| Health Net Comm & Medi-Cal Plan | Donor Lymphocyte Infusion | 2025-02-01 |
| Health Net Comm & Medi-Cal Plan | Implantable Wireless Pulmonary Artery Pressure Monitoring | 2025-02-01 |
| Health Net Comm & Medi-Cal Plan | IMRT | 2025-02-01 |
| Health Net Comm & Medi-Cal Plan | Lung Transplantation | 2025-02-01 |
| Health Net Comm & Medi-Cal Plan | Nerve Blocks | 2025-02-01 |
| Health Net Comm & Medi-Cal Plan | Pediatric Kidney Transplant | 2025-02-01 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Responsive Neurostimulation for the Treatment of Refractory Partial Epilepsy | 2025-02-01 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Corpectomy, Vertebral | 2025-02-01 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Ankle Arthroscopy | 2025-02-01 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Repair, Metatarsal | 2025-02-01 |