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NMMC West Point CDM.Xlsx Facility Description Price CC SWING BED RUGS CODE CC PRIVATE 1ST WEST 861 CC PRIVATE OBSTETRICS 861 CC BAKRI BALLOON FOR PP HEMR 661 CC BAKRI BALLOON FOR PP HEMR 661 CC RPR CMPX LID/N/L 2.6‐7.5 1914 CC RPR CMPX LID/N/ E/A 5CM/< 1053 CC RPR CMPX LID/N/L 2.6‐7.5 1914 CC RPR CMPX LID/N/ E/A 5CM/< 1053 CC PRIVATE ECU 494 CC IV THRPY FIRST HR DX 691 CC IV THRPY EA/ADD HR DX 190 CC IV THRPY ADD/SEQ TO 1 HR 205 CC IV THRPY CONCURRENT 122 CC IV THRPY FIRST HR HYDRTN 690 CC IV THRPY EA/ADD HR HYDRTN 134 CC INJ IV EA ADD DIFF MED 269 CC RECOVERY PER HOUR 280 CC MINOR PROCEDURE 1627 CC ARTERIAL LINE PLACEMENT 463 CC INJ EPIDURAL BLOOD PATCH 2850 CC INJ IV PUSH INITIAL 692 CC ADDITIONAL CPT CODE CC MED ICU ROOM CHARGE 1872 CC NURSERY 1200 CC CIRC TRAY 91 CC INIT HOSP CARE LV 1 P/DAY 205 CC INIT HOSP CARE LV 2 P/DAY 279 CC INIT HOSP CARE LV 3 P/DAY 412 CC SUBS HOSP CARE LV 1 P/DAY 81 CC SUBS HOSP CARE LV 2 P/DAY 147 CC SUBS HOSP CARE LV 3 P/DAY 212 CC HOSP DAY MGMT 30 MNT OR < 147 CC HOSP DAY MGMT > 30 MNTS 214 CC OBS CARE D/C DAY MGMT 155 CC INITL OBS CARE LV 1 P/DAY 197 CC INITL OBS CARE LV 2 P/DAY 239 CC INITL OBS CARE LV 3 P/DAY 362 CC SUBS OBS CARE LV 1 P/DAY 88 CC SUBS OBS CARE LV 2 P/DAY 145 CC SUBS OBS CARE LV 3 P/DAY 236 CC SNF D/C DAY MGMT 30 OR < 240 CC SNF D/C DAY MGMT >30 318 CC PERC REPLAC J TUBE W/O FL 1948 CC INITIAL NF CARE LEVEL 1 204 CC INITIAL NF CARE LEVEL 2 290 CC INITIAL NF CARE LEVEL 3 368 CC SUBSQENT NF CARE LEVEL 197 CC SUBSQENT NF CARE LEVEL 2 151 CC SUBSQENT NF CARE LEVEL 3 198 CC SUBSQENT NF CARE LEVEL 4 295 CC OBS OR I/P CARE LEVEL 1 281 CC OBS OR I/P CARE LEVEL 2 365 CC OBS OR I/P CARE LEVEL 3 455 CC IP CONSULTATION LEVEL 1 103 CC IP CONSULTATION LEVEL 2 188 CC IP CONSULTATION LEVEL 3 230 CC IP CONSULTATION LEVEL 4 271 CC IP CONSULATATION LEVEL 5 312 CC CARDIOPULMONARY RESUSCIT 394 CC PHYSICIAN CRITICAL CARE 1281 CC PHYS CRIT CAR EA AD 30 MN 289 CC REPL CATH CVA SUBQ PORT 6767 CC NF D/S DAY MGMT 30 MNTS 240 CC NF D/S DAY MGMT > 30 MINS 318 CC PLACE CV CATH SUBCLV/JUG 577 CC OBSERVATION PER HOUR 56 CC DIRECT REFER OBS ASSESMT 1951 CC RECOVERY PER HOUR 62 CC BIOPSY CERVIX SINGLE 1832 CC BIOPSY VAGINAL SIMPLE 1830 CC BLADDER IRRIGATION/LAVAGE 594 CC BLOOD DRAW VAD 422 CC CATHETER, INFUSION A79 CC CHANGE CYSTOSTOMY TUBE 596 CC CHANGE GASTROSTOMY TUBE 1317 CC CULDOCNTESIS/COLPOCNTESIS 4357 CC MARSUP BARTHLIN CYST BL 6537 CC DEBRID SKIN SUB‐Q TISSUE 1236 CC APP FINGER SPLINT LT 231 CC DEBRD SKN/SUB OPN FX/DIS 1483 CC BLADDER SCAN 711 CC MOD SEDATION 1ST 15 MIN 399 CC MOD SEDATON EA/ADD 15 MNS 53 CC DILAT URETHRA,FEMALE INIT 350 CC DILT URETRAL MALE INITL 2726 CC E&M LEVEL 1 EST PATIENT 410 CC E&M LEVEL 1 EST PATIENT P 410 CC E&M LEVEL II EST PATIENT 425 CC E&M LEVEL II EST PAT P 425 CC E&M LEVEL 3 EST PATIENT 440 CC E&M LEVEL 3 EST PATIENT P 440 CC E&M LEVEL 4 EST PATIENT 460 CC E&M LEVEL 4 EST PATIENT P 460 CC E&M LEVEL 5 EST PATIENT 485 CC E&M LEVEL 5 EST PATIENT P 485 CC ENDOMTRL BX W/WO ENDOCERV 420 CC FINE NDL ASPRTION WO/IMAG 1238 CC GASTRIC INTUBATION LAVAGE 640 CC GUIDEWIRES 400 CC I&D ABCESS COMPLICATED 1236 CC I&D ABCESS SIMPLE 649 CC I&D BATHOLINS GLAND, LT 473 CC I&D BATHOLINS GLAND, RT 473 CC I&D HEMATOMA,FLUID COLL 4297 CC I&D PERIANAL ABSCESS 1652 CC I&D PERIRECTAL ABSCESS 5594 CC INCIS SOFT TISS ABSCESS 649 CC INCIS THROMBO HEMORRHOID 683 CC IV THRPY EA/ADD HR DX 202 CC IV THRPY IFRST HR DX 691 CC INJ IM OR SQ 205 CC INJ IV PUSH INITIAL 692 CC INSRT INDWL BLDR CATH CMX 468 CC INSRT INDWL BLDR CATH SIM 434 CC INSRT NON‐INDWL BLDR CATH 422 CC INTRDUCR/SHEATH NON‐LASER 719 CC MARSUP BARTHLIN CYST LT 4358 CC MARSUP BARTHLIN CYST RT 4358 CC MISC PROCEDURE CC PERITONEAL LAVAGE INITIAL 1604 CC PLACE CV CATH SUBCLV/JUG 6490 CC PLACE PICC LINE W/O PORT 8466 CC REM CTRL LINE W/O PORT 1883 CC REM FECAL IMPACTION/FB 966 CC REM IMPACTED CERUMEN 248 CC REMOVE SKIN TAG 647 CC SCREENING PAP SMEAR 33 CC SHUNTS/DRAINS CATHS A 442 CC SPINAL PUNCTURE DRAIN CSF 2646 CC SPINAL PUNCTURE LUMBAR DX 2304 CC TRACHEOSTOMY TUBE CHANGE 748 CC TX WD DEHISCENCE SIMPLE 1914 CC BONE MARROW ASPIRATION 2585 CC IV THRPY ADD/SEQ TO 1 HR 205 CC IV THRPY CONCURRENT 122 CC IV THRPY FIRST HR HYDRTN 690 CC IV THRPY EA/ADD HR HYDRTN 134 CC INJ IV EA ADD DIFF MED 288 CC INJ IV EA ADD SAME MED 246 CC BLD DRAW FROM CNTRAL LINE 422 CC IMMUNIZATION 1ST VAC 205 CC IMMUNIZATION EA ADD VAC 205 CC IRRIGATION OF A VAD 231 CC APP LONG ARM SPLINT LT 576 CC APP LONG ARM SPLINT RT 576 CC APP SHORT ARM SPLINT LT 484 CC APP SHORT ARM SPLINT RT 484 CC APP FINGER SPLINT RT 231 CC APP LONG LEG SPLINT LT 557 CC APP LONG LEG SPLINT RT 557 CC APP SHORT LEG SPLINT LT 529 CC APP SHORT LEG SPLINT RT 529 CC OTHER SPLINT 529 CC ANKLE ORTHOSIS 37 CC KO IMMOBLIZR CNVS PREFAB 67 CC POST OF SHOE 27 CC WHO COCK‐UP PREFAB 37 CC APP LONG ARM SPLINT 50 865 CC APP SHORT ARM SPLINT BL 726 CC APP FINGER SPLINT BIL 346 CC APP LONG LEG SPLINT BL 793 CC APP SHORT LEG SPLINT BL 793 CC I&D BATHOLINS GLAND BL 711 CC PARACENTESIS W/O ULTRSOND 1893 CC PARACENTESIS W/ULTRASOUND 2030 CC EX FCE LD NSE LIP 2.1‐3CM 2585 CC SELCT DEBRID 20 SQCM OR < 474 CC PT DEBRID ADD 20 SQCM 198 CC REMOVE CUFFED CHEST TUBE 2805 CC TUBE THORACOSTOMY LT 6490 CC TUBE THORACOSTOMY RT 2893 CC THORCEN INS TUBE W/O GUID 2893 CC PICC LINE REMOVAL 1883 CC DECLOT CATHETER/PORT/VAD 1181 CC EXC NAIL & MATRX PRMNT 1236 CC BX MUSCLE/SOFT TISSUE 2585 CC CHEMODENERVATION MUSCLE 776 CC INJ ANES FEMRAL NRV SINGL 1577 CC INJ FEMORAL NERVE BILAT 2366 CC CLSD TX SHOULDER DISLOCAT 4278 CC ENDOMTRL BX W/WO ENDOCERV 420 CC DESTRUCT MALIG LESN FACE 989 CC IR, MIDLINE PLACEMENT 5900 CC PERCUTANS NEEDLE BX LIVER 3937 CC INJ PLATLET RICH PLASMA 829 CC PICC LINE W/O PRT W/O IMA 4893 CC INTUBATN ENDOTRACHEL EMRG 1444 CC ADMIN INFLUENZA VACINE 61 CC ADMIN OF PNEUMONIA VACINE 61 CC MISC. PROCEDURE CC NEW PAT 20 MIN OFFICE VT 183 CC NEW PAT 30 MIN OFFICE VT 265 CC NEW PAT 45 MIN OFFICE VT 407 CC NEW PAT 60 MIN OFFICE VT 506 CC EST PAT 10 MIN OFFICE V 112 CC EST PAT 15 MIN OFFICE 5 195 CC EST PAT 25 MIN OFFICE 5 276 CC EST PAT 40 MIN OFFICE 5 370 CC NEW PAT 20 MIN OFFICE VT 183 CC NEW PAT 30 MIN OFFICE VT 265 CC NEW PAT 45 MIN OFFICE VT 407 CC NEW PAT 60 MIN OFFICE VT 506 CC EST PAT 05 MIN OFFICE VT 55 CC EST PAT 10 MIN OFFICE V 112 CC EST PAT 15 MIN OFFICE 5 195 CC EST PAT 25 MIN OFFICE 5 276 CC EST PAT 40 MIN OFFICE 5 370 CC CSDS OUTPT ROOM ZERO CHG CC CSDS OUTPT ROOM ZERO CHG 0 CC LITHO SURGERY BASE RATE 13002 CC LITHO SURGERY PER MINUTE 80 CC ORAL/DENTL SURG BASE RATE 6017 CC ORAL/DENTAL SURG PER MIN 69 CC EAR NOSE THRT SURG BASE 7520 CC ENT SURG PER MIN 69 CC OPHTHALMIC SURG BASE RATE 6017 CC OPHTHALMIC SURG PER MIN 69 CC GENERAL SURG BASE RATE 7520 CC GENERAL SURG PER MIN 69 CC ORTHOPEDIC SURG BASE RATE 9023 CC ORTHOPEDIC SURG PER MIN 69 CC PLASTIC SURG BASE RATE 6017 CC PLASTIC SURGERY PER MIN 69 CC UROLOGIC SURG, BASE RATE 8273 CC UROLOGIC SURGERY PER MIN 69 CC MISC SURGERY BASE RATE 7147 CC MISC.SURGERY PER MIN 69 CC ADDITIONAL CPT CODE CC MINOR SURGERY BASE RATE 2159 CC MINOR SURGERY PER MNT 28 CC PLAC NDL BREST 1ST SRT BL 4125 CC NDL PLCMNT BRST EA ADD ST 1376 CC CARDIOVERSION EXTERNAL 4633 CC MISC OPERATING ROOM CHRG CC ADDITIONAL CPT CODE CC ANCHOR/SCREW A 276 CC ANCHOR/SCREW B 537 CC CATH,BALON DILIT/NONVAS A 556 CC CATHTR DILYSIS/SHRT TERM 392 CC CATHETER, INFUSION A79 CC CATHETER, INFUSION B 483 CC CATHETER, INFUSION C 1179 CC CATHETER, THROM/EMBOLEC A 101 CC CATHETER, THROM/EMBOLEC B 625 CC CONNECTVE TISSUE HUMAN A 954 CC CONNECTVE TISSUE HUMAN B 1278 CC CONNECTVE TISSUE HUMAN F 3701 CC CONCTVE TISSU NON‐HUMAN A 1020 CC CONCTVE TISSU NON‐HUMAN B 1700 CC GRAFT VASCULAR D 1303 CC GRAFT VASCULAR E 1731 CC GRAFT VASCULAR F 2049 CC GUIDEWIRE A 139 CC GUIDEWIRE B 258 CC GUIDEWIRE C 420 CC HEMOSTATIC AGENT A75 CC HEMOSTATIC AGENT B 156 CC HEMOSTATIC AGENT C 354 CC HEMOSTATIC AGENT D 2031 CC IMPLNT/ENT/OPH/ORL/PLAS A 171 CC IMPLNT/ENT/OPH/ORL/PLAS B 511 CC IMPLANT/ORTHOPEDIC A 1130 CC IMPLANT/ORTHOPEDIC B 2490 CC IMPLANT/ORTHOPEDIC C 5368 CC IMPLANT/ORTHOPEDIC D 7566 CC IMPLANT/ORTHOPEDIC E 9970 CC INTRDUCR/SHETH NON‐LASR B 327 CC JOINT DEVICE SHOULDER A 18805 CC JOINT DEVICE SHOULDER B 6516 CC JOINT DEVICE SHOULDER C 8812 CC JOINT DEVICE SHOULDER D 10750 CC JOINT DEVICE SHOULDER E 15034 CC JOINT DEVICE KNEE A 1661 CC JOINT DEVICE KNEE B 4545 CC JOINT DEVICE KNEE C 7232 CC JOINT DEVICE KNEE D 9129 CC JOINT DEVICE KNEE E 11558 CC JOINT DEVICE KNEE F 13783 CC JOINT DEVICE KNEE G 16285 CC MESH IMPLANTABLE A 174 CC MESH IMPLANTABLE B 359 CC MESH IMPLANTABLE C 769 CC MESH IMPLANTABLE D 1119 CC MESH IMPLANTABLE E 1488 CC MESH IMPLANTABLE F 1942 CC PORT INDWELLING A 1054 CC PROSTHESIS BREAST A 1280 CC PROSTHESIS BREAST B 2650 CC PROSTHESIS BREAST C 3640 CC RPR DEVCE URNARY W/GRFT A 2778 CC SHNT/DRAIN/CONECTR/CATH A 159 CC SHNT/DRAIN/CONECTR/CATH B 722 CC SHNT/DRAIN/CONECTR/CATH C 1679 CC SHNT/DRAIN/CONECTR/CATH D 2556 CC STENT NON‐CORONARY TEMP A 441 CC STENT NON‐CORONARY TEMP B 558 CC CATH, ABLAT,NON‐CARDIAC 5045 CC INTRAOCULAR LENS POSTRIOR 763 CC CATH BALON DILTN/NONVAS C 1033 CC MESH IMPLANTABLE G 2508 CC MESH IMPLANTABLE H 3079 CC MESH IMPLANTABLE I 4088 CC MESH IMPLANTABLE J 4981 CC MESH, IMPLANTABLE K 7076 CC JOINT DEVICE KNEE I 21296 CC JOINT DEVICE KNEE J 23805 CC JOINT DEVICE KNEE K 26307 CC JOINT DEVICE KNEE L 28812 CC JOINT DEVICE KNEE M 31320 CC JOINT DEVICE KNEE N 33824 CC JOINT DEVICE KNEE O 36327 CC JOINT DEVICE KNEE CC HEMOSTATIC AGENT E 540 CC SURGICAL SUPPLY CC SURGICAL IMPLANT/DEVICE CC HARMONIC SCALPEL SHEARS 1311 CC DEVICE SEALER DISPSBLE A 1477 CC MESH IMPLANTABLE L 7602 CC MESH IMPLANTABLE M 9739 CC MESH IMPLANTABLE
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