| Colonoscopy diagnostic | CPT | 45378 | 4 | $893.39 |
| Colonoscopy with biopsy | CPT | 45380 | 4 | $1,085.78 |
| Colonoscopy with polyp removal | CPT | 45385 | 4 | $1,102.36 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 4 | $1,811.09 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 4 | $292.46 |
| Total hip replacement | CPT | 27130 | 4 | $6,281.88 |
| Total knee replacement | CPT | 27447 | 4 | $6,280.04 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 4 | $3,586.6 |
| Vaginal delivery only | CPT | 59409 | 4 | $1,878.32 |
| Fetal non-stress test | CPT | 59025 | 4 | $210.5 |
| Upper GI endoscopy diagnostic | CPT | 43235 | 4 | $741.4 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 4 | $974.71 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 4 | $629.76 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 4 | $611.65 |
| Total shoulder arthroplasty | CPT | 23472 | 4 | $8,454.48 |
| Hip hemiarthroplasty | CPT | 27125 | 4 | $1,893.87 |
| Knee revision arthroplasty single component | CPT | 27486 | 4 | $2,352.36 |
| Knee revision arthroplasty all components | CPT | 27487 | 4 | $2,939.12 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 4 | $3,848.49 |
| ACL reconstruction | CPT | 29888 | 4 | $3,750.24 |
| Open appendectomy | CPT | 44950 | 4 | $3,047.69 |
| Laparoscopic appendectomy | CPT | 44970 | 4 | $2,851.62 |
| Laparoscopic cholecystectomy | CPT | 47562 | 4 | $2,915.94 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 4 | $2,979.46 |
| Lap inguinal hernia repair | CPT | 49650 | 4 | $2,656.61 |
| Total abdominal hysterectomy | CPT | 58150 | 4 | $1,702.16 |
| Vaginal hysterectomy | CPT | 58260 | 4 | $2,631.37 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 4 | $2,615.35 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 4 | $4,973.41 |
| Lap salpingo-oophorectomy | CPT | 58661 | 4 | $3,055.2 |
