A/B MAC

WPS

Allergen Immunotherapy

Allergy

Testing

Autonomic Function Tests

Bisphosphonate

Drug Therapy

Blepharoplasty, Blepharoptosis

& Brow Lift

Botulinum Toxin Type A & Type B

Chemotherapy Drugs & their Adjuncts

Chiropractic Services

Coenzyme Q10 (CoQ10)

Colonoscopy

& Sigmoidoscopy-Diagnostic

Coronary

Computed Tomography Angiography (CCTA)

Cosmetic & Reconstructive Surgery

Drug

Testing

Drugs & Biologicals, (Non-chemotherapy)

Electrocardiographic (EKG or ECG) Monitoring (Holter

or Real-Time Monitoring)

Endoscopic Treatment of GERD

Erythropoiesis Stimulating Agents (ESA)

Facet Joint Interventions for Pain

Management

Flow

Cytometry

Foot

Care

Human Granulocyte/Macrophage Colony Stimulating Factors

IVIG

(immune globulin)

Immunizations

Intra-articular Injections of Hyaluronan

Intraoperative Neurophysiology Monitoring

Lumbar

Epidural Injections

Mohs Micrographic Surgery

MolDX: 4Kscore Assay

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

MolDX: APC & MUTYH Gene Testing

MolDX: Biomarkers In Cardiovascular

Risk

Assessment

BRCA1 & BRCA2 Genetic Testing

Breast Cancer Assay: Prosigna

Breast Cancer Index Genetic Assay

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: 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: Genomic Health™ Oncotype DX® Prostate Cancer Assay

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

NRAS Genetic

Testing

NSCLC, Comprehensive Genomic Profile 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

Nerve Blocks for Peripheral Neuropathy

Nerve Conduction Studies (NCS) & Electromyography (EMG)

Non-Coronary Vascular

Stents

Non-Invasive Abdominal / Visceral Vascular Studies

Non-Invasive Cerebrovascular Studies

Non-Invasive Peripheral Arterial Vascular Studies

Non-Invasive Peripheral Venous Vascular & Hemodialysis Access Studies

Pelvic Floor Dysfunction: Anorectal Manometry & EMG

Percutaneous Coronary Interventions

Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain

Polysom-

nography & Other Sleep Studies

Posterior Tibial Nerve Stimulation for Voiding Dysfunction

Psychiatry

& Psychology Services

Psychological & Neuropsychological Tests

 Removal of Benign Skin Lesions

 Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

Somatosensory Testing

Special Histochemical Stains & Immunohistochemical Stains

Surgical Treatment of Obstructive Sleep Apnea (OSA)

Transcranial Magnetic Stimulation

Treatment of Varicose Veins of the Lower Extremities

Trigger Points, Local Injections

Vertebroplasty (Percutaneous) & Vertebral Augmentation including cavity creation

Visual Electrophysiology Testing

Visual Fields

Testing

Vitamin D Assay Testing

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