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 |
|---|---|---|---|---|
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $133.05 – $392.50 | 4 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | not published | not published | $149.13 – $417.50 | 4 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | not published | not published | $143.67 – $147.24 | 2 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | not published | not published | $67.02 – $423.90 | 5 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $105.11 – $127.23 | 2 |
| Peginesatide injection HCPCS J0890 | not published | not published | $10.38 – $10.38 | 1 |
| Peg interferon alfa-2a/180 HCPCS S0145 | not published | not published | $831.86 – $1,225.79 | 3 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | $8,118.07 | $12,489.34 | $1,499.74 – $3,999.78 | 4 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $225.66 – $226.93 | 3 |
| Pelv band/spread bar thigh c HCPCS L1640 | not published | not published | $619.54 – $619.54 | 5 |
| Pelvic band & belt thigh fla HCPCS L2192 | not published | not published | $522.88 – $522.88 | 5 |
| Pelvic control band & belt b HCPCS L2640 | not published | not published | $514.89 – $514.89 | 5 |
| Pelvic control band & belt u HCPCS L2630 | not published | not published | $346.53 – $346.53 | 5 |
| Pelvic control hip heavy dut HCPCS L2620 | not published | not published | $409.67 – $409.67 | 5 |
| Pelvic control pelvic sling HCPCS L2580 | $955.25 | $1,469.61 | $611.91 – $611.91 | 5 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $799.16 | $1,229.47 | $158.68 – $303.02 | 3 |
| Pelvic CT scan (with contrast) CPT 72193 | $799.16 | $1,229.47 | $140.67 – $226.50 | 3 |
| Pelvic CT scan (without contrast) CPT 72192 | $499.36 | $768.24 | $67.60 – $137.57 | 3 |
| Pelvic exenteration CPT 45126 | not published | not published | $2,038.22 – $3,548.99 | 2 |
| Pelvic & hip control thigh c HCPCS L1680 | not published | not published | $1,400.11 – $1,400.11 | 5 |
| Pelvic MRI (with and without contrast) CPT 72197 | $1,510.60 | $2,324.00 | $189.99 – $345.01 | 3 |
| Pelvic MRI (with contrast) CPT 72196 | not published | not published | $153.97 – $273.49 | 3 |
| Pelvic MRI (without contrast) CPT 72195 | $956.04 | $1,470.83 | $131.12 – $262.50 | 3 |
| Pelvic ring fracture uni/bil HCPCS G0413 | $10,372.22 | $15,957.26 | $797.91 – $1,225.92 | 2 |
| Pelvic ring fx treat int fix HCPCS G0414 | not published | not published | $754.01 – $1,159.16 | 2 |
| Pelvic Ultrasound (complete) CPT 76856 | $323.71 | $498.02 | $59.42 – $85.87 | 3 |
| Pelvic Ultrasound (limited) CPT 76857 | $323.71 | $498.02 | $22.31 – $45.40 | 3 |
| Pelvis X-ray (1 to 2 views) CPT 72170 | $275.16 | $423.33 | $16.03 – $21.97 | 3 |
| Pelvis X-ray (complete, 4 or more views) CPT 72190 | $275.16 | $423.33 | $25.31 – $31.47 | 3 |
| Pelv & thor control gluteal HCPCS L2650 | not published | not published | $141.61 – $141.61 | 5 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | not published | not published | $50.26 – $64.10 | 4 |
| Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 | not published | not published | $3.59 – $19.08 | 4 |
| Peng benzathine/procaine inj HCPCS J0558 | $39.88 | $61.36 | $7.25 – $19.52 | 4 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $62.04 | $95.44 | $9.16 – $32.59 | 4 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | not published | not published | $0.64 – $1.83 | 4 |
| Penicillin g procaine inj HCPCS J2510 | not published | not published | $24.78 – $50.12 | 3 |
| Penile injection CPT 54235 | not published | not published | $56.27 – $82.90 | 2 |
| Penile vascular study CPT 93980 | not published | not published | $49.86 – $113.26 | 3 |
| Penile vascular study CPT 93981 | not published | not published | $42.77 – $98.62 | 3 |
| Penile venous occlusion CPT 37790 | not published | not published | $365.52 – $553.71 | 2 |
| Penis plastic surgery CPT 54360 | not published | not published | $539.96 – $819.43 | 2 |
| Penis study CPT 54240 | not published | not published | $35.26 – $42.05 | 3 |
| Pentamidine 300 mg solution for injection HCPCS J2516 | not published | not published | $0.16 – $0.24 | 2 |
| Pentamidine non-comp unit HCPCS J2545 | not published | not published | $69.73 – $180.50 | 4 |
| Pentastarch 10% solution HCPCS J2513 | not published | not published | $12.72 – $12.72 | 1 |
| Pentazocine injection HCPCS J3070 | not published | not published | $98.16 – $98.16 | 1 |
| Pentobarbital sodium inj HCPCS J2515 | not published | not published | $44.79 – $54.17 | 3 |
| Pentostatin 10 mg intravenous solution HCPCS J9268 | not published | not published | $1,782.81 – $2,926.88 | 4 |
| Perc cryo ablate renal tum CPT 50593 | not published | not published | $331.52 – $527.58 | 2 |
| Perc d-e cor revasc chro sin HCPCS C9607 | not published | not published | $731.72 – $731.72 | 1 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | not published | not published | $650.59 – $650.59 | 1 |
| Perc d-e cor stent ather s HCPCS C9602 | not published | not published | $730.12 – $730.12 | 1 |
| Perc drug-el cor stent sing HCPCS C9600 | not published | not published | $651.39 – $651.39 | 1 |
| Perc rf ablate renal tumor CPT 50592 | not published | not published | $247.42 – $392.74 | 2 |
| Percut ablate liver rf CPT 47382 | not published | not published | $532.73 – $852.56 | 2 |
| Percutaneous islet celltrans HCPCS G0341 | not published | not published | $235.42 – $399.41 | 2 |
| Perflutren lipid microspheres 1.1 mg/ml intravenous suspension HCPCS Q9957 | $86.61 | $133.25 | $40.21 – $171.64 | 4 |
| Pericardial drain w/cath pq w/ct guid CPT 33019 | $3,377.96 | $5,196.86 | $148.93 – $255.71 | 2 |
| Pericardiectomy/sub or com/w bypas 33031 CPT 33031 | not published | not published | $1,874.46 – $2,735.21 | 2 |
| Pericardiocentesis wwo imaging CPT 33016 | $3,377.96 | $5,196.86 | $165.87 – $265.61 | 2 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | not published | not published | $636.03 – $968.11 | 2 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $531.41 – $819.94 | 2 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $197.99 – $284.73 | 2 |
| Peripheral vascular rehab CPT 93668 | $167.65 | $257.93 | $12.48 – $18.57 | 3 |
| Peri-proc device eval icd CPT 93287 | not published | not published | $12.78 – $36.07 | 3 |
| Peri-proc device eval pm CPT 93286 | not published | not published | $11.76 – $36.07 | 3 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $318.45 – $491.85 | 2 |
| Peritoneogram rs&i CPT 74190 | not published | not published | $60.31 – $217.15 | 2 |
| Perit-vens shunt pat tst CPT 78291 | not published | not published | $156.62 – $240.78 | 3 |
| Peroneal straps pair pre ots HCPCS L0980 | not published | not published | $20.07 – $20.07 | 5 |
| Perp bk ptb thermopls direct HCPCS L5520 | not published | not published | $2,150.91 – $2,150.91 | 5 |
| Perphenazine 4mg oral HCPCS Q0175 | not published | not published | $0.45 – $0.65 | 3 |
| Perphenazine injeciton HCPCS J3310 | not published | not published | $6.01 – $6.01 | 1 |
| Perq art m-thrombect &/nfs CPT 61645 | not published | not published | $607.97 – $927.53 | 2 |
| Perq clsr tcat l atr apndge CPT 33340 | not published | not published | $503.06 – $880.10 | 2 |
| Perq dev breast 1st mr guide CPT 19287 | not published | not published | $88.45 – $146.56 | 2 |
| Perq dev breast 1st strtctc CPT 19283 | not published | not published | $70.08 – $115.41 | 2 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | not published | not published | $829.15 – $1,452.87 | 2 |
| Perq nl/pl lithotrp smpl<2cm CPT 50080 | $9,442.38 | $14,526.74 | $519.88 – $988.64 | 2 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $622.00 – $860.24 | 2 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $527.24 – $729.91 | 2 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $546.19 – $755.59 | 2 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $415.27 – $574.86 | 2 |
| Perq p-art revsc each addl CPT 33904 | not published | not published | $208.64 – $288.69 | 2 |
| Perq plmt bile duct stent CPT 47538 | not published | not published | $168.20 – $272.18 | 2 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $304.85 – $486.54 | 2 |
| Perq plmt bile duct stent CPT 47540 | not published | not published | $313.37 – $507.67 | 2 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $259.28 | $398.89 | $67.93 – $106.87 | 2 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $426.68 – $587.71 | 2 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $387.08 – $540.60 | 2 |
| Perq transcath closure each CPT 93592 | not published | not published | $274.53 – $516.25 | 2 |
| Perq transcath closure pda CPT 93582 | not published | not published | $463.78 – $844.42 | 2 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $629.78 – $1,164.88 | 2 |
| Perq transcath cls mitral CPT 93590 | not published | not published | $763.43 – $1,413.85 | 2 |
| Perq transcath septal reduxn CPT 93583 | not published | not published | $520.22 – $942.92 | 2 |
| Perq trluml angp nt/recr coa CPT 33897 | not published | not published | $407.13 – $579.51 | 2 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | $229.42 – $273.52 | 2 |
| Perq tx malar fracture CPT 21355 | not published | not published | $242.24 – $357.74 | 2 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $376.10 – $492.55 | 2 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $543.74 – $832.50 | 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.