| Colonoscopy diagnostic | CPT | 45378 | 4 | $1,334.2 |
| Colonoscopy with biopsy | CPT | 45380 | 4 | $1,647.73 |
| Colonoscopy with polyp removal | CPT | 45385 | 4 | $1,846.51 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 4 | $1,292.54 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | $432.5 |
| Total hip replacement | CPT | 27130 | 4 | $3,286.76 |
| Total knee replacement | CPT | 27447 | 4 | $3,284.95 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 4 | $5,107.2 |
| Fetal non-stress test | CPT | 59025 | 4 | $147.51 |
| Upper GI endoscopy diagnostic | CPT | 43235 | 4 | $1,167.35 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 4 | $1,273.4 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 4 | $448.5 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 4 | $1,032.36 |
| CABG single arterial graft | CPT | 33533 | 4 | $4,646.7 |
| CABG 2 arterial grafts | CPT | 33534 | 4 | $5,470.83 |
| Total shoulder arthroplasty | CPT | 23472 | 4 | $3,524.85 |
| Hip hemiarthroplasty | CPT | 27125 | 4 | $2,739.17 |
| Knee revision arthroplasty single component | CPT | 27486 | 4 | $3,404.07 |
| Knee revision arthroplasty all components | CPT | 27487 | 4 | $4,266.14 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 4 | $2,532.29 |
| ACL reconstruction | CPT | 29888 | 4 | $2,375.79 |
| Laparoscopic appendectomy | CPT | 44970 | 4 | $1,473.61 |
| Laparoscopic cholecystectomy | CPT | 47562 | 4 | $1,453.94 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 4 | $1,018.74 |
| Lap inguinal hernia repair | CPT | 49650 | 4 | $939.54 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | $2,443.27 |
| Vaginal hysterectomy | CPT | 58260 | 4 | $1,768.1 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 4 | $2,098.33 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 4 | $2,361.28 |
| Lap salpingo-oophorectomy | CPT | 58661 | 4 | $1,403.88 |
