| Colonoscopy diagnostic | CPT | 45378 | 4 | $1,194.66 |
| Colonoscopy with biopsy | CPT | 45380 | 4 | $1,545.06 |
| Colonoscopy with polyp removal | CPT | 45385 | 4 | $1,649.47 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 4 | $1,300.76 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | $435.25 |
| Total hip replacement | CPT | 27130 | 4 | $3,307.66 |
| Total knee replacement | CPT | 27447 | 4 | $3,305.83 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 4 | $5,139.66 |
| Fetal non-stress test | CPT | 59025 | 4 | $130.23 |
| Upper GI endoscopy diagnostic | CPT | 43235 | 4 | $1,026.93 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 4 | $1,138.46 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 4 | $415.17 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 4 | $901.75 |
| CABG single arterial graft | CPT | 33533 | 4 | $4,676.24 |
| CABG 2 arterial grafts | CPT | 33534 | 4 | $5,505.61 |
| Total shoulder arthroplasty | CPT | 23472 | 4 | $3,547.25 |
| Hip hemiarthroplasty | CPT | 27125 | 4 | $2,756.58 |
| Knee revision arthroplasty single component | CPT | 27486 | 4 | $3,425.71 |
| Knee revision arthroplasty all components | CPT | 27487 | 4 | $4,293.26 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 4 | $2,548.39 |
| ACL reconstruction | CPT | 29888 | 4 | $2,390.9 |
| Laparoscopic appendectomy | CPT | 44970 | 4 | $1,482.98 |
| Laparoscopic cholecystectomy | CPT | 47562 | 4 | $1,393.63 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 4 | $1,025.21 |
| Lap inguinal hernia repair | CPT | 49650 | 4 | $900.57 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | $2,458.8 |
| Vaginal hysterectomy | CPT | 58260 | 4 | $1,694.77 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 4 | $2,111.67 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 4 | $2,376.29 |
| Lap salpingo-oophorectomy | CPT | 58661 | 4 | $1,345.65 |
