Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price I & D ABSCESS SIMPLE/SINGLE $ 530.00 I&D ABSC; SMPL OR SGL $ 530.00 I&D ABSC; SMPL OR SGL $ 530.00 INC/REM FOR BODY SUBCUT SIMPLE $ 940.00 INC & REM FB SQ; SMPL $ 940.00 INC/REM FOR BODY SUBCUT COMPLE $ 4,415.00 INC & REM FB SQ; COMPL $ 4,415.00 DEB SUBQ TISSUE ADD-ON =<20 SQ CM $ 90.00 DEB SUBQ TISSUE ADD-ON =<20 SQ CM $ 90.00 EXC BEN LES T/A/L; 2.1-3.0CM $ 1,738.00 EXC BEN LES T/A/L; 2.1-3.0CM $ 1,738.00 DEBRIDEMENT OF NAIL $ 168.00 DEBRIDE NAIL 1-5 $ 168.00 DEBRIDE NAIL 6 OR MORE $ 168.00 DEBRIDE NAIL 6 OR MORE $ 168.00 SINGLE NAIL AVULSION $ 530.00 AVULSION OF NAIL PLATE,SIMPLE, SINGLE $ 530.00 NAIL AVULSION EACH ADDITIONAL $ 60.00 SPL AVULSE NP; EA ADDTL $ 60.00 EVACUATION SUBUNGUAL HEMATOMA $ 320.00 EVAC SU HEMATOMA $ 320.00 REMOVAL OF NAIL BED $ 940.00 REMOVAL OF NAIL BED RIGHT $ 940.00 REMOVAL OF NAIL BED LEFT $ 940.00 REPAIR NAIL BED $ 1,449.00 REPAIR NAIL BED $ 1,449.00 ER SIMPLE <2.5 CM LACERATION $ 529.00 SREP S/N/A/G/TR/E; 2.5CM/< $ 529.00 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING $ 942.00 TX OF SUPERFICIAL WOUND DEHISCENC W PACK $ 942.00 FACIAL INTERMEDIATE REP <2.5CM $ 942.00 FACIAL INTERMEDIATE 0-2.5 CM $ 942.00 DRESS/DEBRIDE INIT W/O ANES SM $ 529.00 DRESS/DEBRID P-THICK BURN S $ 529.00 DRESS/DEBRID P-THICK BURN S $ 529.00 SIMPLE FOR BODY REMOVAL MUS/TE $ 4,127.00 REMOVAL OF FOREIGN BODY IN MUSCLE/TENDON $ 4,127.00 INJ SGL TENDON SHTH OR LIGAMENT $ 742.00 TENDON SHETH/LIGAMENT/CYST INJECTION $ 742.00 INJ SGL TENDON SHTH OR LIGAMENT $ 742.00 INJ TRIGGER POINT 1/2 MUSCL $ 742.00 INJ TRIGGER POINT 1/2 MUSCL $ 742.00 TRIGGER POINTS INJECTION $ 742.00 INJECT TRIGGER POINTS 3/> $ 742.00 Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price INJECT TRIGGER POINTS =/> 3 $ 742.00 INJECT TRIGGER POINTS =/> 3 $ 742.00 SMALL JOINT INJECTION/ASPIRATION $ 742.00 SMALL JOINT/BURSA INJ OR ASPIR $ 742.00 MEDIUM JOINT/BURSA INJ OR ASPIR $ 742.00 MEDIUM JOINT/BURSA INJ OR ASPIR $ 742.00 DRAIN/INJ INTERM JNT/BURSA $ 742.00 LARGE JOINT/BURSA INJ OR ASPIR $ 742.00 DRAIN/INJ MAJOR JNT/BURSA $ 742.00 GANGLION CYST INJECTION $ 742.00 GANGLION CYST INJ OR ASPIR $ 742.00 ASPIRATE/INJ GANGLION CYST $ 742.00 CLOSED TX SHOULDER DISLOCATION $ 700.00 CL TX SHLDR DISL W MANIP; W/O ANESTH $ 700.00 CLOSED TX RADIAL HEAD W/MANIP $ 675.00 CL TX RADIAL HD/NECK FX; WO MANIP- ER $ 675.00 CL TX RAD & ULN SHFT FX W/O MANI $ 675.00 CL TX OF RADIAL SHAFT FX; WO MANIP $ 675.00 CL TX RADIAL & ULNAR SHFT FX; WO MANIP $ 675.00 CLOSED TX RAD/ULN SHAF W/MANI $ 3,940.00 CL TX ULNAR SHFT FX W MANIP $ 3,940.00 CLTX DSTL RDL FX/EPIPHYSL SEP W MNP $ 3,940.00 CLTX DSTL RDL FX/EPIPHYSL SEP W MNP $ 3,940.00 CL TX MC FX SGL; W MANIP $ 675.00 CL TX MC FX SGL; W MANIP $ 675.00 CL TX MC FX SGL; W MANIP $ 675.00 CLOSED TX INTERPHAL JT DISLOCATION $ 675.00 CL TX IP JT D W MANIP W/O ANESTH $ 675.00 CL TX TIB SHFT FX W MANIP $ 3,940.00 CL TX TIB SHFT FX W MANIP $ 3,940.00 PARTIAL REMOVAL PHALANX OF TOE $ 7,870.00 PARTIAL EXC PHALANX TOE BONE $ 7,870.00 JT EXCISION PROX END PHALA $ 7,870.00 INTERPHALANG TOE JNT EXC EA SGL $ 7,870.00 REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANE $ 1,738.00 REM FB FOOT; SQ $ 1,738.00 CORRECTION OF HALLUX VALGUS $ 7,870.00 KELLER/MCBRIDE/MAYO BUNION CORRECT $ 7,870.00 CL TX FX PHALANX/PHALANG; W MANIP $ 675.00 CL TX FX PHALANX/PHALANG; W MANIP $ 675.00 APPLICATION SPLINT- LONG ARM $ 404.00 APPLICATION-LONG ARM SPLINT $ 404.00 LONG ARM SPLINTS APPLICATION $ 404.00 OT APPLY LONG ARM SPLINT $ 404.00 Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price APPLICATION LONG ARM SPLINT $ 404.00 SHORT ARM SPLINTS OR ONLY $ 319.00 SHORT ARM SPLINTS APPL STATIC $ 319.00 APPLICATION STATIC SPLINT- SHORT ARM $ 319.00 APPLIC-SHORT ARM SPLINT DYNAM $ 319.00 OT APPLY SHORT ARM SPLINT; DYNAMIC $ 319.00 APPLY SHORT ARM SPLINT; DYNAMIC $ 319.00 FINGER SPLINT APPLICATION $ 168.00 FINGER SPLINT APPLICATION $ 168.00 STRAPPING; SHOULDER $ 319.00 STRAPPING; SHOULDER $ 319.00 STRAPPING; ELBOW OR WRIST $ 96.00 STRAPPING ELBOW $ 96.00 APPLICATION LONG LEG SPLINT $ 404.00 LONG LEG SPLINT APPLICATION $ 404.00 APPLICATION SPLINT- SHORT LEG $ 404.00 APPLICATION SHORT LEG SPLINT $ 404.00 SHORT LEG SPLINT $ 404.00 APPLY SHORT LEG SPLINT $ 404.00 STRAPPING ANKLE $ 404.00 STRAP ANKLE OR FOOT $ 404.00 STRAPPING OF THE TOES $ 168.00 STRAPPING OF TOES $ 168.00 STRAPPING UNNA BOOT $ 404.00 UNNA BOOT STRAPPING $ 404.00 UNNA BOOT STRAPPING $ 404.00 STRAPPING UNNA BOOT CLINIC $ 404.00 APPLY MULTILAYER COMPRESS - LOWER LEG $ 404.00 APPLY MULTLAY COMPRS LWR LEG $ 404.00 RMVE CAST REMOVE FULL ARM OR LEG CAST $ 707.00 REMOVE FULL ARM OR LEG CAST $ 707.00 INTUBATION ET EMERGENT $ 618.00 INTUBATION MED SURG $ 618.00 MET PATH DRAW FEE $ 9.00 SPECIMEN COLLECTION $ 9.00 VENIPUNCT-HOMEBOUND $ 9.00 VENIPUNCTURE $ 9.00 ER VENIPUNCTURE FEE $ 9.00 TRANSFUSION-BLOOD OVER 4 HRS $ 1,149.00 BLOOD TRANSFUSION $ 1,149.00 TRANSFUSION BLOOD UP TO 2 HOURS $ 1,149.00 TRANSFUSION BLOOD UP TO 4 HOURS $ 1,149.00 TRANSFUSION BLOOD UP TO 6 HOURS $ 1,149.00 TRANSFUSION BLOODUP TO 8 HOURS $ 1,149.00 Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price BLOOD DRAW FROM PORT $ 319.00 DRAW BLOOD OFF VENOUS DEVICE $ 319.00 TOUNGUE LACERATION 2.5CM/LESS $ 618.00 TONGUE LACERATION 2.6 CM $ 618.00 GASTRIC LAVAGE INTUB $ 757.00 TX GASTRO INTUB W/ASP $ 757.00 INS TEMP BLADDER CATH (STRAIGHT CATH) $ 319.00 INSERT BLADDER CATHETER $ 319.00 INJ ANESTH ; GREATER OCCIPITAL NERVE $ 742.00 INJ ANESTH ; GREATER OCCIPITAL NERVE $ 742.00 INJ ANESTH AGENT PERIPH NERVE $ 1,796.00 INJ ANESTH; OTHR PERIPHERAL NRV/BRANCH $ 1,796.00 INJ PARAVERT F JNT L/S 3 LEV $ 171.00 INJ PARAVERT F JNT L/S 3 LEV $ 171.00 X-RAY EXAM OF FACIAL BONES <3 VIEWS $ 187.00 X-RAY EXAM OF FACIAL BONES <3 VIEWS $ 187.00 CT ORBIT/EAR/FOSSA W/O DYE $ 340.00 CT ORBIT/EAR/FOSSA W/O DYE $ 340.00 CT ORBIT/EAR/FOSSA W/DYE $ 605.00 CT ORBIT/EAR/FOSSA W/DYE $ 605.00 X-RAY EXAM OF BREASTBONE 3+ VIEWS $ 187.00 X-RAY EXAM OF BREASTBONE 3+ VIEWS $ 187.00 X-RAY EXAM OF LOWER SPINE $ 338.00 X-RAY EXAM OF LOWER SPINE $ 338.00 X-RAY EXAM OF SHOULDER 1 VIEW, RIGHT $ 186.00 X-RAY EXAM OF SHOULDER 1 VIEW, BILAT $ 342.00 X-RAY EXAM OF SHOULDER 2+ VIEWS, LEFT SIDE $ 187.00 X-RAY EXAM OF SHOULDER 2+ VIEWS, RIGHT SIDE $ 187.00 X-RAY EXAM OF SHOULDER 2+ VIEWS $ 187.00 X-RAY EXAM OF HUMERUS 2+ VIEWS, RIGHT $ 187.00 X-RAY EXAM OF HUMERUS 2+ VIEWS, LEFT $ 187.00 X-RAY EXAM OF HUMERUS 2+ VIEWS $ 187.00 X-RAY EXAM OF FOREARM 2 VIEWS, RIGHT $ 187.00 X-RAY EXAM OF FOREARM 2 VIEWS, LEFT $ 187.00 X-RAY EXAM OF FOREARM 2 VIEWS $ 187.00 X-RAY EXAM OF FOREARM 2 VIEWS, BILATERAL $ 187.00 X-RAY EXAM OF WRIST 2 VIEWS, LEFT $ 187.00 X-RAY EXAM OF WRIST 2 VIEWS, RIGHT $ 187.00 X-RAY EXAM OF WRIST 2 VIEWS, BILAT $ 187.00 X-RAY EXAM OF WRIST 3+ VIEWS, LEFT $ 187.00 X-RAY EXAM OF WRIST 3+ VIEWS, RIGHT $ 187.00 X-RAY EXAM OF WRIST 3+ VIEWS, BILAT $ 187.00 X-RAY EXAM OF ANKLE 2 VIEWS, RIGHT $ 187.00 X-RAY EXAM OF ANKLE 2 VIEWS, LEFT $ 187.00 Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price X-RAY EXAM OF ANKLE 2 VIEWS, BILAT $ 187.00 X-RAY EXAM OF ANKLE 2 VIEWS, BILAT $ 187.00 X-RAY EXAM OF ANKLE 3+ VIEWS, RIGHT $ 187.00 X-RAY EXAM OF ANKLE 3+ VIEWS, LEFT $ 187.00 X-RAY EXAM OF ANKLE 3+ VIEWS, BILAT $ 187.00 X-RAY EXAM OF FOOT; 3+ VIEWS, RIGHT $ 187.00 X-RAY EXAM OF FOOT; 3+ VIEWS, LEFT $ 187.00 X-RAY EXAM OF FOOT; 3+ VIEWS, BILAT $ 187.00 MRI LOWER EXT; ANY JOINT W/DYE $ 2,075.00 MRI LOWER EXT; ANY JOINT W/DYE $ 2,075.00 FLUID AND ABCESS DRAINAGE $ 391.00 ABSCESS DRAINAGE UNDER X-RAY $ 391.00 US EXAM ABDOM COMPLETE $ 600.00 US EXAM ABDOM COMPLETE $ 600.00 US ABDOMEN LIMITED $ 600.00 US OF GALLBLADDER $ 600.00 US ABDOMEN LIMITED $ 600.00 US EXAM ABDO BACK WALL LIM $ 500.00 US EXAM ABDO BACK WALL LIM $ 500.00 US XTR NON-VASC LMTD $ 338.00 US XTR NON-VASC LMTD $ 338.00 US GUIDED NEEDLE PLACEMENT $ 183.00 US GUIDED NEEDLE PLACEMENT $ 183.00 US GUIDED NEEDLE PLACEMENT $ 183.00 US GUIDED NEEDLE PLACEMENT $ 183.00 US GUIDED NEEDLE PLACEMENT $ 183.00 CARDIAC BLD POOL MUGA SCAN $ 1,060.00 MUGA; SGL W WM & EF $ 1,060.00 LUNG VENT AEROSOL ; MULTIPLE $ 1,367.00 LUNG VENTILATION/PERFUSION STUDY $ 1,367.00 LUNG PERF W VENTIL; RB W WO $ 1,367.00 LUNG PERF W VENTIL; SGL BRTH $ 1,367.00 DEPAKENE VALPROIC ACID $ 50.00 DEPAKOTE LEVEL/VALPORIC ACID (VALPORATE) $ 50.00 VANCOMUCIN PEAK $ 50.00 VANCOMUCIN THROUGH $ 50.00 VANCOMYCIN TROUGH $ 50.00 DRUG SCREEN $ 215.00 DRUG TEST PRSMV CHEM ANLYZR $ 215.00 ACETONE SEMI QUANT $ 30.00 SERUME KETONE $ 30.00 ALBUMIN URINE $ 23.00 ALBUMIN FLUID $ 23.00 OSMOLALITY FLUID $ 23.00 Ellenville Regional Hospital - List of Standard Charges 02.01.20 Description Price MICROALBUMIN URINE $ 21.00 MICROALBUMIN 24 HR URINE $ 21.00 ALPHA 1 ANTITRYPSIN $ 50.00 ALPHA I ANTITRYPSIN TOTAL $ 50.00 A-1 ANTITRYPSON $ 50.00 ALPHA FETO PROTEIN $ 62.00 LH-SERUM $ 62.00 LEUKEMIA/LYMPHOCYTE EVALUATION $ 62.00 AFP TUMOR MARKER SERUM $ 62.00 HEMO CARDS $ 13.00 OCCULT BLOOD-STOOL $ 13.00 CARBON DIOXIDE (CO2) $ 18.00 CARBOXY HGB $ 18.00 LAMOTRIGINE $ 72.00 MEXILETINE $ 72.00 NEURONTIN (GABAPENTIN) $ 72.00 COL CHROMOTOGRAPHY QUAL/QUAN $ 72.00 CC/MS; QUAN SS & MP $ 72.00 KEPPRA (LEVETIRACETAM) $ 72.00 ERYTHROPOIETIN-SERUM $ 70.00 ERYTHROPOIETIN -EPOGEN $ 70.00 FOLIC ACID; SERUM $ 54.00 FOLIC ACID (FOLATES) $ 54.00 IGA QUANT CSF $ 34.00 IMMUNOGLOB G CSF (IGG) $ 34.00 GLUCOSE BODY FLUID $ 15.00 GLUCOSE CSF $ 15.00 INSULIN TOLERANCE (3) $ 42.00 INSULIN $ 42.00 DIRECT LDL $ 35.00 LOW DENSITY LIPO PROTEIN $ 35.00