| Sentara Health Plans | Lumbar Discectomy, Surgical 120 - Medicare | 2025-12-01 |
| Sentara Health Plans | Lumbar Fusion, Surgical 118 - Commercial | 2025-12-01 |
| Sentara Health Plans | Lumbar Fusion, Surgical 118 - Medicaid | 2025-12-01 |
| Sentara Health Plans | Lumbar Laminectomy, Surgical 121 - Commercial | 2025-12-01 |
| Sentara Health Plans | Lumbar Laminectomy, Surgical 121 - Medicaid | 2025-12-01 |
| Sentara Health Plans | Orthognathic Surgery, Surgical 34 - Commercial | 2025-12-01 |
| Sentara Health Plans | Orthognathic Surgery, Surgical 34 - Medicaid | 2025-12-01 |
| Sentara Health Plans | Surgical Assisted Liposuction, Surgical 131 - Commercial | 2025-12-01 |
| Sentara Health Plans | Surgical Assisted Liposuction, Surgical 131 - Medicaid | 2025-12-01 |
| Sentara Health Plans | Surgical Assisted Liposuction, Surgical 131 - Medicare | 2025-12-01 |