This Voucher Include MRI OR MRA with & without contrast Of Any (1) One Of The Following Body Part (Facility Or Provider Standard Protocol Applies).I.E. Abdomen, Pelvis, Wrist, Finger, Foot, Forearm, Hand, Heel, Head, Orbits, Brain, Soft Tissue Neck, Cervical Spine, Lumbar Spine, Thoracic Spine, and Toe. 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.
All Bilateral Studies Are 2 Different Tests/Procedures. Entire Spine I.E. Cervical, Thoracic, And Lumbar Are 3 Different Tests/Procedures. Excludes Breast MRI, MRA Runoff, MR Arthrogram Must Have A Valid Prescription/Order From A Licensed Physician. Must Have a recent Blood Work Report to administer contrast. 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