Sunnyview Rehabilitation Hospital The below charges represent Hospital charges only. These charges do not include charges for services provided by physicians or advanced practitioners (ex. anesthesiologists, attending physicians, emergency room physicians, hospitalists, pathologist, radiologists, surgeons, etc.). Room and Board Per Day Charges The following represents the hospital charges for room and care services only. The charges below do not include the fees for drugs, non-routine supplies and procedures that may be rendered during the inpatient visit. Charge Medical/Surgical Semi Private $ 1,514.00 Medical/Surgical Private $ 1,698.00 Physical Therapy Charges The following charges reflect the services offered by our Physical Therapy department. Patients may have additional charges, Aquatic Therapy 97113 $ 117.00 Cold Pack 97010 $ 27.00 Community Re-Entry Visit 97537 $ 89.00 E Stim 2/Attended one - one 97032 $ 226.00 Electrical Stim 1/Unattend 97014 $ 226.00 Evaluation Various $ 447.00 Exercise Group 97150 $ 65.00 Gait Training 97116 $ 89.00 Manual Therapy Technique 97140 $ 89.00 Massage 97124 $ 89.00 Neuro Re Ed 97112 $ 89.00 Orthotic Training 97760 $ 89.00 Patient/Family Education 97535 $ 105.00 Prosthetic Training 97761 $ 89.00 Pulmonary Rehab w/exercise G0424 $ 73.00 Soft Tissue Mobility 97140 $ 89.00
Therapeutic Activities 97530 $ 89.00 Therapeutic Exercises 97110 $ 89.00 Traction Mech 97012 $ 144.00 Ultrasound 97035 $ 172.00 Wheelchair Training 97542 $ 89.00 Occupational Therapy Charges The following charges reflect the services offered by our Occupational Therapy department. Patients may have additional charges, Procedure CPT Code Charge Car lesson/training 97537 $ 33.00 Checkout Orthotic/prost 97763 $ 89.00 Cognitive Therapy 97127 $ 117.00 Community Re-Entry 97537 $ 89.00 Driver Clinical Assessment 97537 $ 52.00 Elbow Kinesiotaping 29260 $ 176.00 E-stim, attended 97032 $ 226.00 Evaluation Various $ 447.00 Fluidotherapy 97022 $ 114.00 Hand or Finger Kinesiotaping 29280 $ 176.00 HMT/Home management train 97535 $ 89.00 Hot Pack 97010 $ 27.00 Manual Therapy Tech 97140 $ 89.00 Neuro Re-Education 97112 $ 96.00 On Road Assessment 97537 $ 52.00 Orthotic Fitting 97760 $ 89.00 Orthotic Training 97760 $ 91.00 Paraffin Bath 97018 $ 114.00 Physical Performance Test 97750 $ 89.00 Prost. Training 97761 $ 88.00 Re-Evaluation 97168 $ 117.00 ROM Arm 95851 $ 99.00 Sensory Treatment 97533 $ 89.00
Shoulder Kinesiotaping 29240 $ 176.00 Therapeutic Activities 97530 $ 101.00 Therapeutic Exercise 97110 $ 117.00 Therapy Group 97150 $ 65.00 Ultrasound 15 Min 97035 $ 36.00 Van Assessment 97537 $ 249.00 Speech Therapy Charges The following charges reflect the services offered by our Speech Therapy department. Patients may have additional charges, Aphasia Assessment Per Hour 96105 $ 201.00 Assess Asphasia Intprt 96105 $ 184.00 Behav-Qualitative Analys Voice 92524 $ 245.00 Eval Language Only 92523 $ 486.00 Eval Speech Fluency 92521 $ 290.00 Eval Speech Sound Prod 92522 $ 236.00 Eval Speech Sound W Lang Comp 92523 $ 486.00 Speech Therapy 92507 $ 111.00 Speech Therapy Group 92508 $ 65.00 St Sgd Evaluation 92607 $ 434.00 St Sgd Training 92609 $ 417.00 Swallowing Eval 92610 $ 361.00 Swallowing Therapy 92526 $ 201.00 Therapeutic Activities 97530 $ 111.00 Videoflouroscopy 92611 $ 201.00 Voice Prosth Eval 92597 $ 231.00 Voice Prosthesis Training 92507 $ 176.00 Audiology Charges The following charges reflect the services offered by our Audiology department. Patients may have additional charges, depending on the services performed.
Basic Vestibular Eval 92540 $ 251.00 Brainstem adtry evok resp 92585 $ 584.00 Caloric Vstblr Tst Bil/Bitherm 92537 $ 246.00 Central Aud Proc Eval 1 Hour 92620 $ 282.00 Cntrl Aud Proc Eval Addl 15Min 92621 $ 76.00 Earmold Impression Bi V5275 $ 44.00 Earmold Impression Mon V5275 $ 34.00 HA Repair Level 1 V5014 $ 215.00 HA Repair Level 2 V5014 $ 285.00 HA Repair Level 3 V5014 $ 356.00 Hearing Aid Delivery Bi V5160 $ 157.00 Hearing Aid Delivery Mon V5241 $ 157.00 Hearing aid Eval Bi 92591 $ 125.00 Hearing Aid Eval Mon 92590 $ 83.00 Hearing Aid Follow-Up Binaural 92593 $ 245.00 Hearing Aid Follow-Up Monaural 92592 $ 164.00 OAE Diagnostic 92588 $ 147.00 OAE Limited Evaluation 92587 $ 73.00 Puretone A/B SAT/SRT DC 92557 $ 201.00 Puretone Threshold A/B Ext 92553 $ 167.00 Puretone Threshold air 92552 $ 70.00 Puretone Threshold Air Ext. 92552 $ 152.00 Puretone Threshold Air/Bone 92553 $ 88.00 SAT or SRT 92555 $ 44.00 SAT or SRT & SD Ext. 92556 $ 189.00 SAT or SRT & Sp Disc 92556 $ 104.00 SAT or SRT Ext. 92555 $ 124.00 Tymp Acstic Rflx Thrshld Decay 92570 $ 184.00 Tympanometry Only 92567 $ 89.00 Tympanometry/Reflex Thresh Msmt 92550 $ 143.00 X-Ray and Radiological Charges The following charges reflect the hospital s 30 most common x-ray and radiological procedures. There may be additional supply and contract media charges depending on the procedure.
Abdomen 2 Postion 74019 $ 508.00 Abdomen KUB/Flat Plate 74018 $ 271.00 Ankle 73610 $ 324.00 Chest (1 View) 71045 $ 324.00 Chest (PA & LAT) 71046 $ 391.00 Clavicle 73000 $ 271.00 Dexa Axial Skeleton (Spine) 77080 $ 718.00 Femur Thigh 73552 $ 391.00 Foot 2 View 73620 $ 271.00 Foot 3+ Views 73630 $ 324.00 Forearm 73090 $ 271.00 Hand 73130 $ 324.00 Hip Unilateral 73502 $ 391.00 Hips Bil (Includes AP Pelvis) 73521 $ 585.00 Kidney Bil (Renal) 76775 $ 1,612.00 Knee 1/2 View 73560 $ 271.00 Knee 3 Views 73562 $ 391.00 Lower Leg 73590 $ 271.00 Pelvis 72170 $ 324.00 Renal (Kidneys) And Bladder 76770 $ 1,841.00 Ribs 71100 $ 391.00 Ruq Biliary 76705 $ 1,055.00 Sacrum & Coccyx 72220 $ 391.00 Shoulder 73030 $ 391.00 Spine Cervical 2 View 72040 $ 391.00 Spine Lumbar 2-3 View 72100 $ 486.00 Spine Lumbosacral 72110 $ 756.00 Upper Abdomen 76705 $ 960.00 Video Fluoro(Swallowing Study) 74230 $ 913.00 Wrist 73110 $ 324.00 Laboratory Charges
The following charges reflect the hospital s 30 most common laboratory tests. APTT Act.Partial Thrombo.Time 85730 $ 69.00 Basic Metabolic Panel 80048 $ 92.00 B-Type Natriuretic Peptid 83880 $ 285.00 C Diff by PCR x2-sv-ellis only 87493 $ 325.00 CBC w/ Automated Differential 85025 $ 88.00 CBC Without Diff 85027 $ 74.00 Comprehensive Metabolic Pan 80053 $ 120.00 Crossmatch,Immediate Spin 86920 $ 94.00 Culture Blood 87040 $ 118.00 Culture Quant Urine 87086 $ 92.00 Culture Sputum 87070 $ 78.00 Glucose 82947 $ 35.00 Glycohemoglobin (HgbA1c) 83036 $ 110.00 Gram Stain 87205 $ 37.00 Hematocrit 85014 $ 23.00 Hemoglobin 85018 $ 23.00 Identification - Aerobic 87077 $ 92.00 Identification - Urine 87088 $ 74.00 Iron 83540 $ 74.00 Iron Binding Capacity 83550 $ 99.00 Levetiracetam/Keppra Level 80177 $ 164.00 Magnesium 83735 $ 77.00 Occult Blood Stool 82272 $ 38.00 Prothrombin Time (PT) w/ INR 85610 $ 35.00 Susceptibility By Mic 87186 $ 97.00 T4 Free 84439 $ 103.00 Troponin 84484 $ 113.00 TSH 84443 $ 190.00 Urinalysis with Microscopic 81001 $ 37.00 Vancomycin Trough 80202 $ 124.00
Respiratory Therapy Charges The following charges reflect the services offered by our Respiratory Therapy department. Patients may have additional charges, Arterial Puncture 36600 $ 204.00 Bronch Therapy 94664 $ 204.00 CPAP Treatment Initial 94660 $ 81.00 Nebulizer TX, Initial 94664 $ 147.00 Oximetry Continuous 94762 $ 254.00 Postural Drainage 15-30 Min 94667 $ 28.00 Resp transport Vent. Various $ 683.00 Suctioning Deep 31720 $ 143.00 Trach Tube Change 31502 $ 191.00 Ventilator Setup/1st Day 94002 $ 229.00 Ventilator Subsequent Days 94003 $ 257.00