| ULTRASOUND | ||
| SERVICE CHARGE CODE | SERVICE DESCRIPTION | SERVICE CHARGE PRICE |
| 2000001 | US-EXT CAROTIDS, BILATERAL | 156.15 |
| 2000004 | US-GUIDED BIOPSY | 296.82 |
| 2000012 | US-FETAL HEART, COMP | 259.71 |
| 2000016 | US-EXT CAROTIDS, UNILATERAL | 121.16 |
| 2000033 | US-FETAL HEART, 2-D | 116.45 |
| 2000050 | US-GUIDE RADIOTX EXC B-SCAN | 116.45 |
| 2000064 | US-TRANSRECTAL | 210.25 |
| 2000066 | US-GUIDE RADIOTX B-SCAN | 121.16 |
| 2000068 | US-TRANSVAGINAL | 210.25 |
| 2000076 | US EXAM FOLLOW-UP | 108.54 |
| 2000079 | US-BIOPHYSICAL PROFILE | 247.35 |
| 2000080 | US-SURGERY | 108.54 |
| 2000084 | US-GUIDED ASPIRATION | 309.16 |
| 2000152 | US-OVA ASPIRATION | 435.71 |
| 2004883 | US-THYROID | 128.96 |
| 2004925 | US-GALLBLADDER | 128.96 |
| 2004933 | US-ABDOMEN (LIVER,PANCREAS,B-DUCT) | 156.46 |
| 2004941 | US-AORTA | 128.96 |
| 2004958 | US-KIDNEY | 128.96 |
| 2004966 | US-BRAIN NEWBORN | 128.96 |
| 2004974 | US-OBSTETRICAL | 128.96 |
| 2004984 | US-PELVIC | 128.96 |
| 2005310 | US-EXTREMITY, NON-VASCULAR | 128.96 |
| 2005328 | US-SPLEEN | 128.96 |
| 2005344 | US-SCROTUM | 128.96 |
| 2050182 | US-GUIDED AMNIOCENTESIS | 104.73 |
| 2050187 | US-BRAIN INFANT | 82.38 |
| 2050192 | US-BREAST | 123.56 |
| 2050194 | US-CHEST | 118.86 |
| 2076705 | US-APPENDIX | 128.96 |
| 2076815 | US-GESTATIONAL, LIMITED | 104.73 |
| 2093925 | US-DUPLEX, LE ARTERIES, BIL | 255.83 |
| 2093926 | US-DUPLEX, LE ARTERIES, UNIL | 127.91 |
| 2093930 | US-DUPLEX, UE ARTERIES, BIL | 255.83 |
| 2093931 | US-DUPLEX, UE ARTERIES, UNIL | 127.91 |
| 2096019 | US-MULTI GESTATION, POST-1ST TRIM | 186.41 |
| 2096020 | US-DUPLEX, EXTREMITY, BIL | 255.83 |
| 2096030 | US-DUPLEX, EXTREMITY, UNIL | 186.41 |
| 2098000 | US-GUIDED PARACENTESIS | 190.32 |