| Medical Mutual | Tryngolza® | 2025-12-18 |
| Medical Mutual | Tysabri (natalizumab) | 2025-12-18 |
| Medical Mutual | Voxzogo™ (vosoritide subcutaneous injection) | 2025-12-18 |
| Medical Mutual | Xeomin® (incobotulinumtoxinA) | 2025-12-18 |
| Medical Mutual | Zilbrysq ® (zilucoplan subcutaneous injection) | 2025-12-18 |
| Cigna EviCore | CMM-208: Ablations/Denervation's of Facet Joints and Peripheral Nerves | 2025-12-18 |
| Cigna EviCore | CMM-308: Intradiscal Procedures | 2025-12-18 |
| Cigna EviCore | CMM-609: Lumbar Fusion (Arthrodesis) | 2025-12-18 |
| Cigna EviCore | CMM-612: Grafts | 2025-12-18 |
| Cigna EviCore | CMM-615: Electrical and Low Frequency US Bone Growth Stimulation Spine | 2025-12-18 |