This voucher includes X-ray for any (1) One of the following body part up to 5 views maximum (Facility or provider standard protocol applies).i.e. Abdomen, AC Joints, Ankle, Bone Age Study, Chest, Clavicle, Elbow, Eyes (Foreign Body), Facial Bones, Femur, Finger, Foot, Forearm, Hand, Heel, Hip, Pelvis, Humerus, Knee, Mandible, Nasal Bones, Orbits, Ribs Unilateral, Sacrum/Coccyx, SC Joints, Scapula, Shoulder, SI Joints, Sinuses, Skull, Soft Tissue Neck, Cervical Spine, Lumbar Spine, Thoracic Spine, Scoliosis, Tib/Fib, Toe and Wrist. Any procedure being upgraded all terms & condition to the upgraded procedure do apply. *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.
All bilateral studies are 2 different tests/procedures. Entire Spine i.e. Cervical, Thoracic and Lumbar are 3 different tests/procedures. Excludes, Dental X-ray, Barium X-ray and other contrast X-rays.. 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