| Aetna | Polio Vaccine | 2025-06-09 |
| Aetna | Selected Aortic Valve Procedures: Ross Pulmonary Autograft and Aortic Valve-Sparing Re-implantation | 2025-06-09 |
| Aetna | Macular/Foveal Translocation | 2025-06-09 |
| Aetna | Hepatitis B Vaccine | 2025-06-09 |
| Aetna | AcuTect Scintigraphic Imaging for Detection of Lower Limb Deep Vein Thrombosis | 2025-06-09 |
| Aetna | Nerve Grafting and Reconstruction: Selected Indications | 2025-06-09 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Electromagnetic Navigational Bronchoscopy (ENB) | 2025-06-09 |
| BCBS Highmark Penn CPA/SEPA/WPA/NEPA | Intravitreal Implants | 2025-06-09 |
| BCBS Highmark Penn Medicare Advantage | Surgical Dressings | 2025-06-09 |
| BCBS Highmark Penn Medicare Advantage | Respiratory Assist Devices | 2025-06-09 |