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 2019. Note: Physician fees are not included in the below pricing and estimates.

Cardiology

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

  • Electrocardiogram: $134 (Code 93005)
  • Doppler Color Flow Mapping: $357 (Code 93325)
  • Echocardiogram (2-D/m-mode): $1,754 (Code 93306)
  • Echocardiogram (Doppler): $357 (Code 93320)

Emergency Room

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: $276 (Code 99281)
  • Emergency Room Level 2: $500 (Code 99282)
  • Emergency Room Level 3: $753 (Code 99283)
  • Emergency Room Level 4: $1,226 (Code 99284)
  • Emergency Room Level 5: $1,821 (Code 99285)
  • Critical Care: $2,497 (Code 99291)

Financial Counseling

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

Heart Catheterization/Angiography

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: $9,464 (Code 93451)
  • Heart Cath, Left: $9,464 (Code 93452)
  • Heart Cath, Bilateral: $9,464 (Code 93453)
  • Coronary Cath Placement for Angiography: $9,464 (Code 93454)
  • Coronary Cath Placement in Bypass Grafts: $9,464 (Code 93455)
  • Left Heart Cath With Coronary Angiography With Graphs: $9,464 (Code 93459)

Laboratory

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.

  • Alt Transaminase (SGPT): $41 (Code 84460)
  • Amylase, Blood: $51 (Code 82150)
  • AST SGOT: $40 (Code 84450)
  • Basic Metabolic: $67 (Code 80048)
  • Blood Drawing Charge: $18 (Code 36415)
  • BNP: $268 (Code 83880)
  • BUN: $31 (Code 84520)
  • CBC: $61 (Code 85025)
  • CBC Without Diff: $51 (Code 85027)
  • CKMB Quantitative: $71 (Code 82553)
  • Comp Metabolic: $84 (Code 80053)
  • CPK Total: $52 (Code 82550)
  • Creatinine Blood: $40 (Code 82565)
  • Electrolytes: $47 (Code 80051)
  • Glucose Fasting: $31 (Code 82947)
  • Glucose Random: $31 (82947)
  • Hematocrit: $19 (Code 85014)
  • Hemoglobin: $19 (Code 85018)
  • Hemoglobin A1C: $77 (Code 83036)
  • Hepatic Function Panel: $64 (Code 80076)
  • Lipase: $55 (Code 83690)
  • Lipid: $106 (Code 80061)
  • Magnesium: $53 (Code 83735)
  • PT (Prothrombin Time): $31 (Code 85610)
  • PTT/APTT: $48 (Code 85730)
  • Sedimentation Rate: $22 (Code 85652)
  • Sensitivity, MIC: $68 (Code 87186)
  • T-3 Uptake: $51 (Code 84479)
  • T4, Thyroxine: $54 (Code 84436)
  • Troponin I: $78 (Code 84484)
  • Thyroid Stimulating Hormone: $132 (Code 84443)
  • Urinalysis Routine (No Micro): $18 (Code 81003)
  • Urine Culture: $64 (Code 87086)

Occupational Therapy

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: $450
  • Therapeutic Exercise, Per 15 Minutes: $94

Physical Therapy

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: $404
  • Gait Training, Per 15 Minutes: $149
  • Therapeutic Exercise, Per 15 Minutes: $94
  • Ultrasound, Per 15 Minutes: $69
  • Whirlpool: $118

Pulmonary Rehabilitation

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: $212
  • Respiratory Exercises Per 15 Minutes: $155
  • PR Group Therapy: $94

Radiology

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: $488 (Code 74022)
  • Xray of Ankle, Three Views: $294 (Code 73610)
  • Xray of Chest, Three Views: $294 (Code 71047)
  • Xray of Chest, Two Views: $294 (Code 71046)
  • Xray of Chest, One View: $294 (Code 71045)
  • Xray of Foot, Three Views: $294 (Code 73630)
  • Xray of Hand, Three Views: $294 (Code 73130)
  • Xray of Hips, Two to Three Views: $294 (Code 73502)
  • Xray of Knee, Four Views: $488 (Code 73564)
  • Xray of Lumbar Spine, Six Views: $488 (Code 72110)
  • Screening Digital Bilateral Mammogram: $368 (Code 77067)
  • Diagnostic Digital Bilateral Mammogram: $444 (Code 77066)
  • Xray of Pelvis, One or Two Views: $488 (Code 72170)
  • Xray of Shoulder, Two or More Views: $294 (Code 73030)
  • Xray of Cervical Spine, Four Views: $488 (Code 72050)
  • CT Scan of Abdomen with Contrast: $2,117 (Code 74160)
  • CT Scan of Head Without Contrast: $1,006 (Code 70450)
  • CT Scan of Head, With and Without Contrast: $2,117 (Code 70470)
  • CT Scan of Chest With Contrast: $2,117 (Code 71260)
  • CT Scan of Pelvis With Contrast: $2,117 (Code 72193)
  • MRI of Brain, With and Without Contrast: $4,015 (Code 70553)
  • MRI of Lumbar Spine Without Contrast: $2,418 (Code 72148)
  • MRI of Cervical Spine Without Contrast: $2,418 (Code 72141)
  • MRI of Lower Extremeties Without Contrast: $2,418 (Code 73721)
  • Pet Scan, Full Body: $6,220 (Code 78815)
  • Carotid Doppler Scan: $743 (Code 93880)
  • Ultrasound of Gallbladder: $743 (Code 76705)
  • Vascular Scan of Lower Extremity, Unilateral: $743 (Code 93971)
  • Ultrasound of Breast, Unilateral: $446 (Code 76641)
  • Ultrasound of Pelvis: $743 (Code 76856)
  • Bone Scan, Whole Body: $1,428 (Code 78306)

Respiratory, Sleep Medicine and Neuro Studies

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 IPPB: $108 (Code 94640)
  • Arterial Blood Gas & Puncture: $412 (Code 82803 & 36600)
  • Smoking Cessation: $130 (Code 99406 or 99407)
  • EEG: $983 (Code 95816 or 95819)
  • Sleep Study: $4,559 (Code 95805)

Room & Board Per Day

  • Medical, Surgical & Pediatric Rooms: $435
  • Telemetry Room: $740
  • Women's Center Obstetrics, Surgical & Medical: $650
  • CCU Room: $1,905
  • ICU Room: $1,905
  • Behavioral Health Pavilion Room: $1,645

Speech Therapy

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: $348
  • Swallowing Evaluation: $384
  • Articulation Evaluation: $408
  • Voice Evaluation: $397
  • Affluency Evaluation: $488
  • Language Evaluation: $757

Surgical Procedures

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 Time Per Minute: $80
  • Recovery Room Per Each 15 Minutes: $274
  • Anesthesia Time Per Minute: $37



            Charge Master Fiscal Year 2019             Average Charge/Payment by DRG