| Colonoscopy diagnostic | CPT | 45378 | 4 | $1,575.55 |
| Colonoscopy with biopsy | CPT | 45380 | 4 | $1,972.01 |
| Colonoscopy with polyp removal | CPT | 45385 | 4 | $2,058.76 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 4 | $6,892.61 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | $5,082.75 |
| Total hip replacement | CPT | 27130 | 4 | $1,942.96 |
| Total knee replacement | CPT | 27447 | 4 | $1,768.41 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 4 | $4,538.06 |
| Routine obstetric care with C-section | CPT | 59510 | 4 | $4,080.63 |
| Vaginal delivery only | CPT | 59409 | 4 | $1,651.77 |
| Vaginal delivery with postpartum | CPT | 59410 | 4 | $2,278 |
| C-section delivery only | CPT | 59514 | 4 | $1,369.12 |
| Fetal non-stress test | CPT | 59025 | 4 | $338.85 |
| Upper GI endoscopy diagnostic | CPT | 43235 | 4 | $1,228.96 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 4 | $1,459.11 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 4 | $1,089.76 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 4 | $1,230.58 |
| Total shoulder arthroplasty | CPT | 23472 | 4 | $9,182.69 |
| Hip hemiarthroplasty | CPT | 27125 | 4 | $2,125.83 |
| Knee revision arthroplasty single component | CPT | 27486 | 4 | $2,256.96 |
| Knee revision arthroplasty all components | CPT | 27487 | 4 | $2,618.19 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 4 | $15,280 |
| ACL reconstruction | CPT | 29888 | 4 | $9,743.74 |
| Laparoscopic appendectomy | CPT | 44970 | 4 | $931.47 |
| Laparoscopic cholecystectomy | CPT | 47562 | 4 | $6,493.93 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 4 | $1,095.15 |
| Lap inguinal hernia repair | CPT | 49650 | 4 | $6,465.3 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | $1,481.89 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 4 | $1,816.88 |
| Lap salpingo-oophorectomy | CPT | 58661 | 4 | $6,317.49 |
