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 |
|---|---|---|---|---|
| Pertussis ag if CPT 87265 | $43.39 | $66.75 | $7.99 – $18.25 | 10 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | not published | not published | $11.51 – $17.20 | 4 |
| Pertuzu, trastuzu, 10 mg HCPCS J9316 | not published | not published | $59.90 – $84.71 | 4 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $120.51 | $185.40 | $70.81 – $70.81 | 5 |
| Pessary reusable rub anytype HCPCS A4561 | $47.81 | $73.56 | $28.43 – $28.43 | 5 |
| Pet CT skull-mid thgh initial CPT 78815 | $3,047.23 | $4,688.05 | $875.00 – $1,523.93 | 2 |
| Pet CT whole body initial CPT 78816 | $2,854.55 | $4,391.62 | $875.00 – $1,523.93 | 2 |
| Pet fdg brain metoblic eval sb CPT 78608 | $3,047.23 | $4,688.05 | $875.00 – $1,523.93 | 2 |
| Pet image full body CPT 78813 | not published | not published | $875.00 – $1,523.93 | 2 |
| Pet image ltd area CPT 78811 | not published | not published | $875.00 – $1,344.36 | 2 |
| Pet image skull-thigh CPT 78812 | not published | not published | $875.00 – $1,523.93 | 2 |
| Pet image w/ct lmtd CPT 78814 | $2,854.55 | $4,391.62 | $875.00 – $1,523.93 | 2 |
| Pet not otherwise specified HCPCS G0235 | not published | not published | $875.00 – $875.00 | 1 |
| Pet scan brain perf study CPT 78609 | not published | not published | $85.24 – $875.00 | 2 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $152.13 | $234.05 | $16.09 – $21.57 | 3 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $187.00 | $287.69 | $24.02 – $32.20 | 3 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $131.16 | $201.78 | $8.08 – $10.83 | 3 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $219.81 – $316.83 | 2 |
| Pharmacologic management w/psytx CPT 90863 | not published | not published | $28.46 – $28.46 | 1 |
| Ph body fluid CPT 83986 | $12.95 | $19.93 | $2.17 – $4.30 | 8 |
| Phencyclidine (pcp) CPT 83992 | $224.64 | $345.60 | $13.59 – $19.15 | 2 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | not published | not published | $24.77 – $48.48 | 4 |
| Phenobarbital therapeutic drug level CPT 80184 | $44.86 | $69.01 | $10.20 – $23.87 | 10 |
| Phentolaine mesylate inj HCPCS J2760 | not published | not published | $174.90 – $545.86 | 4 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | not published | not published | $0.00 – $0.01 | 2 |
| Phenylep ketorolac opth soln HCPCS J1097 | not published | not published | $113.28 – $139.50 | 3 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | not published | not published | $0.52 – $1.02 | 4 |
| Phenytoin total therapeutic drug level CPT 80185 | $47.96 | $73.79 | $8.83 – $23.87 | 10 |
| Phlebotomy therapeutic CPT 99195 | $255.27 | $392.73 | $79.88 – $119.46 | 2 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | not published | not published | $199.56 – $317.19 | 2 |
| Phleb veins 1 extrm >20 stab CPT 37766 | not published | not published | $245.10 – $388.09 | 2 |
| Phone e/m phys/qhp 11-20 min CPT 99442 | $152.13 | $234.05 | $20.00 – $20.00 | 1 |
| Phone e/m phys/qhp 21-30 min CPT 99443 | $187.00 | $287.69 | $24.75 – $24.75 | 1 |
| Phone e/m phys/qhp 5-10 min CPT 99441 | $131.16 | $201.78 | $10.00 – $10.00 | 1 |
| Phosphorus CPT 84100 | $17.15 | $26.39 | $3.16 – $10.66 | 10 |
| Phosphorus 24 hour urine CPT 84105 | $18.74 | $28.83 | $3.86 – $11.43 | 10 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $93.73 – $114.70 | 2 |
| Photochemotherapy puva CPT 96912 | not published | not published | $79.27 – $97.32 | 2 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $120.13 – $139.42 | 2 |
| Photodynamic tx addl 15 min CPT 96571 | not published | not published | $19.54 – $32.87 | 2 |
| Photodynmc tx 30 min add-on CPT 96570 | not published | not published | $38.67 – $69.71 | 2 |
| Photo patch test CPT 95052 | not published | not published | $4.84 – $7.31 | 2 |
| Photopheresis CPT 36522 | not published | not published | $65.39 – $110.73 | 2 |
| Photosensitivity tests CPT 95056 | not published | not published | $42.16 – $51.29 | 2 |
| Phys blood bank serv authrj CPT 86079 | not published | not published | $33.08 – $34.64 | 3 |
| Phys blood bank serv reactj CPT 86078 | $176.32 | $271.26 | $33.31 – $34.64 | 3 |
| Phys blood bank serv xmatch CPT 86077 | $724.88 | $1,115.20 | $33.31 – $34.42 | 3 |
| Physical Therapy Evaluation (high complexity) CPT 97163 | $361.30 | $555.84 | $71.18 – $87.17 | 3 |
| Physical Therapy Evaluation (low complexity) CPT 97161 | $181.16 | $278.70 | $71.18 – $87.17 | 3 |
| Physical Therapy Evaluation (moderate complexity) CPT 97162 | $272.25 | $418.85 | $71.18 – $87.17 | 3 |
| Physical Therapy Re-Evaluation CPT 97164 | $181.16 | $278.70 | $48.84 – $58.02 | 3 |
| Physician standby services CPT 99360 | not published | not published | $76.51 – $76.51 | 1 |
| Phys review of motion tests CPT 96004 | not published | not published | $88.79 – $123.53 | 2 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | not published | not published | $2.45 – $6.45 | 4 |
| Piflu f-18, dia 1 millicurie HCPCS A9595 | not published | not published | $540.32 – $651.96 | 3 |
| Pik3ca gene trgt seq alys CPT 81309 | $647.35 | $995.93 | $166.55 – $329.80 | 8 |
| Pild/placebo control clin tr HCPCS G0276 | not published | not published | $298.01 – $418.63 | 2 |
| Pillow shldr abduc inflat univ HCPCS L3960 | not published | not published | $847.67 – $847.67 | 5 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $351.39 – $496.08 | 2 |
| Pin finger dislocation CPT 26776 | not published | not published | $355.70 – $493.08 | 2 |
| Pin finger fracture each CPT 26756 | not published | not published | $339.17 – $465.21 | 2 |
| Pin hand dislocation CPT 26676 | not published | not published | $399.95 – $560.50 | 2 |
| Pin knuckle dislocation CPT 26706 | not published | not published | $342.78 – $491.30 | 2 |
| Pin service 60m per month HCPCS G0023 | not published | not published | $37.23 – $79.53 | 2 |
| Pinworm exam CPT 87172 | $15.44 | $23.76 | $2.02 – $5.12 | 10 |
| Pinworm examinations HCPCS Q0113 | not published | not published | $2.85 – $5.12 | 8 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $1.62 | $2.50 | $1.09 – $3.60 | 4 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $386.13 – $695.38 | 8 |
| Place breast cath for rad CPT 19297 | not published | not published | $67.45 – $104.90 | 2 |
| Place breast rad tube/caths CPT 19298 | not published | not published | $220.25 – $358.08 | 2 |
| Place cath intracranial art CPT 36228 | not published | not published | $179.46 – $266.51 | 2 |
| Place cath xtrnl carotid CPT 36227 | not published | not published | $86.73 – $129.66 | 2 |
| Place cecostomy tube perc CPT 49442 | not published | not published | $148.43 – $238.65 | 2 |
| Place device/marker, non pro HCPCS C9728 | $3,245.38 | $4,992.90 | $203.62 – $203.62 | 1 |
| Place duod/jej tube perc CPT 49441 | not published | not published | $178.95 – $274.50 | 2 |
| Place endorectal app HCPCS C9725 | not published | not published | $836.94 – $836.94 | 1 |
| Place gastrostomy tube open 43832 CPT 43832 | not published | not published | $798.77 – $1,308.39 | 2 |
| Place gastrostomy tube perc CPT 49440 | $3,379.28 | $5,198.90 | $148.17 – $235.31 | 2 |
| Placement bile duct support CPT 47801 | not published | not published | $842.77 – $1,235.81 | 2 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $1,537.43 | $2,365.27 | $69.40 – $114.75 | 2 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $1,138.09 | $1,750.91 | $34.68 – $57.67 | 2 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $1,517.45 | $2,334.54 | $59.78 – $98.27 | 2 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $3,949.98 | $6,076.90 | $147.72 – $236.53 | 2 |
| Placement of drain pancreas CPT 48001 | not published | not published | $1,721.11 – $2,549.94 | 2 |
| Placement of seton CPT 46020 | not published | not published | $90.64 – $298.90 | 2 |
| Placement stent(s) intravascular transcatheter artery initial CPT 37236 | $15,408.82 | $23,705.87 | $317.00 – $497.24 | 2 |
| Place ndl musc/tis for right CPT 20555 | not published | not published | $233.54 – $372.10 | 2 |
| Place needles h&n for right CPT 41019 | not published | not published | $339.12 – $546.45 | 2 |
| Place needles pelvic for right CPT 55920 | not published | not published | $320.56 – $514.82 | 2 |
| Place non-slctv cath thoracic arta CPT 36221 | not published | not published | $144.55 – $222.76 | 2 |
| Placental lactogen CPT 83632 | $73.20 | $112.61 | $13.47 – $24.26 | 8 |
| Place po breast cath for rad CPT 19296 | not published | not published | $156.98 – $233.06 | 2 |
| Place right device/marker pros CPT 55876 | not published | not published | $75.30 – $114.51 | 2 |
| Place slctv cath carotd art uni CPT 36224 | $9,530.35 | $14,662.08 | $266.09 – $397.54 | 2 |
| Place slctv cath carotid/inom art excrn uni CPT 36222 | not published | not published | $204.40 – $314.20 | 2 |
| Place slctv cath carotid/inom art intcrn uni CPT 36223 | not published | not published | $238.80 – $350.57 | 2 |
| Place slctv cath subclavian art CPT 36225 | not published | not published | $236.48 – $349.37 | 2 |
| Place slctv cath vertebral art uni CPT 36226 | not published | not published | $264.19 – $392.71 | 2 |
| Plaelet rich plasma unit HCPCS P9020 | not published | not published | $435.30 – $435.30 | 1 |
| Plasma cryoprecipitate reduced each unit HCPCS P9044 | not published | not published | $16.01 – $34.46 | 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.