Charge Information

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 January 2020. Note: Physician fees are not included in the below pricing and estimates.

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: $446 (Code 93797)
  • Cardiac Rehab with ECG Per Session: $446 (Code 93798)

The following charges reflect the most common cardiology procedures. Physician fees are not included in these charges and will be billed separately.

  • Electrocardiogram: $141 (Code 93005)
  • Doppler Color Flow Mapping: $375 (Code 93325)
  • Echocardiogram (2-D/m-mode): $1,842 (Code 93306)
  • Echocardiogram (Doppler): $375 (Code 93320)
  • Cardiac Stress Test: $973 (Code 93017)
  • Holter Monitor Scanning: $402 (Code 93225)

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 1: $290 (Code 99281)
  • Emergency Room Level 2: $525 (Code 99282)
  • Emergency Room Level 3: $791 (Code 99283)
  • Emergency Room Level 4: $1,287 (Code 99284)
  • Emergency Room Level 5: $1,912 (Code 99285)
  • Critical Care: $2,622 (Code 99291)
  • Trauma Activation with Critical Care: $1,962 (Code G0390)
  • CPR: $866 (Code 92950)

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

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: $11,225 (Code 93451)
  • Heart Cath, Left: $11,225 (Code 93452)
  • Heart Cath, Bilateral: $11,225 (Code 93453)
  • Coronary Cath Placement for Angiography: $11,225 (Code 93454)
  • Coronary Cath Placement in Bypass Grafts: $11,225 (Code 93455)
  • Left Heart Cath With Coronary Angiography With Graphs: $11,225 (Code 93459)

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 Panel: $263 (Code 80050)
  • Acute Hepatitis Panel: $377 (Code 80074)
  • Albumin: $41 (Code 82040)
  • Alchols: $166 (Code 80320)
  • Alt Transaminase (SGPT): $43 (Code 84460)
  • Ammonia: $121 (Code 82140)
  • Amylase, Blood: $54 (Code 82150)
  • Analgesics, Non-Opioid: $166 (Code 80329)
  • Antinuclear Antibodies (ANA): $100 (Code 86038)
  • AST SGOT: $42 (Code 84450)
  • Basic Metabolic: $70 (Code 80048)
  • Basic Metabolic Panel: $70 (Code 80047)
  • Beta HCG Serum Qualitative: $62 (Code 84703)
  • Beta HCG Serum Quantitative: $125 (Code 84702)
  • Bilirubin Driect: $34 (Code 82248)
  • Bilirubin Total: $34 (Code 82247)
  • Blood Administration: $487 (Code 36430)
  • Blood Count Manual Differential: $28 (Code 85007)
  • Blood Drawing Charge: $19 (Code 36415)
  • Blood Typing ABO: $536 (Code 86900)
  • Blood Typing Rh: $37 (Code 86901)
  • BNP: $281 (Code 83880)
  • BUN: $33 (Code 84520)
  • Calcium Total: $42 (Code 82310)
  • Carcinoembryonic Antigen CEA: $158 (Code 82378)
  • CBC: $64 (Code 85025)
  • CBC Without Diff: $54 (Code 85027)
  • CKMB Quantitative: $75 (Code 82553)
  • Comp Metabolic: $88 (Code 80053)
  • Collection of Blood from Venous Access Device: $358 (Code 36591)
  • Cortisol Total: $134 (Code 82533)
  • CPK Total: $55 (Code 82550)
  • Creatinine Blood: $42 (Code 82565)
  • Creatinine: $42 (Code 82570)
  • CRP C-Reactive Protein: $42 (Code 86140)
  • Culture Anaerobic: $79 (Code 87075)
  • Culture Blood: $86 (Code 87040)
  • Culture Fungus: $69 (Code 87102)
  • Culture Identification: $67 (Code 87077)
  • Culture Throat: $71 (Code 87070)
  • Cytophatology, Body Fluids: $103 (Code 88104)
  • D-Dimer Quantitative: $85 (Code 85379)
  • Digoxin Total: $110 (Code 80162)
  • Drug Screen Urine 10 Panel: $291 (Code 80307)
  • Electrolytes: $49 (Code 80051)
  • Electronic Blood Crossmatch: $635 (Code 86923)
  • Fecal Lactoferrin: $163 (Code 83630)
  • Ferritin: $113 (Code 82728)
  • Fibrinogen: $70 (Code 85384)
  • Flow Cytology, Ea Add’l Marker: $41 (Code 88185)
  • Folic Acid: $122 (Code 82746)
  • Free T4: $75 (Code 84439)
  • Gases, Blood pH Only: $63 (Code 82800)
  • Gases, Blood pH/pCO2/p02/C02/HC03: $158 (Code 82805)
  • Glucose, Blood: $20 (Code 82962)
  • Glucose Random: $33 (82947)
  • Gram Strain: $28 (Code 87205)
  • Hematocrit: $20 (Code 85014)
  • Hemoglobin: $20 (Code 85018)
  • Hemoglobin A1C: $81 (Code 83036)
  • Hepatic Function Panel: $67 (Code 80076)
  • Immunoassay Fecal Occult Blood: $131 (Code 82274)
  • Immunoglobulin IGG: $77 (Code 82784)
  • Immunohistochemistry Each Add’l Specimen: $41 (Code 88341)
  • Immunohistochemistry Inital Specimen: $950 (Code 88342)
  • Indirect Coombs Test: $706 (Code 86885)
  • Infectious Agent Detection, Chlamydia: $194 (Code 87491)
  • Infectious Agent Detection, Clostridum Difficile: $194 (Code 87493)
  • Infectious Agent Detection, Gonorrhoeae: $194 (Code 87591)
  • Infectious Agent Detection, Herpes Simplex: $99 (Code 87449)
  • Infectious Agent Detection, Influenza Virus: $471 (Code 87502)
  • Infectious Agent Detection, Respiratory Virus: $710 (Code 87631) 
  • Infectious Agent Detection, Stool Enteric Panel: $1,181 (Code 87506)
  • Infectious Agent Detection, Strep Screen: $99 (Code 87880)
  • Iron: $54 (Code 83540)
  • Ketone Body(s): $29 (Code 82009)
  • Lactic Acid: $88 (Code 83605)
  • LDH: $50 (Code 83615)
  • Lead: $100 (Code 83655)
  • Lipase: $58 (Code 83690)
  • Lipid: $111 (Code 80061)
  • Lipoprotein: $128 (Code 82172)
  • Lithium: $55 (Code 80178)
  • Magnesium: $56 (Code 83735)
  • Microalbumin: $48 (Code 82043)
  • Mono Screen: $42 (Code 86308)
  • Phosphorus Serum: $39 (Code 84100)
  • PKU Amino Acid: $141 (Code 82139)
  • PKU Cystic Fibrosis: $107 (Code 83520)
  • PKU Neonatal Thyroxine: $54 (Code 84437)
  • PKU Phenylatanine Blood: $45 (Code 84030)
  • Potassium Serum: $38 (Code 84132)
  • Prealbumin: $121 (Code 84134)
  • Protein Electrophoretic Fractionation: $89 (Code 84165)
  • Protein Total Urine: $30 (Code 84156)
  • PT (Prothrombin Time): $33 (Code 85610)
  • PTT/APTT: $50 (Code 85730)
  • PSA Free: $152 (Code 84154)
  • PSA Screening: $152 (Code 84153)
  • PTH Intact: $342 (Code 83970)
  • RBC: $25 (Code 85041)
  • Rheumatoid Factor, Qualitative: $47 (Code 86430)
  • Rubella Antibody: $120 (Code 86762)
  • Sedimentation Rate: $23 (Code 85652)
  • Sensitivity, MIC: $71 (Code 87186)
  • Special Antigen Blood Typing: $1,393 (Code 86902)
  • Special Stains for Microorganisms: $112 (Code 88312)
  • Stool Occult Blood: $27 (Code 82272)
  • Surgical Pathology Level II: $103 (Code 88302)
  • Surgical Pathology Level III: $205 (Code 88304)
  • Surgical Pathology Level IV: $205 (Code 88305)
  • Surgical Pathology Level V: $318 (Code 88307
  • T-3 Uptake: $54 (Code 84479)
  • T4, Thyroxine: $57 (Code 84436)
  • Transferrin: $101 (Code 84466)
  • Troponin I: $82 (Code 84484)
  • Thyroid Stimulating Hormone: $139 (Code 84443)
  • Uric Acid Serum: $37 (Code 84550)
  • Urinalysis with Microscopy: $26 (Code 81001)
  • Urinalysis Routine (No Micro): $19 (Code 81003)
  • Urine Culture: $67 (Code 87086)
  • Urine Pregnancy Test: $52 (Code 81025)
  • Valproic Acid Total: $72 (Code 80164)
  • Vancomycin: $72 (Code 80202)
  • Vitamin B-12: $125 (Code 82607)
  • Vitamin D-25: $246 (Code 82306)

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: $473 (Code 97165/97166/97167)
  • OT Therapeutic Exercise, Per 15 Minutes: $180 (Code 97110)
  • OT Functional Activities, Per 15 Minutes: $190 (Code 97530)

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 Evaluation: $424 (Code 97161/97162/97163)
  • Gait Training, Per 15 Minutes: $156 (Code 97116)
  • PT Therapeutic Exercise, Per 15 Minutes: $180 (Code 97110)
  • Ultrasound, Per 15 Minutes: $72 (Code 97035)
  • PT Electrical Stimulation: $77 (Code 97014)
  • PT Manual Therapy Techniques, Per 15 Minutes: $166 (Code 97140)

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: $223 (Code G0424)
  • Respiratory Exercises Per 15 Minutes: $180 (Code G0238)
  • PR Group Therapy: $99 (Code G0239)

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: $512 (Code 74022)
  • Xray of Ankle, Three Views: $309 (Code 73610)
  • Xray of Chest, Three Views: $309 (Code 71047)
  • Xray of Chest, Two Views: $309 (Code 71046)
  • Xray of Chest, One View: $309 (Code 71045)
  • Xray of Foot, Three Views: $309 (Code 73630)
  • Xray of Hand, Three Views: $309 (Code 73130)
  • Xray of Hips, Two to Three Views: $309 (Code 73502)
  • Xray of Knee, Four Views: $512 (Code 73564)
  • Xray of Lumbar Spine, Six Views: $512 (Code 72110)
  • Screening Digital Bilateral Mammogram: $386 (Code 77067)
  • Diagnostic Digital Bilateral Mammogram: $466 (Code 77066)
  • Xray of Pelvis, One or Two Views: $512 (Code 72170)
  • Xray of Shoulder, Two or More Views: $309 (Code 73030)
  • Xray of Cervical Spine, Four Views: $512 (Code 72050)
  • CT Scan of Abdomen Without Contrast: $1,056 (Code 74150)
  • CT Scan of Abdomen with Contrast: $2,223 (Code 74160)
  • CT Scan of Head Without Contrast: $1,056 (Code 70450)
  • CT Scan of Head With Contrast: $2,223 (Code 70460)
  • CT Scan of Head, With and Without Contrast: $2,223 (Code 70470)
  • CT Scan of Chest With Contrast: $2,223 (Code 71260)
  • CT Scan of Pelvis With Contrast: $2,223 (Code 72193)
  • MRI of Brain, With Contrast: $4,216 (Code 70552)
  • MRI of Brain, With and Without Contrast: $4,216 (Code 70553)
  • MRI of Lumbar Spine Without Contrast: $2,539 (Code 72148)
  • MRI of Cervical Spine Without Contrast: $2,539 (Code 72141)
  • MRI of Lower Extremeties Without Contrast: $2,539 (Code 73721)
  • Pet Scan, Skull Base to Mid Thigh: $6,531 (Code 78815)
  • Pet Scan, Full Body: $6,531 (Code 78816)
  • Carotid Doppler Scan: $780 (Code 93880)
  • Ultrasound of Gallbladder: $780 (Code 76705)
  • Vascular Scan of Lower Extremity, Unilateral: $780 (Code 93971)
  • Ultrasound of Breast, Unilateral: $468 (Code 76641)
  • Ultrasound of Pelvis: $780 (Code 76856)
  • Bone Scan, Whole Body: $1,499 (Code 78306)
  • CT Scan of Neck, With and Without Contrast: $2,223 (Code 70492)
  • MRI of Brain Without Contrast: $2,539 (Code 70551)
  • CT of Thorax Without Contrast: $1,056 (Code 71250)
  • CT Angiography of Chest With and Without Contrast: $2,233 (Code 71275)
  • Xray of Thoracic Spine, Two Views: $512 (Code 72070)
  • CT Scan of Cervical Spine Without Contrast: $1,056 (Code 72125
  • Xray of Hips Bilateral, Three to Four Views: $512 (Code 73522)
  • Xray of Abdomen, One View: $309 (Code 74018)
  • Xray of Abdomen, Two Views: $309 (Code 74019)
  • CT Scan of Abdomen and Pelvis Without Contrast: $1,802 (Code 74176)
  • CT Scan of Abdomen and Pelvis With and Without Contrast: $3,262 (Code 74178)
  • ERCP: $831 (Code 74329)
  • Ultrasound of Thyroid: $780 (Code 76536)
  • Ultrasound of Abdomen Complete: $780 (Code 76700)
  • Ultrasound of Kidneys and Bladder Complete: $780 (Code 76770)
  • Ultrasound of Kidneys Bilateral: $780 (Code 76775)
  • Ultrasound Pregnant Uterus Greater Than or Equal to 14 Weeks: $780 (Code 76805)
  • Ultrasound Transvaginal: $780 (Code 76830)
  • Diagnostic or Screening Digital Tomosynthesis Bilateral: $28 (Code 77062/77063)
  • Bone Density Study: $512 (Code 77080)
  • Hepatobiliary System Imaging: $512 (Code 77080)
  • Myocardial Perfusion With Wall Motion and Ejection Infraction: $4.995 (Code 78452)
  • Ultrasound Duplex Scan of Extremity Veins: $780 (Code 93970)
  • Xray Ribs Unilateral, Two Views: $309 (Code 71100)
  • Xray Elbow, Minimum of Three Views: $309 (Code 73080)
  • Xray Wrist, Minimum of Three Views: $309 (Code 73110)
  • Xray Knee, Three Views: $309 (Code 73562)
  • Diagnostic Digital Unilateral Mammogram: $365 (Code 77065)
  • Aerosol Treatment, Nebulizer, MDI or IPPB: $157 (Code 94640)
  • Arterial Blood Gas & Puncture: $433 (Code 82803 & 36600)
  • Smoking Cessation: $137 (Code 99406 or 99407)
  • EEG: $1,032 (Code 95816 or 95819)
  • Sleep Study: $4,787 (Code 95805)
  • Bronchodilation Spirometry: $393 (Code 94060)
  • CPAP, Initiation and Management: $352 (Code 94660)
  • Patient Teaching and/or Evaluation for Nebulizer: $157 (Code 94664)
  • Plethysmography for Lung Volumes: $254 (Code 94726)
  • Sleep Study for Four or More Parameters: $4,787 (Code 95810)
  • Medical, Surgical & Pediatric Rooms: $455
  • Telemetry Room: $775
  • Women’s Center Obstetrics, Surgical & Medical: $680
  • CCU Room: $2,000
  • ICU Room: $2,000
  • Behavioral Health Pavilion Room: $1,725
  • Observation Per Hour: $19

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: $365 (Code 92507)
  • Swallowing Evaluation: $396 (Code 92526)
  • Articulation Evaluation: $428 (Code 92522)
  • Voice Evaluation: $417 (Code 92524)
  • Affluency Evaluation: $512 (Code 92521)
  • Language Evaluation: $795 (Code 92523)
  • Barium Swallowing Function: $512 (Code 74230)

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: $84
  • Intraoperative Cholangiography: $1,161 (Code 74300)
  • Conscious Sedation 5 Year or Greater Initial 15 Mins: $97 (Code 99152)

Other Common Surgical Procedures

  • Removal of 1 or More Breast Growths, Open Procedure: $8,290 (Code 19120)
  • Shaving of Shoulder Bone Using an Endoscope: $19,978 (Code 29826)
  • Removal of One Knee Cartilage Using an Endoscope: $11,252 (Code 29881)
  • Removal of Tonsils and Adenoid Glands Under 12 Years: $10,652 (Code 42820)
  • Diagnostic Exam of Esophagus, Stomach and/or Upper Small Bowel Using an Endoscope: $4,839 (Code 43235)
  • Biopsy of Esophagus, Stomach or Upper Small Bowel Using an Endoscope: $4,266 (Code 43239)
  • Diagnostic Examination of Large Bowel Using an Endoscope: $3,378 (Code 45378)
  • Biopsy of Large Bowel Using an Endoscope: $4,209 (Code 45380)
  • Removal of Polyps or Growths of Large Bowel Using an Endoscope: $4,273 (Code 45385)
  • Removal of Gallbladder Using an Endoscope: $15,411 (Code 47562)
  • Repair of Groin Hernia Under 5 Years of Age: $10,686 (Code 49505)
  • Biopsy of Prostate Gland: $14,035 (Code 55700)
  • Surgical Removal of Prostate and Surrounding Lymph Notes Using an Endoscope: $58,000 (Code 55866)
  • Injection of Anesthetic or Steroid into Lower Back or Sacrum Using Imaging Guidance: $2,593 (Code 64483)
  • Removal of Cataract With Insertion of Lens: $11,721 (Code 66984)

Recovery

  • Recovery Room Per Each 15 Minutes: $288

Anesthesia

  • Anesthesia Time Per Minute: $39

The following charges represent the other common services offered. Patient may have additional charges, depending on the services performed.

  • Insertion of Catheter: $358 (Code 51701/51702)
  • Bladder Scan: $345 (Code 51798)
  • Fetal Non-Stress Test: $355 (Code 59025)
  • Injection Lumber or Sacral with Image Guidance: $2,021 (Code 62322/62323)
  • Immunization Administration: $69 (Code 90471)
  • Newborn Hearing Screen: $279 (Code 92586)
  • Intravenous Hydration First Hour: $364 (Code 96360)
  • Intravenous Hydration Each Add’l Hour: $127 (Code 96361)
  • IV Infusion with Drug, First Hour: $681 (Code 96365)
  • IV Infusion with Drug, Each Add’l  Hour: $127 (Code 96366)
  • IV Sequential Infusion: $206 (Code 96367)
  • Injection Subcutaneous or Intramuscular: $167 (Code 96372)
  • Injection Intravenous Push: $364 (Code 96374)
  • Injection Intravenous Push Initial Drug: $167 (Code 96375)
  • Injection Intravenous Push Each Add’l Sequential Drug: $127 (Code 96376)
  • Chemotherapy Administration up to 1 Hour: $1,104 (Code 96413)
  • Chemotherapy Administration Each Add’l Hour: $167 (Code 96415)
  • Chemotherapy Administration Each Sequential Drug: $206 (Code 96417)

Evaluation and Management

  • Hospital Outpatient Clinic Visit: $168 (Code G0463)
  • Psychiatric Group Therapy per Hour Session: $169 (Code 90853)
  • Psychotherapy with Patient 60 Mins: $265 (Code 90837)
  • Psychotherapy with Patient 45 Mins: $213 (Code 90834)
  • Psychotherapy with Patient 30 Mins: $150 (Code 90832)
  • Psychiatric Outpatient Facility Visit 60 Mins – New Patient: $285 (Code 99205)
  • Psychiatric Outpatient Facility Visit 45 Mins – New Patient: $249 (Code 99204)
  • Psychiatric Outpatient Facility Visit 30 Mins – New Patient: $213 (Code 99203)
  • Psychiatric Outpatient Facility Visit 40 Mins – Established Patient: $249 (Code 99215)
  • Psychiatric Outpatient Facility Visit 25 Mins – Established Patient: $213 (Code 99214)
  • Psychiatric Outpatient Facility Visit 15 Mins – Established Patient: $180 (Code 99213)

Common Inpatient DRGs

  • Heart Failure and Shock with Major Complications: $19,243 (DRG 291)
  • Appendectomy with Major Complications: $29,842 (DRG 338)
  • Bilateral Joint Replacement – Knee or Hip: $52,259 (DRG 462)
  • Joint Replacement – Knee or Hip: $37,102 (DRG 470)
  • Uterine and Adnexa Procedures for Non Malignant with Complications: $27,857 (DRG 743)
  • C-Section Delivery: $15,965 (DRG 788)
  • Vaginal Delivery: $8,222 (DRG 807)
  • Psychoses: $14,309 (DRG 885)
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