ALLIED SERVICES REHABILITATION HOSPITAL Hospital

Legal name: ALLIED SERVICES INSTITUTE OF REHABILITATION MEDICINE

SCRANTON, PA 185082605 (570) 348-1300 283X00000X

Published Procedure Prices

Procedure	CPT	Cash Price	Insurance Range
CT Cerebral Perfusion Study	0042T	N/A	N/A
US Uterine Leiomyomata w/ MRI < 200cc	0071T	N/A	N/A
US Uterine Leiomyomata w/ MRI > 200cc	0072T	N/A	N/A
ROOM/BED: Semi Private	10200	N/A	N/A
ROOM/BED: Private	10300	N/A	N/A
ROOM/BED: HL Private	10700	N/A	N/A
ROOM/BED: HL Semi Private	10800	N/A	N/A
PT Dry Needling, 1-2 Muscles Units	20560	N/A	N/A
PT Dry Needling, 3+ Muscles Units	20561	N/A	N/A
IR Angiogram Cervicocerebral	36221	N/A	N/A
IR Angiogram Carotid Cervical Left	36222	N/A	N/A
IR Angiogram Carotid Cerebral Left	36223	N/A	N/A
IR Angiogram Carotid Cervical Bilateral	36224	N/A	N/A
IR Angiogram Cervical	36225	N/A	N/A
IR Angiogram Vertebral	36226	N/A	N/A
IR Angiogram Carotid External Bilateral	36227	N/A	N/A
US Intravascular Initial Vessel	37250	N/A	N/A
JHI PT Fitness Eval	42044	N/A	N/A
SLP Cognitive Skills Development Units	44035	N/A	N/A
Wechsler Adult Int 4E 59000 Units	59000	N/A	N/A
Wechsler Adult Int 4 Graph 59001 Units	59001	N/A	N/A
Ind Diag Personality Test 59004 Units	59004	N/A	N/A
Voc Apt Battery Tests 59005 Units	59005	N/A	N/A
Wood Johnson Cog Ability 59007 Units	59007	N/A	N/A
Halstead Npsych Battery 59010 Units	59010	N/A	N/A
Wechsler Memory Scale 59018 Units	59018	N/A	N/A
Psychological Evaluation 59030 Units	59030	N/A	N/A
Trichiasis; Epilation	67820	N/A	N/A
XR Myelography Posterior Fossa	70010	N/A	N/A
XR Cisternography	70015	N/A	N/A

Prices shown are published rates from hospital chargemaster files and insurer rate data. Your actual cost depends on your insurance plan, deductible status, and services rendered.