SDI Patient Assistance Programs available by calling (602) 521-6203

AT-A-GLANCEINSURANCE PLANSTax ID Number: 200382536

SCHEDULING: (623) 847-2000 • FAX: (623) 847-2001 PET/IR SCHEDULING: (623) 842-5614

NUCLEAR MEDICINE SCHEDULING: (623) 842-5910 DIGITAL RECORDS/PATIENT REPORTS: (623) 842-5620

IT SUPPORT LINE: (602) 521-6373 www.valleyradiolgists.com

AETNA (ALL PRODUCTS*)

AMBETTER

ARIZONA CARE NETWORK

ARIZONA FOUNDATION

BANNER HEALTH NETWORK

BEECH STREET

BCBS – AZ (ALL STATES)

CIGNA (ALL PRODUCTS* – INCLUDES GREATWEST AND GWH)

CORECHOICE

COVENTRY HEALTH CARE (ALL PRODUCTS*)

FIRST HEALTH

GALAXY HEALTH

HEALTH MANAGEMENT NETWORK – AMN/RAN/HMN

HEALTH NET (ALL PRODUCTS *- EXCEPT AZPCP)

HUMANA (ALL PRODUCTS *– EXCEPT HMOx)

INTEGRATED HEALTH PLAN

MULTIPLAN

OPTUM MEDICAL NETWORK (FORMERLY LIFEPRINT)

PPO NEXT

PRIVATE HEALTHCARE SYSTEMS (PHCS)

THREE RIVERS PROVIDER NETWORK

TRICARE/UHC MILITARY & VETERANS SERVICES

UNITEDHEALTHCARE (ALL PRODUCTS*)

UA HEALTHCARE (ALL PRODUCTS*)

USA MANAGED CARE

VA (DEPARTMENT OF VETERANS AFFAIRS - INCLUDES TRI-WEST VAPC3)

WORKERS COMPENSATION (MOST PLANS)

MEDICARESDI AND AFFILIATES ARE IN NETWORK WITH A FULL RANGE OF TRADITIONAL MEDICARE AND MEDICARE ADVANTAGE PLANS.

INCLUDING BUT NOT LIMITED TO:

AHCCCSSDI AND AFFILIATES ARE IN NETWORK WITH ALL MARICOPA COUNTY AHCCCS PLANS (PLUS RELATED MEDICARE ADVANTAGE & ALTCS PLANS).

INCLUDING BUT NOT LIMITED TO:

BANNER HEALTH NETWORK

BLUE CROSS BLUE SHIELD ADVANTAGE

HEALTH CHOICE GENERATIONS

TRADITIONAL MEDICARE (FFS)/RAILROAD MEDICARE

MERCY CARE ADVANTAGE

ONECARE

OPTUMCARE

UNITEDHEALTHCARE AARP MEDICARECOMPLETE

BANNER-UNIVERSITY FAMILY CARE

CARE 1ST

CENPATICO

HEALTH CHOICE ARIZONA (EXCEPT ESSENTIALS)

INDIAN HEALTH SERVICES

MERCY CARE PLAN

MERCY MARICOPA INTEGRATED CARE

UNITEDHEALTHCARE COMMUNITY PLAN (FORMERLY APIPA & EVERCARE)

UNIVERSITY FAMILY CARE/BANNER

AUTHORIZATION ASSISTANCE IS AVAILABLE

*SOME NARROW NETWORKS MAY BE EXCLUDED

Plans we are NOT contracted with: • Caremore • Kaiser Permanente (CA HMO plan) • Out of State Medicaid • Out of State Medicare Advantage Plans • Health Partners

• SMIL, EVDI and Valley Radiologists are affiliates of Southwest Diagnostic Imaging (SDI). All share the same Tax ID and extensive network of plans. • This At-A-Glance reference is intended to be a guide. For the full list or with questions call (623) 931-1128.

CPT Code Guidelines for X-Ray, CT and MRIMRI Head and Neck (soft tissue)70540 MRI Orbit, Face, Neck, Sella w/o70543 MRI Orbit, Face, Neck, Sella w/wo70551 MRI Brain w/o70553 MRI Brain w/wo70553 MRI Brain IAC w/wo70553 MRI Brain Pituitary w/wo

MRI Breast77059 MRI Bilateral Breast w/wo

MRI Spine72141 MRI Cervical Spine w/o72156 MRI Cervical Spine w/wo72146 MRI Thoracic Spine w/o72157 MRI Thoracic Spine w/wo72148 MRI Lumbar Spine w/o72158 MRI Lumbar Spine w/wo72195 MRI Sacrum & Coccyx w/o72197 MRI Sacrum & Coccyx w/wo

MRI Upper Extremity73218 MRI Upper Extremity, No Joint, w/o73220 MRI Upper Extremity, No Joint w/wo (Humerus/Forearm/Hand)73221 MRI Upper Extremity Joint w/o73223 MRI Upper Extremity Joint w/wo (Shoulder/Elbow/Wrist)

MRI Abdomen & Pelvis74181 MRI Abdomen w/o74181 MRCP w/o74183 MRI Abdomen w/wo74183 MRI Abdomen w/wo Eovist72195 MRI Pelvis w/o72197 MRI Pelvis w/wo

MRI Lower Extremity73718 MRI Lower Extremity, No Joint, w/o73720 MRI Lower Extremity, No Joint, w/wo (Femur/Tib/Fib/Foot)73721 MRI Lower Extremity Joint w/o73723 MRI Lower Extremity Joint w/wo (Hip/Knee/Ankle)

MR Angiography70544 MRA Head/COW w/o70546 MRA Head/COW w/wo70547 MRA Neck w/o70549 MRA Neck w/wo74185 MRA Abdomen w/o or w/wo

CT Head & Neck70450 CT Brain w/o Contrast70470 CT Brain w/wo Contrast70486 CT Sinus w/o70486 CT Facial Bones w/o Contrast70487 CT Facial Bones with Contrast70488 CT Facial Bones w/wo Contrast70480 CT Orbits w/o Contrast70481 CT Orbits with Contrast70482 CT Orbits w/wo Contrast70480 CT Temporal Bones w/o Contrast70481 CT Temporal Bones with Contrast70482 CT Temporal Bones w/wo Contrast70490 CT Soft Tissue Neck w/o Contrast70491 CT Soft Tissue Neck with Contrast70492 CT Soft Tissue Neck w/wo Contrast

CT Chest71250 CT Chest w/o Contrast71260 CT Chest with Contrast75571 CT Calcium Scoring71250 CT Low Dose Lung Screening

CT Extremity 73200 CT Upper Extremity w/o (Shoulder/Humerus/Elbow/ Forearm/Wrist/Hand) 73700 CT Lower Extremity w/o (Hip/Femur/Knee/Tib/Fib/ Ankle/Foot)

CT Spine 72125 Cervical Spine w/o Contrast 72128 Thoracic Spine w/o Contrast 72131 Lumbar Spine w/o Contrast

CT Abdomen & Pelvis74176 CT Abdomen & Pelvis w/o74177 CT Abdomen & Pelvis with74178 CT Abdomen & Pelvis w/wo74261 Virtual Colonoscopy Diagnostic74263 Virtual Colonoscopy Screening

CT Angiography70496 CTA Head w/wo70496/70498 CTA Carotids w/wo71275 CTA Chest/Thoracic Aorta w/wo71275 CTA Pulmonary Arteries (PE) w/wo75572 CTA Cardiac - Lt Atrium & Pulmonary Vein w/wo75574 CTA Coronary Arteries with Calcium Score w/wo75635 CTA Abdominal Aorta with Runoff w/wo74174 CTA Abdomen & Pelvis w/woDigital X-Ray Head and Neck

70110 Mandible Complete70140 Facial Bones Less than3 views70150 Facial Bones Complete70160 Nasal Bones Complete70200 Orbits Complete 4 Views Minimum70210 Sinus Less than 3 Views70220 Sinus Complete70250 Skull Less than 4 Views70260 Skull Complete70360 Soft Tissue Neck Lateral

Digital X-Ray Chest71020 Chest; 2 Views71100 Ribs; Unilateral,2 Views71101 Ribs; Bilateral, 3 Views71130 Sternoclavicular Joints

Digital X-Ray Spine72040 Cervical Spine 2-3 Views72050 Cervical Spine Complete72072 Thoracic Spine 3 Views72100 Lumbar 2-3 Views72110 Lumbar Spine Complete72114 Lumbar Complete w/Flexion & Extension

Digital X-Ray Upper Extremities73000 Clavicle Unilateral Complete73030 Shoulder Unilateral Complete73050 AC Joints 2 Views73060 Humerus 2 Views73080 Elbow Unilateral Complete73090 Forearm Unilateral 2 Views73110 Wrist Unilateral Complete73130 Hand Unilateral Complete

Digital X-Ray Abdomen74000 Abdomen/KUB Single View74020 Abdomen 2 View Supine & Erect Digital X-Ray Lower Extremities73510 Hip Unilateral 2 Views73520 Hips Bilateral w/AP Pelvis73540 Hips/Pelvis Infant73550 Femur 2 Views73562 Knee Unilateral Complete73565 Bilateral Standing Knees73590 Tibia/Fibula 2 Views73592 Lower Ext. Infant 2 views73610 Ankle Unilateral Complete73630 Foot Unilateral Complete

To schedule an appointment Call 623-847-2000.VR 408 - 01/2018