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 |
|---|---|---|---|---|
| Ghs IV infusion sotrovimab HCPCS M0247 | not published | not published | $466.39 – $466.39 | 1 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $590.24 | $908.06 | $360.79 – $360.79 | 1 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $255.27 | $392.72 | $135.93 – $172.62 | 2 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $842.52 | $1,296.18 | $110.05 – $171.33 | 2 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $842.52 | $1,296.18 | $106.78 – $166.40 | 2 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $842.52 | $1,296.18 | $123.19 – $191.73 | 2 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $842.52 | $1,296.18 | $142.69 – $228.11 | 2 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $912.66 | $1,404.09 | $139.31 – $224.20 | 2 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $841.68 | $1,294.90 | $154.49 – $243.99 | 2 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $842.52 | $1,296.18 | $148.48 – $232.02 | 2 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $1,287.29 | $1,980.44 | $157.16 – $240.54 | 2 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | not published | not published | $162.28 – $248.23 | 2 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $1,256.37 | $1,932.88 | $219.69 – $300.33 | 2 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | not published | not published | $240.47 – $337.44 | 2 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | not published | not published | $254.04 – $344.37 | 2 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | not published | not published | $285.50 – $427.85 | 2 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $280.22 – $383.48 | 2 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | not published | not published | $313.13 – $475.35 | 2 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $31.14 | $47.90 | $5.73 – $19.35 | 10 |
| Ghs low level laser therapy CPT 97039 | not published | not published | $10.60 – $14.00 | 2 |
| Ghs mbp CPT 83873 | $62.27 | $95.80 | $11.46 – $20.64 | 8 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $18.20 | $28.00 | $17.70 – $30.02 | 2 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $36.41 | $56.02 | $67.61 – $103.52 | 2 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $39.48 | $60.74 | $59.14 – $94.92 | 2 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $35.33 | $54.36 | $9.96 – $12.53 | 2 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $35.33 | $54.36 | $45.01 – $77.60 | 2 |
| Ghs musc test done w/n test comp CPT 95886 | not published | not published | $39.09 – $57.33 | 3 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $517.14 | $795.60 | $37.10 – $48.70 | 3 |
| Ghs musc tst done w/n tst non ext CPT 95887 | not published | not published | $39.75 – $51.80 | 3 |
| Ghs myocardial strain img spckl track CPT 93356 | $219.26 | $337.32 | $8.38 – $15.41 | 2 |
| Ghs nailbed repair/nail removal CPT 11760 | $1,256.37 | $1,932.88 | $85.80 – $128.37 | 2 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | not published | not published | $18.09 – $29.26 | 2 |
| Ghs nerve blk intercostal, single level CPT 64420 | $648.41 | $997.55 | $43.71 – $69.20 | 2 |
| Ghs nerve block axillary nerve CPT 64417 | $2,053.63 | $3,159.43 | $51.13 – $71.13 | 2 |
| Ghs nerve block brachial plexus CPT 64415 | $1,665.09 | $2,561.68 | $55.55 – $74.02 | 2 |
| Ghs nerve block celiac plexus CPT 64530 | not published | not published | $71.01 – $104.01 | 2 |
| Ghs nerve block interscaline CPT 64510 | $1,665.09 | $2,561.68 | $57.96 – $84.18 | 2 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | not published | not published | $63.81 – $92.20 | 2 |
| Ghs nerve block sciatic nerve CPT 64445 | $1,041.62 | $1,602.49 | $54.92 – $62.84 | 2 |
| Ghs nerve block suprascapular CPT 64418 | $743.36 | $1,143.63 | $40.05 – $64.52 | 2 |
| Ghs ng placement w fluoro guidance CPT 43752 | $335.39 | $515.99 | $28.60 – $52.45 | 2 |
| Ghs o2 saturation CPT 82810 | $31.58 | $48.58 | $6.51 – $21.98 | 10 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $36.97 – $48.40 | 3 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $39.77 – $51.64 | 3 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,285.65 | $1,977.93 | $24.72 – $39.49 | 2 |
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $139.60 – $206.16 | 2 |
| Ghs optokenetic CPT 92544 | not published | not published | $2.93 – $23.68 | 3 |
| Ghs oscillating trac CPT 92545 | not published | not published | $2.93 – $22.66 | 3 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $73.40 | $112.92 | $16.54 – $32.34 | 2 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | not published | not published | $24.99 – $48.96 | 2 |
| Ghs ot dds rom CPT 95851 | not published | not published | $5.62 – $8.36 | 2 |
| Ghs ot group caregiver training CPT 97552 | $15.56 | $23.94 | $7.90 – $21.57 | 2 |
| Ghs ot prosthetic training/15 min CPT 97761 | $130.62 | $200.95 | $33.67 – $34.87 | 3 |
| Ghs ot sensory integrative tech/15min CPT 97533 | not published | not published | $14.43 – $53.00 | 4 |
| Ghs ot work hardening-additional hours CPT 97546 | not published | not published | $25.68 – $49.23 | 2 |
| Ghs pacing - transcutaneous CPT 92953 | not published | not published | $0.77 – $1.16 | 2 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | not published | not published | $42.73 – $68.84 | 2 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | not published | not published | $37.68 – $59.68 | 2 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $129.18 | $198.74 | $3.51 – $19.39 | 5 |
| Ghs peritonsillar abscess i andd CPT 42700 | $586.66 | $902.56 | $105.28 – $151.38 | 2 |
| Ghs phenylketonurid CPT 84030 | $19.90 | $30.62 | $3.67 – $12.38 | 10 |
| Ghs picc line insert < 5 CPT 36568 | not published | not published | $69.61 – $105.14 | 2 |
| Ghs plngl fx pm cl CPT 26725 | $580.85 | $893.61 | $262.82 – $336.70 | 2 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $2.02 – $5.17 | 10 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | not published | not published | $724.23 – $1,022.43 | 3 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $3.21 – $28.11 | 3 |
| Ghs ppd (tb intradermal) CPT 86580 | $54.85 | $84.38 | $6.45 – $8.94 | 2 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $34.97 | $53.80 | $6.43 – $21.74 | 10 |
| Ghs protein, misc fluid CPT 84160 | $14.92 | $22.95 | $1.74 – $11.43 | 10 |
| Ghs protoporphyrins fract CPT 84202 | $51.92 | $79.87 | $9.09 – $20.45 | 10 |
| Ghs pr without cont pulse ox CPT 94625 | $139.96 | $215.32 | $13.54 – $19.07 | 2 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $44.32 | $68.19 | $8.16 – $14.70 | 8 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | not published | not published | $49.23 – $64.34 | 2 |
| Ghs quinidine CPT 80194 | not published | not published | $9.73 – $23.87 | 10 |
| Ghs refill of implantable pump CPT 95990 | not published | not published | $79.88 – $97.21 | 2 |
| Ghs removal intranasal foreign body CPT 30300 | $255.27 | $392.72 | $94.81 – $125.38 | 2 |
| Ghs removal pharyngeal foreign body CPT 42809 | $766.19 | $1,178.75 | $96.12 – $137.67 | 2 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | not published | not published | $489.31 – $640.02 | 2 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | not published | not published | $384.97 – $545.59 | 2 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $8.11 – $19.07 | 10 |
| Ghs reticulocyte count CPT 85044 | $15.60 | $24.00 | $1.44 – $5.17 | 10 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $43.39 | $66.75 | $8.11 – $18.25 | 10 |
| Ghs sedimentation rate CPT 85651 | $12.84 | $19.75 | $2.02 – $5.12 | 10 |
| Ghs semen analysis fert CPT 89320 | not published | not published | $8.20 – $14.77 | 8 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $5.98 – $11.81 | 8 |
| Ghs sensitivity (per antimicro) CPT 87184 | $24.96 | $38.40 | $4.98 – $14.98 | 10 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $842.52 | $1,296.18 | $73.11 – $105.89 | 2 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $912.66 | $1,404.09 | $99.30 – $143.21 | 2 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $842.52 | $1,296.18 | $88.96 – $129.93 | 2 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $842.52 | $1,296.18 | $124.99 – $169.22 | 2 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $444.52 | $683.87 | $58.58 – $83.55 | 2 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $444.52 | $683.87 | $58.61 – $81.76 | 2 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $444.52 | $683.87 | $73.33 – $105.12 | 2 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $444.52 | $683.87 | $109.09 – $161.53 | 2 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | not published | not published | $140.99 – $191.73 | 2 |
| Ghs sleep study unattended CPT 95800 | not published | not published | $83.64 – $206.59 | 3 |
| Ghs somatosensory testing lower extremit CPT 95926 | not published | not published | $89.57 – $124.51 | 3 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | not published | not published | $245.91 – $319.17 | 3 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $157.50 | $242.31 | $40.02 – $60.69 | 3 |
| Ghs sphenopalatine ganglion block CPT 64505 | not published | not published | $78.90 – $105.96 | 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.