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 spont nystagmus CPT 92541 | not published | not published | $3.47 – $25.04 | 3 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $328.83 | $505.89 | $85.86 – $127.13 | 3 |
| Ghs st - eval for alt comm CPT 92567 | not published | not published | $7.31 – $12.37 | 2 |
| Ghs strapping shoulder - 29240 CPT 29240 | not published | not published | $13.03 – $21.57 | 3 |
| Ghs st - re-eval for alt comm CPT 92597 | $224.37 | $345.18 | $59.75 – $82.11 | 3 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $95.48 | $146.90 | $14.10 – $17.26 | 2 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $50.00 | $76.92 | $118.53 – $176.23 | 2 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,651.23 | $2,540.35 | $146.67 – $210.67 | 2 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $826.18 | $1,271.04 | $110.28 – $154.71 | 2 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | not published | not published | $228.33 – $360.55 | 2 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $4.87 – $8.76 | 8 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $529.65 | $814.84 | $244.21 – $302.48 | 2 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $212.48 – $262.78 | 2 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $16.20 – $54.68 | 10 |
| Ghs urine, porphyrins quant CPT 84120 | $53.23 | $81.89 | $9.80 – $33.10 | 10 |
| Ghs vaginal delivery only CPT 59409 | not published | not published | $581.82 – $939.15 | 2 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $522.17 – $522.17 | 1 |
| Ghs windowing of cast CPT 29730 | not published | not published | $31.85 – $49.51 | 2 |
| Giardia ag if CPT 87269 | $43.39 | $66.75 | $9.07 – $30.62 | 10 |
| Giardia lamblia antibody CPT 86674 | not published | not published | $9.81 – $33.12 | 10 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $71.62 – $144.28 | 2 |
| Gi inhouse confirmation CPT 87045 | $34.19 | $52.60 | $6.29 – $18.52 | 10 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $244.61 – $316.41 | 2 |
| Gi protein loss CPT 78282 | not published | not published | $59.83 – $225.81 | 2 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,569.26 | $2,414.24 | $559.07 – $937.06 | 3 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $700.90 – $802.14 | 2 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $683.83 – $961.41 | 3 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $1,049.79 – $1,911.32 | 3 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $61.28 – $121.34 | 8 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $36.70 – $73.82 | 8 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $17.32 – $42.00 | 8 |
| Glassia injection HCPCS J0257 | not published | not published | $4.70 – $7.20 | 4 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $53.16 – $72.92 | 2 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $33.20 – $52.83 | 2 |
| Glaucoma surgery CPT 66150 | not published | not published | $630.84 – $1,028.75 | 2 |
| Glaucoma surgery CPT 66155 | not published | not published | $630.55 – $1,027.91 | 2 |
| Glaucoma surgery CPT 66160 | not published | not published | $703.52 – $1,159.57 | 2 |
| Glaucoma surgery CPT 66170 | not published | not published | $778.32 – $1,284.46 | 2 |
| Glove finger flexion right lg xl HCPCS L3912 | $166.49 | $256.14 | $106.64 – $106.64 | 5 |
| Glucagon 1 mg solution for injection HCPCS J1610 | not published | not published | $117.33 – $204.60 | 4 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $129.28 – $199.50 | 4 |
| Glucagon plasma - sendout CPT 82943 | $51.72 | $79.57 | $9.52 – $32.15 | 10 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $30.70 – $55.28 | 8 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $33.65 – $60.60 | 8 |
| Glucagon tolerance test CPT 82946 | not published | not published | $11.84 – $21.32 | 8 |
| Glucose 1 hr post dose CPT 82950 | $17.18 | $26.43 | $3.17 – $10.69 | 10 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $19.70 | $30.31 | $3.03 – $7.26 | 10 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $9.62 | $14.80 | $2.18 – $3.94 | 8 |
| Glucose blood quantitative CPT 82947 | $14.21 | $21.86 | $2.62 – $8.84 | 10 |
| Glucose body fluid CPT 82945 | $14.21 | $21.86 | $2.62 – $8.84 | 10 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $139.95 | $215.31 | $56.75 – $72.73 | 2 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $46.58 | $71.66 | $6.91 – $15.55 | 10 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $14.19 | $21.83 | $1.41 – $4.70 | 10 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.36 – $0.51 | 3 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $10.84 – $10.84 | 1 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $81.81 | $125.86 | $10.77 – $47.98 | 4 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $67.23 | $103.43 | $12.38 – $41.80 | 10 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $98.90 – $333.92 | 10 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $67.00 | $103.08 | $12.34 – $41.67 | 10 |
| Gonioscopy CPT 92020 | not published | not published | $13.82 – $25.12 | 2 |
| Goniotomy CPT 65820 | not published | not published | $598.72 – $941.76 | 2 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $1,999.35 | $3,075.93 | $304.33 – $940.33 | 3 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $67.37 | $103.65 | $30.23 – $54.41 | 3 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $103.97 – $474.00 | 2 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $1,035.45 | $1,593.00 | $67.27 – $100.00 | 2 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $732.31 – $979.84 | 2 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | not published | not published | $36.60 – $103.97 | 2 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $278.27 – $935.00 | 3 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | not published | not published | $41.81 – $75.36 | 3 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $460.69 | $708.75 | $101.03 – $206.25 | 3 |
| Graft repair of spine defect 63710 CPT 63710 | not published | not published | $842.91 – $1,197.26 | 2 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $103.97 – $266.88 | 2 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $170.10 | $261.69 | $41.87 – $52.75 | 2 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $103.97 – $103.97 | 1 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | not published | not published | $103.97 – $103.97 | 1 |
| Graft viashield 2layer amnion patch 2x2cm-cost per sq cm HCPCS Q4211 | not published | not published | $103.97 – $103.97 | 1 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $103.97 – $352.00 | 2 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $4,134.08 | $6,360.12 | not published | 0 |
| Granisetron 1 mg tab HCPCS Q0166 | $2.60 | $4.00 | $2.88 – $3.60 | 3 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.15 – $1.14 | 4 |
| Granulocyte pheresis ea unit HCPCS P9050 | not published | not published | $621.86 – $621.86 | 1 |
| Great toe-hand transfer CPT 26551 | not published | not published | $2,427.09 – $3,647.55 | 2 |
| Great toe with reduction 28495 CPT 28495 | not published | not published | $127.01 – $167.89 | 2 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $372.74 – $543.90 | 2 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $387.64 – $537.84 | 2 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $103.47 – $158.96 | 2 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $371.31 – $541.78 | 2 |
| Ground mileage HCPCS A0425 | not published | not published | $7.91 – $7.91 | 1 |
| Group behave couns 2-10 HCPCS G0473 | not published | not published | $8.45 – $13.36 | 2 |
| Group health education CPT 99078 | not published | not published | $51.57 – $51.57 | 1 |
| Group mnt 2 or more 30 mins HCPCS G0271 | not published | not published | $10.39 – $21.42 | 2 |
| Group train without patient HCPCS G0543 | not published | not published | $7.90 – $16.80 | 2 |
| Growth hormone antibody CPT 86277 | not published | not published | $10.48 – $18.89 | 8 |
| Growth hormone panel CPT 80428 | not published | not published | $44.45 – $150.07 | 10 |
| Growth hormone panel CPT 80430 | not published | not published | $77.61 – $174.62 | 10 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $18.14 – $90.72 | 8 |
| Grp adapt bhv tx by phy/qhp CPT 97158 | not published | not published | $10.36 – $10.36 | 1 |
| Grp adapt bhv tx by tech CPT 97154 | not published | not published | $12.96 – $12.96 | 1 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $1,439.09 – $2,423.56 | 2 |
| Gstr rstcv oth/thn v-band CPT 43843 | not published | not published | $976.13 – $1,598.01 | 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.