27604 | not published | not published | $259.32 – $374.47 | 2 |
| Drain lower leg lesion 27603 CPT 27603 | not published | not published | $304.24 – $433.08 | 2 |
| Drain neck/chest lesion 21501 CPT 21501 | not published | not published | $267.38 – $359.42 | 2 |
| Drain open lung lesion 32200 CPT 32200 | not published | not published | $899.64 – $1,253.44 | 2 |
| Drain ostomy pouch w/flange HCPCS A5063 | not published | not published | $2.67 – $3.86 | 6 |
| Drain ovarn cyst abd CPT 58805 | not published | not published | $312.55 – $450.55 | 2 |
| Drain ovary abscess open CPT 58820 | not published | not published | $248.88 – $353.86 | 2 |
| Drain pancreatic pseudocyst 48510 CPT 48510 | not published | not published | $845.05 – $1,216.35 | 2 |
| Drain penis lesion CPT 54015 | not published | not published | $229.33 – $350.29 | 2 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $518.25 – $753.22 | 2 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $176.15 – $232.68 | 2 |
| Drain shoulder lesion CPT 23030 | not published | not published | $199.09 – $278.54 | 2 |
| Drain thigh/knee lesion 27301 CPT 27301 | not published | not published | $395.51 – $559.48 | 2 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $119.73 – $169.86 | 2 |
| Drain to peritoneal cavity CPT 49062 | not published | not published | $593.80 – $821.06 | 2 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $497.06 | $764.71 | $83.76 – $123.13 | 2 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $444.52 | $683.87 | $44.62 – $60.51 | 2 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $842.52 | $1,296.18 | $100.28 – $148.41 | 2 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $32.01 – $51.78 | 2 |
| Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm HCPCS Q4108 | not published | not published | $38.54 – $55.93 | 3 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | not published | not published | $742.70 – $977.07 | 2 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | not published | not published | $227.48 – $341.05 | 2 |
| Driver pneumatic vad, rep HCPCS Q0480 | not published | not published | $108,243.35 – $108,243.35 | 5 |
| Drm agrft f/s/n/h/f/g/m ea CPT 15136 | not published | not published | $61.65 – $101.95 | 2 |
| Drm agrft t/a/l ea addl CPT 15131 | not published | not published | $61.65 – $101.95 | 2 |
| Drng appendix abscess open 44900 CPT 44900 | not published | not published | $602.12 – $975.11 | 2 |
| Drng hand tendon sheath 26020 CPT 26020 | not published | not published | $434.99 – $586.47 | 2 |
| Drng of eyelid abscess 67700 CPT 67700 | not published | not published | $84.96 – $136.40 | 2 |
| Drng of finger abscess comp 26011 CPT 26011 | $3,168.00 | $4,873.85 | $149.07 – $205.01 | 2 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $63.75 – $96.09 | 2 |
| Drng of mouth lesion 40801 CPT 40801 | not published | not published | $155.99 – $233.11 | 2 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $230.90 – $332.27 | 2 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $380.98 – $545.61 | 2 |
| Drng of palm single bursa 26025 CPT 26025 | $6,184.83 | $9,515.12 | $330.55 – $469.27 | 2 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $338.08 – $540.07 | 2 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $173.01 – $250.05 | 2 |
| Drng of scrotum abscess 55100 CPT 55100 | $3,486.44 | $5,363.76 | $134.72 – $187.87 | 2 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | not published | not published | $834.17 – $1,221.50 | 2 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | not published | not published | $777.15 – $1,108.74 | 2 |
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $519.04 – $756.17 | 2 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $1,208.07 – $1,768.29 | 2 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $116.63 – $170.93 | 2 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $105.21 – $152.39 | 2 |
| Dronabinol 2.5mg oral HCPCS Q0167 | not published | not published | $1.35 – $2.03 | 4 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | not published | not published | $2.60 – $10.33 | 4 |
| Drop lock knee HCPCS L2182 | not published | not published | $105.33 – $105.33 | 5 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $42.89 – $42.89 | 5 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | not published | not published | $12.49 – $12.49 | 1 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $9.26 | $14.25 | $11.62 – $13.50 | 3 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $685.67 | $1,054.88 | $2.49 – $15.00 | 2 |
| Drsg sht 5.625x4.625in std HCPCS A6025 | not published | not published | $41.99 – $41.99 | 1 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | not published | not published | $15.59 – $15.59 | 5 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | not published | not published | $103.97 – $103.97 | 1 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | not published | not published | $28.69 – $30.40 | 2 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | not published | not published | $35.21 – $55.48 | 3 |
| Drsg wound/burn 18x10cm suprathel resorb cost per sq cm HCPCS A2012 | not published | not published | $103.97 – $103.97 | 1 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | not published | not published | $103.97 – $103.97 | 1 |
| Drug admin & hemodynmic meas CPT 93463 | not published | not published | $69.48 – $128.00 | 2 |
| Drug assay caffeine CPT 80155 | $113.07 | $173.96 | $11.70 – $46.28 | 8 |
| Drug assay posaconazole CPT 80187 | $75.50 | $116.15 | $10.61 – $32.53 | 10 |
| Drug assay rufinamide CPT 80210 | $63.86 | $98.24 | $16.43 – $36.97 | 10 |
| Drug assay vedolizumab CPT 80280 | $80.18 | $123.36 | $10.61 – $46.28 | 10 |
| Drug assay voriconazole CPT 80285 | $75.69 | $116.45 | $10.61 – $32.53 | 10 |
| Drug asy hydroxychloroquine CPT 80220 | $43.91 | $67.55 | $10.61 – $23.87 | 10 |
| Drug of abuse screen urine CPT 80305 | $35.17 | $54.11 | $5.05 – $15.12 | 10 |
| Drug screening tapentadol CPT 80372 | $100.30 | $154.31 | $8.51 – $8.51 | 1 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $10.61 – $32.53 | 10 |
| Drug/substance nos 4-6 CPT 80376 | $671.32 | $1,032.80 | $14.15 – $15.07 | 2 |
| Drug test def 15-21 classes HCPCS G0482 | $582.56 | $896.25 | $100.61 – $238.49 | 8 |
| Drug test def 1-7 classes HCPCS G0480 | $186.98 | $287.66 | $15.15 – $137.32 | 10 |
| Drug test def 22+ classes HCPCS G0483 | $723.78 | $1,113.51 | $130.43 – $296.30 | 8 |
| Drug test def 8-14 classes HCPCS G0481 | $459.01 | $706.17 | $74.53 – $187.91 | 8 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $41.41 – $74.57 | 8 |
| Drug test prsmv instrmnt CPT 80306 | $52.64 | $80.99 | $5.05 – $20.57 | 10 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $121.92 | $187.57 | $7.58 – $74.57 | 10 |
| Drvvt confirm - quest CPT 85597 | $65.05 | $100.08 | $11.99 – $21.58 | 8 |
| Dry needling (97799) CPT 97799 | not published | not published | $49.23 – $49.23 | 1 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $178.79 – $301.44 | 2 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | not published | not published | $110.83 – $167.40 | 2 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $139.13 – $221.09 | 2 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $117.15 – $186.93 | 2 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $137.22 – $218.39 | 2 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $186.39 – $296.82 | 2 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $673.43 – $673.43 | 1 |
| Ductogram sgl duct CPT 77053 | not published | not published | $29.67 – $47.35 | 3 |
| Duodenal exclusion CPT 48547 | not published | not published | $1,346.61 – $1,983.92 | 2 |
| Duodenal motility study CPT 91022 | not published | not published | $96.18 – $124.98 | 3 |
| Duplex scan bilateral study 93985 CPT 93985 | not published | not published | $172.93 – $282.29 | 2 |
| Duplex scan unilateral study 93986 CPT 93986 | not published | not published | $102.12 – $133.87 | 2 |
| Dup scan/hemodialysis access 93990 CPT 93990 | not published | not published | $96.40 – $142.37 | 3 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | not published | not published | $115.49 – $188.54 | 3 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | not published | not published | $131.86 – $214.83 | 3 |
| Duragen 1x1 5ea/bx HCPCS C9354 | not published | not published | $22.80 – $22.80 | 1 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $83.87 – $91.98 | 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.