WESTFIELD MEMORIAL HOSPITAL INC
189 EAST MAIN STREET, WESTFIELD, NY · Ahn · · NPI 1942236427
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 sensitivity (per antimicro) CPT 87184 | $39.00 | $50.00 | $4.38 – $12.80 | 15 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $935.22 | $1,199.00 | $76.38 – $515.34 | 15 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $1,169.22 | $1,499.00 | $96.60 – $515.34 | 15 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $1,169.22 | $1,499.00 | $83.01 – $515.34 | 15 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $1,169.22 | $1,499.00 | $96.60 – $515.34 | 15 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $581.88 | $746.00 | $49.88 – $256.30 | 15 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $581.88 | $746.00 | $50.93 – $256.30 | 15 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $581.88 | $746.00 | $64.58 – $256.30 | 15 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $581.88 | $746.00 | $19.32 – $256.30 | 15 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $464.88 | $596.00 | $19.32 – $277.99 | 15 |
| Ghs sleep study unattended CPT 95800 | $23.76 | $108.00 | $32.19 – $201.81 | 15 |
| Ghs somatosensory testing lower extremit CPT 95926 | $16.06 | $73.00 | $22.14 – $401.66 | 15 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $27.50 | $125.00 | $35.79 – $684.40 | 15 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | not published | not published | $40.09 – $77.10 | 4 |
| Ghs sphenopalatine ganglion block CPT 64505 | $691.08 | $886.00 | $57.23 – $380.75 | 15 |
| Ghs spont nystagmus CPT 92541 | $12.76 | $58.00 | $3.43 – $166.26 | 15 |
| Ghs sp train/fitting sp device - kx CPT 92609 | not published | not published | $70.55 – $163.77 | 12 |
| Ghs st - eval for alt comm CPT 92567 | $6.60 | $30.00 | $8.82 – $50.63 | 15 |
| Ghs strapping shoulder - 29240 CPT 29240 | $11.00 | $50.00 | $14.67 – $166.26 | 15 |
| Ghs st - re-eval for alt comm CPT 92597 | not published | not published | $50.09 – $115.48 | 12 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $13.09 – $59.51 | 15 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $113.97 – $271.76 | 15 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,432.86 | $1,837.00 | $15.33 – $789.56 | 15 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $935.22 | $1,199.00 | $11.49 – $515.34 | 15 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $196.02 | $891.00 | $215.47 – $1,910.65 | 15 |
| Ghs trypsin (fecal) CPT 84488 | $4.84 | $22.00 | $4.64 – $16.14 | 15 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $701.22 | $899.00 | $23.08 – $449.00 | 15 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $150.04 | $682.00 | $19.57 – $387.02 | 15 |
| Ghs urine, hydroxproline total CPT 83505 | $15.84 | $72.00 | $15.45 – $40.00 | 15 |
| Ghs urine, porphyrins quant CPT 84120 | $9.68 | $44.00 | $7.50 – $16.03 | 15 |
| Ghs vaginal delivery only CPT 59409 | $6,509.88 | $8,346.00 | $641.43 – $4,101.16 | 14 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $1,086.54 | $1,393.00 | $320.29 – $1,391.46 | 15 |
| Ghs windowing of cast CPT 29730 | $27.50 | $125.00 | $17.59 – $203.53 | 15 |
| Giardia ag if CPT 87269 | $8.80 | $40.00 | $8.99 – $19.70 | 15 |
| Giardia lamblia antibody CPT 86674 | $9.68 | $44.00 | $6.21 – $16.04 | 12 |
| Gi endoscopic ultrasound CPT 76975 | $24.86 | $113.00 | $33.21 – $311.79 | 15 |
| Gi inhouse confirmation CPT 87045 | $49.92 | $64.00 | $6.00 – $11.04 | 15 |
| Gingivoplasty each quadrant CPT 41872 | $188.76 | $858.00 | $22.37 – $4,183.11 | 12 |
| Gi protein loss CPT 78282 | $9.46 | $43.00 | $12.57 – $518.31 | 15 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $68.20 | $310.00 | $91.41 – $1,209.32 | 15 |
| Gi trc img intral colon i&r CPT 91113 | $73.70 | $335.00 | $98.58 – $1,175.98 | 12 |
| Gi trc img intral esophagus CPT 91111 | $27.50 | $125.00 | $36.83 – $1,209.32 | 12 |
| Gi wireless capsule measure CPT 91112 | $64.02 | $291.00 | $85.84 – $1,209.32 | 12 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $66.74 – $110.22 | 12 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $40.60 – $67.06 | 12 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $23.10 – $38.15 | 12 |
| Glassia injection HCPCS J0257 | not published | not published | $4.15 – $8.08 | 15 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $14.78 – $51.81 | 11 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $23.69 – $50.63 | 11 |
| Glaucoma surgery CPT 66150 | $528.66 | $2,403.00 | $71.18 – $5,188.94 | 15 |
| Glaucoma surgery CPT 66155 | $528.22 | $2,401.00 | $71.15 – $5,188.94 | 15 |
| Glaucoma surgery CPT 66160 | $594.44 | $2,702.00 | $79.97 – $2,941.83 | 15 |
| Glaucoma surgery CPT 66170 | $660.22 | $3,001.00 | $88.70 – $2,941.83 | 15 |
| Glove finger flexion right lg xl HCPCS L3912 | not published | not published | $60.46 – $140.03 | 11 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $132.13 | $600.60 | $142.26 – $277.04 | 15 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | not published | not published | $105.27 – $205.01 | 15 |
| Glucagon plasma - sendout CPT 82943 | $9.24 | $42.00 | $9.09 – $31.60 | 15 |
| Glucagon tolerance panel CPT 80422 | $30.36 | $138.00 | $29.30 – $101.90 | 15 |
| Glucagon tolerance panel CPT 80424 | $33.44 | $152.00 | $29.11 – $111.68 | 15 |
| Glucagon tolerance test CPT 82946 | $11.88 | $54.00 | $9.58 – $33.33 | 15 |
| Glucose 1 hr post dose CPT 82950 | $24.96 | $32.00 | $2.78 – $10.45 | 15 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $3.96 | $18.00 | $3.61 – $12.80 | 15 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $17.94 | $23.00 | $2.00 – $3.58 | 15 |
| Glucose blood quantitative CPT 82947 | $20.28 | $26.00 | $2.49 – $6.40 | 15 |
| Glucose body fluid CPT 82945 | $20.28 | $26.00 | $2.60 – $6.94 | 15 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $35.86 – $99.74 | 15 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $67.86 | $87.00 | $7.33 – $20.00 | 15 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $20.28 | $26.00 | $2.49 – $5.23 | 15 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | not published | not published | $0.31 – $0.61 | 15 |
| Gold sodium thiomaleate inj HCPCS J1600 | not published | not published | $12.04 – $30.15 | 3 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | not published | not published | $8.01 – $15.61 | 15 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $97.50 | $125.00 | $11.82 – $28.00 | 15 |
| Gonadotropin hormone panel CPT 80426 | $98.12 | $446.00 | $94.37 – $328.26 | 15 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $97.50 | $125.00 | $11.78 – $27.20 | 15 |
| Gonioscopy CPT 92020 | $12.32 | $56.00 | $16.58 – $166.26 | 15 |
| Goniotomy CPT 65820 | $492.58 | $2,239.00 | $66.75 – $5,188.94 | 15 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | not published | not published | $533.43 – $1,038.82 | 15 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | not published | not published | $28.59 – $42.88 | 8 |
| Graft bone flex 2.5cm x 5cm grafton-cost per sq cm HCPCS Q4205 | not published | not published | $1,123.06 – $1,684.47 | 8 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | not published | not published | $62.56 – $98.48 | 8 |
| Graft hand or finger tendon CPT 26416 | $563.42 | $2,561.00 | $75.21 – $4,185.10 | 15 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | not published | not published | $31.11 – $40.60 | 3 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | not published | not published | $762.88 – $2,606.74 | 4 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | not published | not published | $44.17 – $44.17 | 1 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $283.85 | $1,290.25 | $660.15 – $660.15 | 1 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | not published | not published | $61.70 – $92.55 | 8 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $712.92 | $914.00 | $92.96 – $139.44 | 8 |
| Graft repair of spine defect 63710 CPT 63710 | $676.72 | $3,076.00 | $96.57 – $1,736.01 | 7 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | not published | not published | $128.47 – $192.69 | 8 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | not published | not published | $46.09 – $69.12 | 8 |
| Graft tis hmatrix dermis 10x5 -cost per sq cm HCPCS Q4134 | not published | not published | $162.08 – $211.51 | 2 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | not published | not published | $43.59 – $178.59 | 8 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $1,430.00 | $6,500.00 | $54.52 – $54.52 | 1 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | not published | not published | $73.44 – $73.44 | 1 |
| Granisetron 1 mg tab HCPCS Q0166 | not published | not published | $3.06 – $4.03 | 4 |
| Granisetron hcl injection HCPCS J1626 | not published | not published | $0.21 – $0.32 | 8 |
| Granulocyte pheresis ea unit HCPCS P9050 | not published | not published | $660.00 – $660.00 | 1 |
| Great toe-hand transfer CPT 26551 | $2,024.66 | $9,203.00 | $210.00 – $5,222.66 | 7 |
| Great toe with reduction 28495 CPT 28495 | $701.22 | $899.00 | $12.53 – $309.41 | 15 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | $311.08 | $1,414.00 | $40.84 – $2,359.45 | 15 |
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.