A/B MAC

Noridian

Benign Skin Lesion Removal (Excludes Actinic Keratosis, & Mohs)

Bladder/Urothelial Tumor Markers

Blepharoplasty, Eyelid Surgery,

& Brow Lift

Botulinum Toxin

Types A & B

B-Type Natriuretic Peptide (BNP)

Cardiovascular

Stress

Testing

Cataract Surgery in Adults

Chest

X-Ray

Chiropractic Services

Coenzyme Q10 (CoQ10)

Controlled Substance Monitoring & Drugs of Abuse Testing

Diagnostic & Therapeutic Colonoscopy

Electro-

cardiograms

Facet Joint Injections, Medial Branch Blocks, & Facet Joint Radiofrequency Neurotomy

Flow

Cytometry

GlycoMark

Testing for Glycemic Control

IVIG

(immune globulin)

In Vitro Chemosensitivity & Chemoresistance Assays

Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes & Morton's Neuroma

Intensity Modulated Radiation Therapy (IMRT)

Lumbar

Epidural Injections

Lumbar

MRI

Measurement of Salivary Hormones

Mohs Micrographic Surgery

MolDX: AlloSure® Donor-Derived Cell-Free DNA Test

MolDX: APC & MUTYH Gene Testing

MolDX: Biomarkers In Cardiovascular

Risk

Assessment

MolDX: Circulating Tumor Cell Marker Assays

MolDX: ConfirmMDx Epigenetic Molecular Assay

MolDX: CYP2C19, CYP2D6, CYP2C9, & VKORC1 Genetic Testing

MolDX: Decipher® Prostate Cancer Classifier Assay

MolDX: DecisionDx-UM (Uveal Melanoma)

MolDX: EndoPredict Breast Cancer Gene Expression Test

 MolDX: GeneSight ® Assay for Refractory Depression

MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease

MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor V Leiden, Factor II Prothrombin, & MTHFR)

MolDX: Genetic Testing

for

Lynch Syndrome

MolDX:

HLA-B15:02

Genetic

Testing

MolDX:

HLA-DQB1*06:02 Testing for Narcolepsy

MolDX: MGMT Promoter Methylation Analysis

MolDX: Molecular Diagnostic Tests (MDT)

MolDX: Molecular RBC Phenotyping

MolDX: NRAS Genetic

Testing

MolDX: Oncotype DX Breast Cancer for DCIS (Genomic Health)

MolDX: Oncotype DX Genomic Prostate Score for Men with Favorable Intermediate Risk Prostate Cancer

MolDX: Percepta Bronchial Genomic Classifier

MolDX: Prolaris™ Prostate Cancer Genomic

Assay

MolDX: Prolaris™ Prostate Cancer Genomic Assay for Men with Favorable Intermediate Risk Disease

MolDX: ProMark Risk Score

MolDX: Prometheus IBD sgi Diagnostic Policy

MolDX: Xpresys

Lung Test

MolDX-CDD: Genomic Health(tm) Oncotype DX® Prostate Cancer Assay

MRI & CT Scans of the Head & Neck

Nerve Blockade for Treatment of Chronic Pain & Neuropathy

Nerve Conduction Studies (NCS) & Electromyography (EMG)

Percutaneous Vertebral Augmentation

Peripheral Nerve Stimulation

Plastic Surgery

Polysomnography & Other Sleep Studies

Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder

Respiratory Care (Respiratory Therapy)

Sensory Evoked Potentials & Intraoperative Neurophysiology Monitoring

Serum Magnesium

Special Histochemical Stains & Immunohistochemical Stains

Spinal Cord Stimulation for Chronic Pain

Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) & Stereotactic Body Radiation Therapy (SBRT)

Total Hip Arthroplasty

Total Knee Arthroplasty

Treatment of Males with Low Testosterone

Treatment of Ulcers & Symptomatic Hyperkeratoses

Varicose Veins of the Lower Extremity, Treatment of

Trigger Point Injections

Vitamin D Assay Testing

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