Charge Information and Pricing Tool

To maximize our communications with the community and our patients; Princeton Community Hospital is providing the below price list which includes the most common charges for room and board, emergency services, surgical services, physical therapy and other ancillary departmental services. Charges are the same for all patients, but a patient’s responsibility may vary, dependent on individual insurance plans and coverage limitations within those plans. The pricing is correct as of July 2022.

Note: Physician fees are not included in the below pricing and estimates.

Medical, Surgical and Pediatric Private Room $525
Medical, Surgical and Pediatric Semi-Private Room $500
Telemetry Private Room $890
Telemetry Semi-Private Room $865
Women’s Center Obstetrics, Surgical & Medical Private Room $785
Women’s Center Obstetrics, Surgical & Medical Semi-Private Room $760
CCU Room $2,315
ICU Room $2,315
Behavioral Health Pavilion Room $1,995
Observation Per Hour $22

Surgery Related Charges are based on the time of the procedure and includes staff, equipment, room, overhead, and other items to perform the surgery. The below charges represent the charges either per minute or per 15 minutes for Surgery, Recovery, and Anesthesia. To obtain an ESTIMATE for a specific surgery performed by your attending physician, please contact our financial counseling services by calling (304) 431 – 5117. Please be advised the charges will vary from the estimate due to surgery time, physician performing, supply and medication requirements and other factors as each surgery case is independent. Physician fees are not included in these charges and will be billed separately.

Surgery  
   
Surgery time per minute $97
Intraoperative Cholangiography74300$1,344
Conscious Sedation 5 Years or Greater Initial 15 Mins99152$112
   
Other Common Surgical Procedures  
Removal of 1 or more breast growths, open procedure19120$12,428
Shaving of shoulder bone using an endoscope29826$22,703
Removal of one knee cartilage using an endoscope29881$12,122
Removal of tonsils & adenoid glands under 12 years42820$12,106
Diagnostic Exam of esophagus, stomach, and/or upper small bowel using and endoscope43235$9,920
Biopsy of the esophagus , stomach, or upper small bowel using and endoscope43239$4,998
Diagnostic examination of large bowel using and endoscope45378$4,039
Biopsy of large bowel using an endoscope45380$4,822
Removal of polyps or growths of large bowel using an endoscope45385$4,822
Removal of gallbladder using an endoscope47562$22,868
Repair of groin hernia under 5 years of age49505$13,003
Biopsy of prostate gland55700$13,986
Removal of cataract with insertion of lens66984$13,221
   
Recovery  
Recovery Room per each 15 minutes $333
   
Anesthesia  
Anesthesia time per minute $45

Emergency Department charges are based on the level of emergency care provided to our patients. The levels range from 1 – 5 and reflect personnel, resources, the intensity of care, and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required. Emergency Room Physician fees are not included in these charges and will be billed separately.

Emergency Room Level 199281$336
Emergency Room Level 299282$608
Emergency Room Level 399283$917
Emergency Room Level 499284$1,490
Emergency Room Level 599285$2,213
Critical Care99291$3,036
Trauma Activation with Critical CareG0390$2,271
CPR92950$1,002

The following charges reflect the hospital’s most common laboratory procedures. Physician fees for pathology services as applicable are not included and will be billed separately. The following charges reflect the hospital’s most common laboratory procedures. Physician fees for pathology services as applicable are not included and will be billed separately.

General Health Panel80050$305
Alt transaminase (SGPT)84460$49
Amylase, blood82150$63
AST SGOT84450$48
Basic metabolic80048$82
Blood drawing charge36415$22
BNP83880$326
BUN84520$39
CBC85025$74
CBC without diff85027$63
CKMB quantitative82553$87
Comp metabolic80053$102
CPK total82550$64
Creatinine blood82565$48
Electrolytes80051$57
Glucose random82947$39
Hematocrit85014$23
Hemoglobin85018$23
Hemoglobin A1C83036$93
Hepatic Function Panel80076$78
Lipase83690$67
Lipid80061$129
Magnesium83735$65
PT (prothrombin time85610$39
PTT/APTT85730$59
Sedimentation Rate85652$26
Sensitivity, MIC87186$83
T-3 uptake84479$63
T4, thyroxine84436$66
Troponin I84484$95
Thyroid stimulating hormone84443$161
Urinalysis routine (no micro)81003$22
Urine culture87086$78
Blood Administration36430$564
Collection of Blood from Venous Access Device36591$415
Basic Metabolic Panel80047$82
Acute Hepatitis Panel80074$437
Digoxin Total80162$128
Valproic Acid Total80164$84
Lithium80178$64
Vancomycin80202$84
Drug Screen Urine 10 Panel80307$394
Alcohols80320$192
Analgesics, Non-Opioid80329$192
Urinalysis with Microscopy81001$29
Urine Pregnancy Test81025$62
Ketone Body(s)82009$34
Albumin82040$47
Microalbumin82043$56
PKU Amino Acid82139$163
Lipoprotein82172$148
Ammonia82140$140
Bilirubin Total82247$40
Bilirubin Direct82248$40
Stool Occult Blood82272$30
Immunoassay Fecal Occult Blood82274$152
Vitamin D-2582306$285
Calcium Total82310$48
Carcinoembryonic Antigen CEA82378$183
Cortisol Total82533$155
Creatinine82570$48
Vitamin B-1282607$145
Ferritin82728$131
Folic Acid82746$141
Immunoglobulin IGG82784$89
Gases, Blood pH Only82800$72
Gases, Blood pH/pC02/p02/C02/HC0382805$183
Glucose, Blood82962$23
PKU Cystic Fibrosis83520$124
Iron83540$63
Lactic Acid83605$102
LDH83615$59
Fecal Lactoferrin83630$189
Lead83655$116
PTH Intact83970$396
PKU Phenylatanine Blood84030$51
Phosphorus Serum84100$45
Potassium Serum84132$44
Prealbumin84134$140
PSA Screening84153$176
PSA Free84154$176
Protein Total Urine84156$36
Protein Electrophoretic Fractionation84165$103
PKU Neonatal Thyroxine84437$63
Free T484439$87
Transferrin84466$117
Uric Acid Serum84550$43
Beta HCG Serum Quantitative84702$145
Beta HCG Serum Qualitative84703$71
Blood Count Manual Differential85007$32
RBC85041$28
D-Dimer Quantitative85379$98
Fibrinogen85384$82
Antinuclear Antibodies (ANA)86038$116
CRP C-Reactive Protein86140$48
Mono Screen86308$48
Rheumatoid Factor, Qualitative86430$54
Rubella Antibody86762$139
Indirect Coombs Test86885$768
Blood Typing ABO86900$583
Blood Typing Rh86901$177
Special Antigen Blood Typing86902$1,521
Electronic Blood Crossmatch86923$768
Culture Blood87040$100
Culture Throat87070$83
Culture Anaerobic87075$91
Culture Identification87077$78
Culture Fungus87102$80
Gram Stain87205$32
Infectious Agent Detection, Herpes Simplex87449$114
Infections Agent Detection, Chlamydia87491$225
Infectious Agent Detection, Clostridum Difficile87493$225
Infectious Agent Detection, Influenza Virus87502$546
Infectious Agent Detection, Stool Enteric Panel87506$1,367
Infectious Agent Detection, Gonorrhoeae87591$225
Infectious Agent Detection, Respiratory Virus87631$822
Infectious Agent Detection, Strep Screen87880$114
Cytopathology, Body Fluids88104$119
Flow Cytology, Ea Add’l Marker88185$47
Surgical Pathology Level II88302$119
Surgical Pathology Level III88304$237
Surgical Pathology Level IV88305$237
Surgical Pathology Level V88307$369
Special Stains for Microorganisms88312$130
Immunohistochemistry Each Add’l Specimen88341$47
Immunohistochemistry Initial Specimen88342$1,100
The following charges reflect the most common cardiology procedures. Physician fees are not included in these charges and will be billed separately.
Electrocardiogram 93005 $163
Doppler color flow mapping 93325 $435
Echocardiogram (2-D/m-mode) 93306 $2,133
Echocardiogram (Doppler) 93320 $435
Cardiac Stress Test 93017 $1,127
Holter Monitor Scanning 93225 $465
The following charges reflect the hospital’s most common x-ray and radiological procedures. Physician fees as applicable are not included in these charges and will be billed separately.
Abdomen acute series 74022 $593
Xray of Ankle, three views 73610 $357
Xray of Chest, 3 Views 71047 $357
Xray of Chest, 2 Views 71046 $357
Xray of Chest, 1 View 71045 $357
Xray of Foot, three views 73630 $357
Xray of Hand, three views 73130 $357
Xray of Hips, 2 to 3 views 73502 $357
Xray of Knee, four views 73564 $593
Xray of Lumbar Spine, six views 72110 $593
Screening Digital Bilateral Mammogram 77067 $446
Diagnostic Digital Bilateral Mammogram 77066 $539
Xray of Pelvis, one or two views 72170 $593
Xray of Shoulder, two or more views 73030 $357
Xray of Cervical Spine, four views 72050 $593
CT Scan of Abdomen without Contrast 74150 $1,222
CT Scan of Abdomen with Contrast 74160 $2,574
CT Scan of Head without Contrast 70450 $1,222
CT Scan of Head with Contrast 70460 $2,574
CT Scan of Head, with and without contrast 70470 $2,574
CT Scan of Chest with Contrast 71260 $2,574
CT Scan of Pelvis with Contrast 72193 $2,574
MRI of Brain with Contrast 70552 $4,880
MRI of Brain, with and without contrast 70553 $4,880
MRI of Lumbar Spine without contrast 72148 $2,939
MRI of Cervical Spine without contrast 72141 $2,939
MRI of Lower Extremeties without contrast 73721 $2,939
Pet Scan, skull base to mid-thigh 78815 $7,561
Pet Scan, full body 78816 $7,561
Carotid Doppler Scan 93880 $903
Ultrasound of Gallbladder 76705 $903
Vascular Scan of Lower Extremity, unilateral 93971 $903
Ultrasound of Breast, unilateral 76641 $542
Ultrasound of Pelvis 76856 $903
Bone Scan, whole body 78306 $1,736
CT Scan of Neck With and Without Contrast 70492 $2,574
MRI of Brain Without Contrast 70551 $2,939
CT of Thorax Without Contrast 71250 $1,222
CT Angiography of Chest With and Without Contrast 71275 $2,574
Xray of Thoracic Spine, Two Views 72070 $593
CT Scan of Cervical Spine Without Contrast 72125 $1,222
Xray of Hips Bilateral, Three to Four Views 73522 $593
Xray of Abdomen, One View 74018 $357
Xray of Abdomen, Two Views 74019 $357
CT Scan of Abdomen and Pelvis Without Contrast 74176 $2,939
CT Scan of Abdomen and Pelvis With and Without Contrast 74178 $3,776
ERCP 74329 $963
Ultrasound of Thyroid 76536 $903
Ultrasound of Abdomen Complete 76700 $903
Ultrasound of Kidneys and Bladder Complete 76770 $903
Ultrasound of Kidneys Bilateral 76775 $903
Ultrasound Pregnant Uterus Greater Than or Equal to 14 Weeks 76805 $903
Ultrasound Transvaginal 76830 $903
Diagnostic or Screening Digital Tomosynthesis Bilateral 77062/77063 $54
Bone Density Study 77080 $593
Hepatobiliary System Imaging 78227 $2,302
Myocardial Perfusion With Wall Motion and Ejection Infraction 78452 $5,782
Ultrasound Duplex Scan of Extremity Veins 93970 $903
Xray Ribs Unilateral, Two Views 71100 $357
Xray Elbow, Minimum of Three Views 73080 $357
Xray Wrist, Minimum of Three Views 73110 $357
Xray Knee, Three Views 73562 $357
Diagnostic Digital Unilateral Mammogram 77065 $422
The below charges reflect the hospital’s pricing for heart catheterization and angiography procedures. Ancillary testing, Supplies and Medications that may be required are not included in the pricing. Physician fees as applicable are not included and will be billed separately.
Heart Cath, Right 93451 $12,994
Coronary Cath Placement for angiography 93454 $12,994
Coronary Cath Placement in bypass grafts 93455 $12,994
Coronary Cath Placement in bypass grafts w/ Right Heart Cath 93456 $12,994
Coronary Cath Placement in bypass grafts w/ Left Heart Cath 93458 $12,994
Left Heart Cath with coronary angiography w/graphs 93459 $12,994

The following charges represent the most common charges for Respiratory, Sleep Medicine and Neuro Studies. Physician fees are not included in these charges and will be billed separately.

Aerosol treatment, Nebulizer, MDI or IPPB94640$183
Arterial blood gas & puncture82803 & 36600$501
Smoking Cessation99406 or 99407$159
EEG95816 or 95819$1,195
Sleep Study95805$5,541
Bronchodilation Spirometry94060$456
CPAP, Initiation and Management94660$469
Patient Teaching and/or Evaluation for Nebulizer94664$183
Plethysmography for Lung Volumes94726$294
Sleep Study with Four or More Parameters95810$5,541

The following charges represent the most common services offered by our physical therapy department. Patients may have additional charges, depending on the services performed.

PT Evaluation97161/97162/97163$490
Gait training, per 15 minutes97116$181
PT Therapeutic exercise, per 15 min97110$208
Ultrasound, per 15 min97035$84
PT Electrical Stimulation97014$89
PT Manual Therapy Techniques per 15 Minutes97140$192

 

The following charges represent the most common services offered by our occupational therapy department. Patients may have additional charges, depending on the services performed.
OT Evaluation 97165/97166/97167 $548
OT Therapeutic exercise per 15 min 97110 $208
OT Functional Activities Per 15 Minuntes 97530 $221
 
The following charges represent the most common services offered by our speech therapy department. Patients may have additional charges, depending on the services performed.
Speech Therapy per session 92507 $422
Swallowing Evaluation 92526 $459
Articulation Evaluation 92522 $495
Voice Evaluation 92524 $483
Affluency Evaluation 92521 $593
Language Evaluation 92523 $921
Barium Swallowing Function 74230 $593
 
The following charges represent the most common services offered by our Cardiac Rehabilitation department. Patients may have additional charges, depending on the services performed.
Cardiac Rehab without ECG per session 93797 $516
Cardiac Rehab with ECG per session 93798 $516
 
The following charges represent the most common services offered by our pulmonary rehabilitation department. Patients may have additional charges, depending on the services performed.
PR per 1 hour session 94625/94626 $258
Respiratory Exercises per 15 minutes G0237/G0238 $208
 
The following charges represent the other common services offered. Patient may have additional charges, depending on the services performed.
Insertion of Catheter 51701/51702 $415
Bladder Scan 51798 $399
Fetal Non-Stress Test 59025 $412
Injection Lumbar or Sacral with Image Guidance 62323 $2,339
Immunization Administration 90471 $80
Newborn Hearing Screen 92650 $323
Intraveneous Hydration 1st Hour 96360 $421
Intraveneous Hydration Ea Add’l Hour 96361 $147
IV Infusion with Drug, 1st Hour 96365 $789
IV Infusion with Drug, Each Add’l Hour 96366 $147
IV Sequential Infusion 96367 $238
Injection Subcutaneous or intramuscular 96372 $193
Injection Intravenous Push 96374 $421
Injection Intravenous Push Initial Drug 96375 $193
Injection Intravenous Push Ea Add’l Sequential Drug 96376 $147
Chemotherapy Administration up to 1 Hour 96413 $1,278
Chemotherapy Administration Ea Add’l Hour 96415 $193
Chemotherapy Administration Ea Sequential Drug 96417 $238
Hospital Outpatient Clinic Visit G0463 $250
Psychiatric Group Therapy per Hour Session 90853 $195
Psychotherapy With Patient 60 Mins 90837 $307
Psychotherapy With Patient 45 Mins 90834 $247
Psychotherapy With Patient 30 Mins 90832 $174
Psychiatric Outpatient Facility Visit 60 Mins- New Patient 99205 $330
Psychiatric Outpatient Facility Visit 45 Mins – New Patient 99204 $288
Psychiatric Outpatient Facility Visit 30 Mins- New Patient 99203 $247
Psychiatric Outpatient Facility Visit 40 Mins- Established Patient 99215 $288
Psychiatric Outpatient Facility Visit 25 Mins- Established Patient 99214 $247
Psychiatric Outpatient Facility Visit 15 Mins- Established Patient 99213 $208
 
Heart Failure & Shock with Major Complications 291 $25,057
Appendectomy with Major Complications 339 $35,200
Bilateral Joint Replacement- Knee or Hip 462 $56,736
Joint Replacement- Knee or Hip 470 $43,315
Uterine & Adnexa Procedures for Non Malignant with complications 743 $29,758
C-Section Delivery 788 $18,070
Vaginal Delivery 807 $10,254
Psychoses 885 $17,180

If you would like to speak directly with a PCHA representative please call 304-431-5117.

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