🫀 High-Acuity Clinical Pricing Calculator
High-acuity roles do not price like standard contract staffing. A CRNA, an ICU nurse, or a locum physician carries higher pay, real malpractice cost, heavier credentialing, and a client who expects you to know all of that. This calculator, straight from Dee's How To Charge workbook, builds the true hourly cost floor first (pay plus burden plus per-hour malpractice plus per-hour credentialing), then prices bill rates across a 25% to 50% markup range with GP per hour, weekly GP, and full-engagement GP. Section 2 sizes the one-time fee for permanent physician and specialty placements, with a minimum floor to protect your time. Run your numbers once free; the $27 one-time unlock keeps every section live forever and includes the Excel workbook.
Your hourly cost floor
CRNAs, MDs, and specialty RNs carry higher pay, higher malpractice, higher credentialing costs, and higher client expectations. Bake those costs into the hourly floor before you mark anything up.
Employer payroll taxes, workers comp, and benefits as a percent of pay. Pick your state above for a planning default.
Annual malpractice premium divided by total billable hours.
Total credentialing cost divided by expected billable hours.
Engagement and markup
13 weeks is the standard contract block.
High-acuity roles typically carry 25% to 55% depending on specialty. The proposed bill rate calculates automatically.
Custom bill rate (optional)
To use a negotiated or agreed bill rate, enter it here. GP per hour, weekly GP, and engagement GP calculate automatically. Leave it at 0 until you have a real number.
Section 2: direct hire placement (one-time fee)
Placing a physician, CRNA, or specialty provider permanently means a one-time flat fee, not an ongoing hourly margin. The fee is a percent of first-year base compensation with a minimum floor to protect your time on complex searches.
The provider's annual base salary, not total comp.
Typical clinical ranges: 18-22% for NP/PA, 20-25% for primary care and CRNA, 22-30% for specialists and surgeons.
Set your floor to protect your time. If comp is low, you still earn this minimum.
Standard: 90 days. Physicians: 90 to 180 days. If the provider leaves, redo the search.
Estimates for planning, not financial advice. Rates, premiums, and burden numbers are the workbook's guidance ranges; your market and your carriers decide the real ones.
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Build my launch plan free →Good questions about this math
What do high-acuity and ICU roles bill compared to med-surg staffing?
Materially more, and at higher markups. The workbook's reference table puts ICU nurses at $75 to $135 an hour billed (versus roughly $50 to $90 pay), OR nurses at $80 to $140, CRNAs at $175 to $350, and anesthesiologists at $275 to $550. Standard med-surg contract staffing usually bills below those ranges and at thinner markups, because the roles are easier to fill and carry less liability.
What markup should a high-acuity clinical role carry?
The sheet's reference ranges run 25% to 55% depending on specialty: specialty RNs (ICU, OR, L&D, cath lab) at 35% to 55%, CRNAs and psychiatrists at 30% to 50%, and physicians at roughly 25% to 45%. The scenario table prices your exact cost floor at 25%, 30%, 35%, 40%, 45%, and 50% so you can see what each tier is worth per hour, per week, and per engagement.
How do I turn an annual malpractice premium into a per-hour cost?
Divide the annual premium by the provider's expected billable hours. A $10,000 policy over 2,000 billable hours is $5 an hour, which is exactly what the malpractice input expects. Do the same with credentialing: total credentialing spend divided by expected billable hours. If you skip these lines, your markup is quietly eating them.
Do certifications like CCRN or CNOR change what I can bill?
They support the top of the range rather than creating a separate rate. A CCRN in a CVICU or a CNOR scrub nurse is easier to sell at the high end of the 35% to 55% markup band because the facility is buying verified competence in a unit where mistakes are expensive. Certifications also speed credentialing, which lowers your per-hour credentialing cost.
What burden % should I use on clinical W2 payroll?
Burden is your employer-side payroll cost as a percent of pay: FICA at 7.65%, state unemployment, workers comp, and any benefits. The calculator's state dropdown fills a planning default from your state's 2025 new-employer schedules using the field-labor workers comp class; the sheet's default is 21.55%. Your real number comes from your rate notices and your carrier, so verify before quoting.
Do I get the Excel version?
Yes. The $27 unlock includes the standalone High-Acuity Clinical workbook from Dee's How To Charge master, plus the START HERE guide tab, yours to download and keep.
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