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 2021.

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

Medical, Surgical and Pediatric Private Room $500
Medical, Surgical and Pediatric Semi-Private Room $475
Telemetry Private Room $850
Telemetry Semi-Private Room $825
Women’s Center Obstetrics, Surgical & Medical Private Room $750
Women’s Center Obstetrics, Surgical & Medical Semi-Private Room $725
CCU Room $2,205
ICU Room $2,205
Behavioral Health Pavilion Room $1,900
Observation Per Hour $21

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 $92
Intraoperative Cholangiography74300$1,280
Conscious Sedation 5 Years or Greater Initial 15 Mins99152$107
   
Other Common Surgical Procedures  
Removal of 1 or more breast growths, open procedure19120$11,915
Shaving of shoulder bone using an endoscope29826$21,435
Removal of one knee cartilage using an endoscope29881$11,874
Removal of tonsils & adenoid glands under 12 years42820$11,794
Diagnostic Exam of esophagus, stomach, and/or upper small bowel using and endoscope43235$7,068
Biopsy of the esophagus , stomach, or upper small bowel using and endoscope43239$5,007
Diagnostic examination of large bowel using and endoscope45378$3,814
Biopsy of large bowel using an endoscope45380$4,848
Removal of polyps or growths of large bowel using an endoscope45385$4,672
Removal of gallbladder using an endoscope47562$19,263
Repair of groin hernia under 5 years of age49505$11,836
Biopsy of prostate gland55700$12,537
Removal of cataract with insertion of lens66984$12,598
   
Recovery  
Recovery Room per each 15 minutes $317
   
Anesthesia  
Anesthesia time per minute $43
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 99281 $320
Emergency Room Level 2 99282 $579
Emergency Room Level 3 99283 $873
Emergency Room Level 4 99284 $1,419
Emergency Room Level 5 99285 $2,108
Critical Care 99291 $2,891
Trauma Activation with Critical Care G0390 $2,163
CPR 92950 $954
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 80050 $290
Alt transaminase (SGPT) 84460 $47
Amylase, blood 82150 $60
AST SGOT 84450 $46
Basic metabolic 80048 $78
Blood drawing charge 36415 $21
BNP 83880 $310
BUN 84520 $37
CBC 85025 $70
CBC without diff 85027 $60
CKMB quantitative 82553 $83
Comp metabolic 80053 $97
CPK total 82550 $61
Creatinine blood 82565 $46
Electrolytes 80051 $54
Glucose random 82947 $37
Hematocrit 85014 $22
Hemoglobin 85018 $22
Hemoglobin A1C 83036 $89
Hepatic Function Panel 80076 $74
Lipase 83690 $64
Lipid 80061 $123
Magnesium 83735 $62
PT (prothrombin time 85610 $37
PTT/APTT 85730 $56
Sedimentation Rate 85652 $25
Sensitivity, MIC 87186 $79
T-3 uptake 84479 $60
T4, thyroxine 84436 $63
Troponin I 84484 $90
Thyroid stimulating hormone 84443 $153
Urinalysis routine (no micro) 81003 $21
Urine culture 87086 $74
Blood Administration 36430 $537
Collection of Blood from Venous Access Device 36591 $395
Basic Metabolic Panel 80047 $78
Acute Hepatitis Panel 80074 $416
Digoxin Total 80162 $122
Valproic Acid Total 80164 $80
Lithium 80178 $61
Vancomycin 80202 $80
Drug Screen Urine 10 Panel 80307 $375
Alcohols 80320 $183
Analgesics, Non-Opioid 80329 $183
Urinalysis with Microscopy 81001 $28
Urine Pregnancy Test 81025 $59
Ketone Body(s) 82009 $32
Albumin 82040 $45
Microalbumin 82043 $53
PKU Amino Acid 82139 $155
Lipoprotein 82172 $141
Ammonia 82140 $133
Bilirubin Total 82247 $38
Bilirubin Direct 82248 $38
Stool Occult Blood 82272 $29
Immunoassay Fecal Occult Blood 82274 $145
Vitamin D-25 82306 $271
Calcium Total 82310 $46
Carcinoembryonic Antigen CEA 82378 $174
Cortisol Total 82533 $148
Creatinine 82570 $46
Vitamin B-12 82607 $138
Ferritin 82728 $125
Folic Acid 82746 $134
Immunoglobulin IGG 82784 $85
Gases, Blood pH Only 82800 $69
Gases, Blood pH/pC02/p02/C02/HC03 82805 $174
Glucose, Blood 82962 $22
PKU Cystic Fibrosis 83520 $118
Iron 83540 $60
Lactic Acid 83605 $97
LDH 83615 $56
Fecal Lactoferrin 83630 $180
Lead 83655 $110
PTH Intact 83970 $377
PKU Phenylatanine Blood 84030 $49
Phosphorus Serum 84100 $43
Potassium Serum 84132 $42
Prealbumin 84134 $133
PSA Screening 84153 $168
PSA Free 84154 $168
Protein Total Urine 84156 $34
Protein Electrophoretic Fractionation 84165 $98
PKU Neonatal Thyroxine 84437 $60
Free T4 84439 $83
Transferrin 84466 $111
Uric Acid Serum 84550 $41
Beta HCG Serum Quantitative 84702 $138
Beta HCG Serum Qualitative 84703 $68
Blood Count Manual Differential 85007 $30
RBC 85041 $27
D-Dimer Quantitative 85379 $93
Fibrinogen 85384 $78
Antinuclear Antibodies (ANA) 86038 $110
CRP C-Reactive Protein 86140 $46
Mono Screen 86308 $46
Rheumatoid Factor, Qualitative 86430 $51
Rubella Antibody 86762 $132
Indirect Coombs Test 86885 $731
Blood Typing ABO 86900 $555
Blood Typing Rh 86901 $169
Special Antigen Blood Typing 86902 $1,449
Electronic Blood Crossmatch 86923 $731
Culture Blood 87040 $95
Culture Throat 87070 $79
Culture Anaerobic 87075 $87
Culture Identification 87077 $74
Culture Fungus 87102 $76
Gram Stain 87205 $30
Infectious Agent Detection, Herpes Simplex 87449 $109
Infections Agent Detection, Chlamydia 87491 $214
Infectious Agent Detection, Clostridum Difficile 87493 $214
Infectious Agent Detection, Influenza Virus 87502 $520
Infectious Agent Detection, Stool Enteric Panel 87506 $1,302
Infectious Agent Detection, Gonorrhoeae 87591 $214
Infectious Agent Detection, Respiratory Virus 87631 $783
Infectious Agent Detection, Strep Screen 87880 $109
Cytopathology, Body Fluids 88104 $113
Flow Cytology, Ea Add’l Marker 88185 $45
Surgical Pathology Level II 88302 $113
Surgical Pathology Level III 88304 $226
Surgical Pathology Level IV 88305 $226
Surgical Pathology Level V 88307 $351
Special Stains for Microorganisms 88312 $124
Immunohistochemistry Each Add’l Specimen 88341 $45
Immunohistochemistry Initial Specimen 88342 $1,048
The following charges reflect the most common cardiology procedures. Physician fees are not included in these charges and will be billed separately.
Electrocardiogram 93005 $155
Doppler color flow mapping 93325 $414
Echocardiogram (2-D/m-mode) 93306 $2,031
Echocardiogram (Doppler) 93320 $414
Cardiac Stress Test 93017 $1,073
Holter Monitor Scanning 93225 $443

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 series74022$565
Xray of Ankle, three views73610$340
Xray of Chest, 3 Views71047$340
Xray of Chest, 2 Views71046$340
Xray of Chest, 1 View71045$340
Xray of Foot, three views73630$340
Xray of Hand, three views73130$340
Xray of Hips, 2 to 3 views73502$340
Xray of Knee, four views73564$565
Xray of Lumbar Spine, six views72110$565
Screening Digital Bilateral Mammogram77067$425
Diagnostic Digital Bilateral Mammogram77066$513
Xray of Pelvis, one or two views72170$565
Xray of Shoulder, two or more views73030$340
Xray of Cervical Spine, four views72050$565
CT Scan of Abdomen without Contrast74150$1,164
CT Scan of Abdomen with Contrast74160$2,451
CT Scan of Head without Contrast70450$1,164
CT Scan of Head with Contrast70460$2,451
CT Scan of Head, with and without contrast70470$2,451
CT Scan of Chest with Contrast71260$2,451
CT Scan of Pelvis with Contrast72193$2,451
MRI of Brain with Contrast70552$4,648
MRI of Brain, with and without contrast70553$4,648
MRI of Lumbar Spine without contrast72148$2,799
MRI of Cervical Spine without contrast72141$2,799
MRI of Lower Extremeties without contrast73721$2,799
Pet Scan, skull base to mid-thigh78815$7,201
Pet Scan, full body78816$7,201
Carotid Doppler Scan93880$860
Ultrasound of Gallbladder76705$860
Vascular Scan of Lower Extremity, unilateral93971$860
Ultrasound of Breast, unilateral76641$516
Ultrasound of Pelvis76856$860
Bone Scan, whole body78306$1,653
CT Scan of Neck With and Without Contrast70492$2,451
MRI of Brain Without Contrast70551$2,799
CT of Thorax Without Contrast71250$1,164
CT Angiography of Chest With and Without Contrast71275$2,451
Xray of Thoracic Spine, Two Views72070$565
CT Scan of Cervical Spine Without Contrast72125$1,164
Xray of Hips Bilateral, Three to Four Views73522$565
Xray of Abdomen, One View74018$340
Xray of Abdomen, Two Views74019$340
CT Scan of Abdomen and Pelvis Without Contrast74176$2,799
CT Scan of Abdomen and Pelvis With and Without Contrast74178$3,596
ERCP74329$917
Ultrasound of Thyroid76536$860
Ultrasound of Abdomen Complete76700$860
Ultrasound of Kidneys and Bladder Complete76770$860
Ultrasound of Kidneys Bilateral76775$860
Ultrasound Pregnant Uterus Greater Than or Equal to 14 Weeks76805$860
Ultrasound Transvaginal76830$860
Diagnostic or Screening Digital Tomosynthesis Bilateral77062/77063$30
Bone Density Study77080$565
Hepatobiliary System Imaging78227$2,192
Myocardial Perfusion With Wall Motion and Ejection Infraction78452$5,507
Ultrasound Duplex Scan of Extremity Veins93970$860
Xray Ribs Unilateral, Two Views71100$340
Xray Elbow, Minimum of Three Views73080$340
Xray Wrist, Minimum of Three Views73110$340
Xray Knee, Three Views73562$340
Diagnostic Digital Unilateral Mammogram77065$402

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, Right93451$12,375
Coronary Cath Placement for angiography93454$12,375
Coronary Cath Placement in bypass grafts93455$12,375
Coronary Cath Placement in bypass grafts w/ Right Heart Cath93456$12,375
Coronary Cath Placement in bypass grafts w/ Left Heart Cath93458$12,375
Left Heart Cath with coronary angiography w/graphs93459$12,375

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$173
Arterial blood gas & puncture82803 & 36600$477
Smoking Cessation99406 or 99407$151
EEG95816 or 95819$1,138
Sleep Study95805$5,277
Bronchodilation Spirometry94060$434
CPAP, Initiation and Management94660$389
Patient Teaching and/or Evaluation for Nebulizer94664$173
Plethysmography for Lung Volumes94726$280
Sleep Study with Four or More Parameters95810$5,277

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$467
Gait training, per 15 minutes97116$172
PT Therapeutic exercise, per 15 min97110$198
Ultrasound, per 15 min97035$80
PT Electrical Stimulation97014$85
PT Manual Therapy Techniques per 15 Minutes97140$183

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 Evaluation97165/97166/97167$522
OT Therapeutic exercise per 15 min97110$198
OT Functional Activities Per 15 Minuntes97530$210

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 session92507$402
Swallowing Evaluation92526$437
Articulation Evaluation92522$471
Voice Evaluation92524$460
Affluency Evaluation92521$565
Language Evaluation92523$877
Barium Swallowing Function74230$565

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 session93797$491
Cardiac Rehab with ECG per session93798$491

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 sessionG0424$246
Respiratory Exercises per 15 minutesG0237/G0238$198

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

Insertion of Catheter51701/51702$395
Bladder Scan51798$380
Fetal Non-Stress Test59025$392
Injection Lumbar or Sacral with Image Guidance62323$2,228
Immunization Administration90471$76
Newborn Hearing Screen92586$308
Intraveneous Hydration 1st Hour96360$401
Intraveneous Hydration Ea Add’l Hour96361$140
IV Infusion with Drug, 1st Hour96365$751
IV Infusion with Drug, Each Add’l Hour96366$140
IV Sequential Infusion96367$227
Injection Subcutaneous or intramuscular96372$184
Injection Intravenous Push96374$401
Injection Intravenous Push Initial Drug96375$184
Injection Intravenous Push Ea Add’l Sequential Drug96376$140
Chemotherapy Administration up to 1 Hour96413$1,217
Chemotherapy Administration Ea Add’l Hour96415$184
Chemotherapy Administration Ea Sequential Drug96417$227
Hospital Outpatient Clinic Visit G0463 $238
Psychiatric Group Therapy per Hour Session 90853 $186
Psychotherapy With Patient 60 Mins 90837 $292
Psychotherapy With Patient 45 Mins 90834 $235
Psychotherapy With Patient 30 Mins 90832 $166
Psychiatric Outpatient Facility Visit 60 Mins- New Patient 99205 $314
Psychiatric Outpatient Facility Visit 45 Mins – New Patient 99204 $274
Psychiatric Outpatient Facility Visit 30 Mins- New Patient 99203 $235
Psychiatric Outpatient Facility Visit 40 Mins- Established Patient 99215 $274
Psychiatric Outpatient Facility Visit 25 Mins- Established Patient 99214 $235
Psychiatric Outpatient Facility Visit 15 Mins- Established Patient 99213 $198
Common Inpatient DRGs DRG
Heart Failure & Shock with Major Complications 291 $31,567
Appendectomy with Major Complications 339 $33,327
Bilateral Joint Replacement- Knee or Hip 462 $54,597
Joint Replacement- Knee or Hip 470 $38,702
Uterine & Adnexa Procedures for Non Malignant with complications 743 $32,883
C-Section Delivery 788 $16,764
Vaginal Delivery 807 $9,785
Psychoses 885 $15,542
 

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

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