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 |
|---|---|---|---|---|
| Pvb thoracic cont infusion CPT 64463 | not published | not published | $64.01 – $96.18 | 2 |
| Pvb thoracic single inj site CPT 64461 | not published | not published | $59.99 – $90.58 | 2 |
| Pwr adpt pneum vad, rep veh HCPCS Q0504 | not published | not published | $824.68 – $824.68 | 5 |
| Pwr pck base combo vad, rep HCPCS Q0489 | not published | not published | $19,535.67 – $19,535.67 | 5 |
| Pyelotomy w/drg pyelostomy CPT 50125 | not published | not published | $729.89 – $1,117.57 | 2 |
| Pyelotomy w/exploration CPT 50120 | not published | not published | $706.00 – $1,079.63 | 2 |
| Pyelotomy w/removal calculus CPT 50130 | not published | not published | $766.32 – $1,174.52 | 2 |
| Pyloroplasty 43800 CPT 43800 | not published | not published | $706.75 – $1,173.17 | 2 |
| Pyridoxine hcl 100 mg HCPCS J3415 | not published | not published | $10.85 – $19.88 | 4 |
| Pyruvate CPT 84210 | $42.44 | $65.29 | $9.65 – $17.38 | 8 |
| Pyruvate kinase CPT 84220 | not published | not published | $6.29 – $21.24 | 10 |
| Quadrilateral brim HCPCS L2188 | not published | not published | $458.87 – $458.87 | 5 |
| Quan puplmtry phy/qhp uni/bi CPT 95919 | not published | not published | $5.38 – $5.89 | 2 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $859.59 | $1,322.44 | $185.21 – $297.23 | 3 |
| Quant diff pulm perf w/imaging CPT 78597 | not published | not published | $119.86 – $186.29 | 3 |
| Quest t3 uptake CPT 84479 | $23.40 | $36.00 | $3.33 – $7.76 | 10 |
| Quick disconn hook adapter o HCPCS L6628 | not published | not published | $586.48 – $586.48 | 5 |
| Quinupristin/dalfopristin HCPCS J2770 | not published | not published | $365.35 – $559.21 | 2 |
| Rabies ig heat-treated human im/subq 90376 CPT 90376 | not published | not published | $479.72 – $517.22 | 2 |
| Rabies ig ht&sol human im/sc CPT 90377 | $465.81 | $716.63 | $240.13 – $427.88 | 3 |
| Rabies immune globulin (pf) 300 unit/ml intramuscular solution CPT 90375 | not published | not published | $279.95 – $402.26 | 3 |
| Radial keratotomy CPT 65771 | not published | not published | $1,593.51 – $1,593.51 | 1 |
| Radiation handling CPT 77790 | not published | not published | $9.97 – $30.80 | 3 |
| Radiation physics consult CPT 77336 | $342.80 | $527.39 | $74.82 – $152.25 | 3 |
| Radiation therapy dose plan CPT 77300 | $342.80 | $527.39 | $28.04 – $38.67 | 3 |
| Radiation therapy management CPT 77431 | not published | not published | $88.59 – $180.27 | 3 |
| Radiation treatment aid(s) CPT 77332 | $342.80 | $527.39 | $13.85 – $28.18 | 3 |
| Radiation treatment aid(s) CPT 77333 | $342.80 | $527.39 | $17.55 – $98.33 | 3 |
| Radiation treatment aid(s) CPT 77334 | $880.61 | $1,354.79 | $53.96 – $91.80 | 3 |
| Radiation treatment delivery CPT 77401 | not published | not published | $25.38 – $45.18 | 2 |
| Radiation treatment delivery CPT 77402 | $338.86 | $521.33 | $66.99 – $150.31 | 3 |
| Radiation treatment delivery CPT 77412 | $598.61 | $920.94 | $233.17 – $361.90 | 3 |
| Radiation tx management x5 CPT 77427 | not published | not published | $162.63 – $330.94 | 3 |
| Radical abdominal hysterectomy 58210 CPT 58210 | not published | not published | $1,367.66 – $1,916.12 | 2 |
| Radical rescj tumor clavicle CPT 23200 | not published | not published | $1,113.79 – $1,683.83 | 2 |
| Radical rescj tumor prox hum CPT 23220 | not published | not published | $1,417.43 – $2,172.67 | 2 |
| Radical rescj tumor scapula CPT 23210 | not published | not published | $1,296.48 – $1,977.95 | 2 |
| Radical resection of elbow CPT 24149 | not published | not published | $890.84 – $1,310.92 | 2 |
| Radical resection sternum 21630 CPT 21630 | not published | not published | $958.70 – $1,366.42 | 2 |
| Radic resect abd tumor<5cm 22904 CPT 22904 | not published | not published | $801.56 – $1,170.42 | 2 |
| Radic resect shoulder tumor 5cm/> 23078 CPT 23078 | not published | not published | $1,079.05 – $1,594.52 | 2 |
| Radiesse injection HCPCS Q2026 | not published | not published | $56.48 – $56.48 | 1 |
| Radiofq trsmtr for implt neu HCPCS L8683 | $9,845.61 | $15,147.09 | $6,306.81 – $6,306.81 | 5 |
| Radiof trsmtr implt scrl neu HCPCS L8684 | not published | not published | $833.64 – $833.64 | 5 |
| Radiology port images(s) CPT 77417 | $27.80 | $42.77 | $12.34 – $14.82 | 2 |
| Radiotherapy dose plan imrt CPT 77301 | $3,221.39 | $4,955.98 | $1,256.54 – $1,687.24 | 3 |
| Radium ra223 dichl ther/uci HCPCS A9606 | $338.00 | $520.00 | $179.23 – $180.17 | 2 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | not published | not published | $191.28 – $315.96 | 3 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $3,219.59 | $4,953.21 | $421.04 – $647.28 | 3 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $3,219.59 | $4,953.21 | $442.32 – $900.08 | 3 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $2,146.40 | $3,302.15 | $233.78 – $355.58 | 3 |
| Radphm lcl tumor plr sgl day CPT 78800 | not published | not published | $145.58 – $237.47 | 3 |
| Radphm quant measure sgl area add-on CPT 78835 | not published | not published | $55.87 – $113.70 | 3 |
| Rad rescj tum dstl/shft hum CPT 24150 | not published | not published | $1,139.78 – $1,729.18 | 2 |
| Rad rescj tum shoulder<5 cm CPT 23077 | not published | not published | $855.89 – $1,259.63 | 2 |
| Rad rescj tum tiss a/e 5 cm+ CPT 24079 | not published | not published | $997.84 – $1,470.48 | 2 |
| Rad rescj tum tiss a/e <5cm CPT 24077 | not published | not published | $779.61 – $1,151.24 | 2 |
| Rad resec soft tis tum/ft/toe/<3cm 28046 CPT 28046 | not published | not published | $547.56 – $819.13 | 2 |
| Rad resect abd tumor 5 cm/> CPT 22905 | not published | not published | $1,006.99 – $1,478.65 | 2 |
| Rad resect hand tumor < 3 cm CPT 26117 | not published | not published | $567.47 – $827.47 | 2 |
| Rad resect hand tumor 3 cm/> CPT 26118 | not published | not published | $795.83 – $1,171.10 | 2 |
| Rad resection tum radial h/n CPT 24152 | not published | not published | $998.68 – $1,487.66 | 2 |
| Rad resect tumor/neck/ant thor/<5cm21557 CPT 21557 | not published | not published | $719.48 – $1,060.49 | 2 |
| Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 | not published | not published | $59.42 – $79.19 | 4 |
| Range of motion measurements CPT 95852 | not published | not published | $4.18 – $6.19 | 2 |
| Ranibizumab injection HCPCS J2778 | $823.88 | $1,267.50 | $51.09 – $468.00 | 4 |
| Rapid desensitization CPT 95180 | not published | not published | $73.34 – $112.54 | 2 |
| Rapid Strep Test CPT 87880 | $48.45 | $74.54 | $3.79 – $19.84 | 10 |
| Rasburicase 1.5 mg intravenous solution HCPCS J2783 | not published | not published | $255.06 – $405.05 | 4 |
| Ravulizumab-cwvz 100 mg/ml intravenous solution HCPCS J1303 | not published | not published | $220.32 – $256.16 | 4 |
| Rb82 rubidium HCPCS A9555 | not published | not published | $532.65 – $552.06 | 2 |
| Rbc count only automated CPT 85041 | $10.93 | $16.82 | $2.01 – $6.80 | 10 |
| Rbc deglycerolized each unit HCPCS P9039 | $562.09 | $864.76 | $310.93 – $310.93 | 1 |
| Rbc depletion of harvest CPT 38212 | not published | not published | $55.73 – $55.73 | 1 |
| Rbc irradiated each unit HCPCS P9038 | not published | not published | $127.99 – $127.99 | 1 |
| Rbc mechanical fragility CPT 85547 | not published | not published | $5.73 – $10.32 | 8 |
| Rbc osmotic fragility CPT 85555 | $24.19 | $37.21 | $4.98 – $16.81 | 10 |
| Rbc serum pretx incubj drugs CPT 86975 | not published | not published | $13.44 – $16.28 | 2 |
| Rcm img acquisj&i&r 1st les CPT 96931 | not published | not published | $135.37 – $171.64 | 2 |
| Rcm img acquisj&i&r ea addl CPT 96934 | not published | not published | $95.27 – $105.83 | 2 |
| Rcm img acquisj only 1st les CPT 96932 | not published | not published | $100.08 – $120.62 | 2 |
| Rcm img acquisj only ea addl CPT 96935 | not published | not published | $62.22 – $66.01 | 2 |
| Rcm i&r only 1st lesion CPT 96933 | not published | not published | $35.29 – $46.35 | 2 |
| Rcm i&r only ea addl lesion CPT 96936 | not published | not published | $33.05 – $44.20 | 2 |
| Rcnst bfrnt sp orb rm&lw fhd CPT 21175 | not published | not published | $1,582.23 – $2,476.88 | 2 |
| Rcnstj forehead w/autograft CPT 21180 | not published | not published | $1,224.95 – $1,903.91 | 2 |
| Rcnstj forehead with grafts CPT 21179 | not published | not published | $1,099.90 – $1,695.41 | 2 |
| Rcnstj mdfc lefort i 1 w/grf CPT 21145 | not published | not published | $1,145.84 – $1,794.69 | 2 |
| Rcnstj mdfc lefort i 2 w/grf CPT 21146 | not published | not published | $1,196.97 – $1,867.82 | 2 |
| Rcnstj mdfc lefort iii w/i CPT 21155 | not published | not published | $1,526.38 – $2,443.41 | 2 |
| Rcnstj mdfc lefort iii without i CPT 21154 | not published | not published | $1,379.60 – $2,202.28 | 2 |
| Rcnstj mdfc lefrtii w/b1 grf CPT 21151 | not published | not published | $1,280.79 – $2,047.23 | 2 |
| Rcnst mdfc lfrtiii advm w/i CPT 21160 | not published | not published | $1,973.42 – $3,177.12 | 2 |
| Rcnst mdfc lfrtiii advm wo i CPT 21159 | not published | not published | $1,822.46 – $2,929.01 | 2 |
| Rdctj forehead cntrg only CPT 21137 | not published | not published | $560.89 – $839.54 | 2 |
| Rdctj forehead cntrg&prostc CPT 21138 | not published | not published | $676.81 – $1,025.36 | 2 |
| Rdctj forehead cntrg&setback CPT 21139 | not published | not published | $805.92 – $1,248.42 | 2 |
| Realignment of knee CPT 27457 | not published | not published | $718.06 – $1,069.23 | 2 |
| Realignment of knee CPT 27455 | not published | not published | $728.48 – $1,045.51 | 2 |
| Realignment of tendons CPT 26437 | not published | not published | $531.20 – $706.06 | 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.