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365 days
Category Diagnostic Radiology
Subcategory Ultrasound*
Voucher Type Single
Validity 365 days
Ultrasound Any (1) Body Part*
Diagnostic Radiology
Tier I
Terms & Conditions

This Voucher Include Ultrasound/Sonogram of Any (1) One Of The Following Body Part (Facility Or Ordering Provider's Standard Protocol Applies), i.e. Abdomen, Pelvis Trans-abdominal, Pelvis Trans-vaginal, Kidneys, Bladder, Neck (Soft Tissue), Rectum, Scrotal, Testicles, Chest, Extremity (Non Vascular), Breast, OB First Trimester. Any procedure being upgraded all terms & condition to the upgraded procedure do apply. If the value of the voucher is lower than the Tier purchased you are accepting the lesser value & lose any remaining balance.

*The CPT code,(s) provided are property of AMA and are to be used for reference purpose only. They may change at any given time without notice and THP is not responsible for accuracy. Multiple CPT codes listed may be irrelevant in some or all circumstances.

Exclusions And Special Instructions

All Bilateral Studies Are 2 Different Tests/Procedures i.e (Breasts, Extremities). Female Pelvis (Trans-abdominal & Trans-vaginal) are 2 Different Tests/Procedures. Excludes All Arterial, Venous, Carotid, Vascular, Doppler Studies & Ultrasound Guided Biopsy. Must Have A Valid Prescription/Order From A Licensed Physician. Must Check Availability And Follow Scheduling Requirements Of A Participating THP Provider/Facility Before Purchase. TERMS USED BUT NOT DEFINED HEREIN SHALL HAVE THE RESPECTIVE MEANINGS GIVEN TO THEM IN THP’S TERMS & CONDITIONS FOUND ON Www.Transparenthealthplans.Com/Term

Related CPT Code
76700, 76705, 76775, 76770, 76882, 76442, 76441, 76881, 76817, 76801, 76812, 76536, 76856, 76857, 76830, 76870, 76776, 76872

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