Overview

Naples Community Hospital
NCH Bonita
NCOL
MIU
NCH BH
NCH CR
NCH NE


Sheet 1: Naples Community Hospital

Naples Community Hospital










































File Effective Date: 1/1/2022 - 12/31/2022










































Note: File Contains Services Provided by Naples Community Hospital






















































































Primary Code Primary Code Description Revenue Code Service Code Billed Charges Discounted Cash Price Minimum Negotiated Allowable Maximum Negotiated Allowable Aetna Aetna International Aetna MCR ADV Armor Health Beech Street Blue Cross Health Options Blue Cross MCR ADV HMO/PPO Blue Cross NWB Blue Cross PPC Blue Cross Traditional Cigna Consortium First Health FL Medicaid Freedom Health HMO/PPO MCR ADV Freedom Health PPO Humana Choice Care Humana MCR ADV HMO/PPO Mail Handlers Medicare Molina MCD ADV Multiplan PHCS NCH Employee Health Self Insured Plans LLC Seminole Tribe Employee PPO Seminole Tribe MCR ADV Simply Health MCD ADV Staywell Healthy Kids MCD ADV Sunshine State HP MCD ADV Tricare Florida UHC UHC MCR ADV HMO/PPO UPMC MCR ADV VA Community Care Network Vivida MCD ADV Wellcare MCR Adv HMO
039 Extracranial Procedures without Complication Claim IP $45,017.60 $18,007.04 $1,328.35 $40,515.84 $14,731.50 $36,014.08 $7,918.71 $1,328.35 $40,515.84 $13,662.37 $7,757.87 $15,502.01 $17,948.80 $21,097.27 $30,476.92 $25,660.03 $36,014.08 $21,872.53 $9,581.16 $27,010.56 $18,746.17 $7,913.03 $31,512.32 $7,735.57 $21,872.53 $19,330.97 $20,708.10 $16,098.93 $38,264.96 $7,757.87 $21,872.53 $22,966.15 $21,872.53 $8,514.33 $18,576.44 $7,835.45 $8,145.76 $8,158.29 $26,247.03 $8,068.18
039
0200 - Intensive care
Included






































039
0250 - Pharmacy
Included






































039
0272 - Medical/Surgical Supplies: Sterile supplies
Included






































039
0278 - Medical/Surgical Supplies: Other implants
Included






































039
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































039
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































039
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































039
0309 - Laboratory - Clinical Diagnostic: Other laboratory
Included






































039
0312 - Laboratory - Pathology: Histology
Included






































039
0360 - Operating Room Services
Included






































039
0370 - Anesthesia
Included






































039
0710 - Recovery Room
Included






































039
0730 - EKG/ECG
Included






































039
0740 - EEG
Included






























































































































064 Intracranial Hemorrhage or Stroke w Major Compl Claim IP $54,547.60 $21,819.04 $4,000.00 $49,092.84 $24,816.33 $43,638.08 $13,013.49 $4,000.00 $49,092.84 $23,015.29 $12,748.93 $26,114.31 $30,236.11 $35,539.95 $36,928.73 $31,092.13 $43,638.08 $22,742.36 $15,817.21 $32,728.56 $31,579.34 $13,003.91 $38,183.32 $12,711.37 $22,742.36 $33,246.62 $25,091.90 $46,365.46 $46,365.46 $12,748.93 $22,742.36 $23,879.48 $22,742.36 $14,217.83 $31,293.42 $12,876.42 $13,386.38 $13,317.21 $27,290.83 $13,258.89
064
0206 - Intermediate ICU
Included






































064
0250 - Pharmacy
Included






































064
0271 - Medical/Surgical Supplies: Nonsterile supplies
Included






































064
0300 - Laboratory - Clinical Diagnostic
Included






































064
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































064
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































064
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































064
0307 - Laboratory - Clinical Diagnostic: Urology
Included






































064
0309 - Laboratory - Clinical Diagnostic: Other laboratory
Included






































064
0324 - Radiology - Diagnostic: Chest X-ray
Included






































064
0351 - CT Scan: Head
Included






































064
0352 - CT Scan: Body
Included






































064
0420 - Physical Therapy
Included






































064
0424 - Physical Therapy: Evaluation/re-evaluation
Included






































064
0434 - Occupational Therapy: Evaluation/re-evaluation
Included






































064
0444 - Speech-Language Pathology: Evaluation/ re-evaluation
Included






































064
0450 - Emergency Room
Included






































064
0483 - Cardiology: Echocardiology
Included






































064
0611 - Magnetic Resonance Tech. (MRT): Brain (incl. Brainstem)
Included






































064
0730 - EKG/ECG
Included






































064
0762 - Treatment/Observation Room: Observation room
Included






































064
0940 - Other Therapeutic Serv
Included






























































































































065 Intracranial Hemorrhage or Stroke w Complication Claim IP $33,272.77 $13,309.11 $2,000.00 $29,945.49 $13,191.23 $26,618.22 $7,140.57 $2,000.00 $29,945.49 $12,233.88 $6,995.57 $13,881.18 $16,072.14 $18,891.42 $22,525.67 $18,965.48 $26,618.22 $8,734.07 $8,628.72 $19,963.66 $16,786.14 $7,135.48 $23,290.94 $6,975.61 $8,734.07 $17,309.80 $15,305.47 $14,391.51 $28,281.85 $6,995.57 $8,734.07 $9,170.77 $8,734.07 $7,576.29 $16,634.16 $7,065.53 $7,345.35 $7,477.02 $10,480.88 $7,275.39
065
0120 - Room & Board (Semi-Private 2 beds)
Included






































065
0250 - Pharmacy
Included






































065
0300 - Laboratory - Clinical Diagnostic
Included






































065
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































065
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































065
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































065
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































065
0309 - Laboratory - Clinical Diagnostic: Other laboratory
Included






































065
0351 - CT Scan: Head
Included






































065
0424 - Physical Therapy: Evaluation/re-evaluation
Included






































065
0434 - Occupational Therapy: Evaluation/re-evaluation
Included






































065
0440 - Speech-Language Pathology
Included






































065
0450 - Emergency Room
Included






































065
0483 - Cardiology: Echocardiology
Included






































065
0611 - Magnetic Resonance Tech. (MRT): Brain (incl. Brainstem)
Included






































065
0614 - Magnetic Resonance Tech. (MRT): MRI - Other
Included






































065
0615 - Magnetic Resonance Tech. (MRT): MRA - Head and Neck
Included






































065
0730 - EKG/ECG
Included






































065
0732 - EKG/ECG: Telemetry
Included






























































































































165 Major Chest Proc for Resp Disorders Claim IP $64,497.54 $25,799.02 $3,500.00 $58,047.79 $24,786.58 $51,598.03 $12,998.46 $3,500.00 $58,047.79 $22,987.70 $12,734.21 $26,083.01 $30,199.87 $35,497.35 $43,664.83 $36,763.60 $51,598.03 $20,210.83 $15,798.81 $38,698.52 $31,541.49 $12,988.89 $45,148.28 $12,696.70 $20,210.83 $34,700.08 $29,668.87 $54,822.91 $54,822.91 $12,734.21 $20,210.83 $21,221.37 $20,210.83 $13,009.80 $31,255.91 $12,861.55 $13,370.92 $13,259.73 $24,253.00 $13,243.58
165
0110 - Room & Board (Private)
Included






































165
0210 - Coronary care
Included






































165
0250 - Pharmacy
Included






































165
0272 - Medical/Surgical Supplies: Sterile supplies
Included






































165
0300 - Laboratory - Clinical Diagnostic
Included






































165
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































165
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































165
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































165
0307 - Laboratory - Clinical Diagnostic: Urology
Included






































165
0309 - Laboratory - Clinical Diagnostic: Other laboratory
Included






































165
0312 - Laboratory - Pathology: Histology
Included






































165
0324 - Radiology - Diagnostic: Chest X-ray
Included






































165
0360 - Operating Room Services
Included






































165
0370 - Anesthesia
Included






































165
0420 - Physical Therapy
Included






































165
0424 - Physical Therapy: Evaluation/re-evaluation
Included






































165
0430 - Occupational Therapy
Included






































165
0434 - Occupational Therapy: Evaluation/re-evaluation
Included






































165
0730 - EKG/ECG
Included






































165
0732 - EKG/ECG: Telemetry
Included






























































































































177 Respiratory Infection with Major Complication Claim IP $47,693.21 $19,077.28 $5,000.00 $42,923.89 $23,913.63 $38,154.57 $12,557.45 $5,000.00 $42,923.89 $22,178.11 $12,302.18 $25,164.40 $29,136.27 $34,247.18 $32,288.30 $27,185.13 $38,154.57 $19,366.99 $15,259.02 $28,615.93 $30,430.64 $12,548.22 $33,385.25 $12,265.99 $19,366.99 $31,379.95 $21,938.88 $26,081.97 $40,539.23 $12,302.18 $19,366.99 $20,335.34 $19,366.99 $11,785.26 $30,155.12 $12,425.20 $12,917.29 $12,838.00 $23,240.38 $12,794.27
177
0110 - Room & Board (Private)
Included






































177
0250 - Pharmacy
Included






































177
0258 - Pharmacy: IV solutions
Included






































177
0300 - Laboratory - Clinical Diagnostic
Included






































177
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































177
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































177
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































177
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































177
0307 - Laboratory - Clinical Diagnostic: Urology
Included






































177
0324 - Radiology - Diagnostic: Chest X-ray
Included






































177
0351 - CT Scan: Head
Included






































177
0410 - Respiratory Services
Included






































177
0450 - Emergency Room
Included






































177
0730 - EKG/ECG
Included






































177
0732 - EKG/ECG: Telemetry
Included






























































































































192 Chronic Obstructive Pulmonary Disease Claim IP $22,665.33 $9,066.13 $3,000.00 $20,398.80 $8,995.90 $18,132.26 $5,021.12 $3,000.00 $20,398.80 $8,343.03 $4,919.27 $9,466.42 $10,960.57 $12,883.21 $15,344.43 $12,919.24 $18,132.26 $6,053.91 $6,034.50 $13,599.20 $11,447.49 $5,017.66 $15,865.73 $4,905.66 $6,053.91 $11,804.60 $10,426.05 $9,821.90 $19,265.53 $4,919.27 $6,053.91 $6,356.60 $6,053.91 $3,863.07 $11,343.84 $4,968.46 $5,165.23 $5,201.66 $7,264.69 $5,116.04
192
0120 - Room & Board (Semi-Private 2 beds)
Included






































192
0250 - Pharmacy
Included






































192
0258 - Pharmacy: IV solutions
Included






































192
0271 - Medical/Surgical Supplies: Nonsterile supplies
Included






































192
0272 - Medical/Surgical Supplies: Sterile supplies
Included






































192
0300 - Laboratory - Clinical Diagnostic
Included






































192
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































192
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































192
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































192
0324 - Radiology - Diagnostic: Chest X-ray
Included






































192
0410 - Respiratory Services
Included






































192
0420 - Physical Therapy
Included






































192
0424 - Physical Therapy: Evaluation/re-evaluation
Included






































192
0450 - Emergency Room
Included






































192
0730 - EKG/ECG
Included






























































































































194 Simple Pneumonia & Pleurisy with Complication Claim IP $20,951.85 $8,380.74 $2,000.00 $18,856.67 $11,172.46 $16,761.48 $6,120.70 $2,000.00 $18,856.67 $10,361.62 $5,996.46 $11,756.82 $13,612.47 $16,000.29 $14,184.40 $11,942.55 $16,761.48 $5,690.87 $7,380.39 $12,571.11 $14,217.20 $6,116.39 $14,666.30 $5,979.56 $5,690.87 $14,660.72 $9,637.85 $12,197.88 $17,809.07 $5,996.46 $5,690.87 $5,975.41 $5,690.87 $5,018.29 $14,088.48 $6,056.42 $6,296.28 $6,293.46 $6,829.04 $6,236.32
194
0120 - Room & Board (Semi-Private 2 beds)
Included






































194
0250 - Pharmacy
Included






































194
0258 - Pharmacy: IV solutions
Included






































194
0300 - Laboratory - Clinical Diagnostic
Included






































194
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































194
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































194
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































194
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































194
0324 - Radiology - Diagnostic: Chest X-ray
Included






































194
0352 - CT Scan: Body
Included






































194
0410 - Respiratory Services
Included






































194
0450 - Emergency Room
Included






































194
0730 - EKG/ECG
Included






































194
0732 - EKG/ECG: Telemetry
Included






























































































































195 Simple Pneumonia & Pleurisy Claim IP $30,789.36 $12,315.74 $2,000.00 $27,710.42 $8,610.51 $24,631.49 $4,826.43 $2,000.00 $27,710.42 $7,985.61 $4,728.53 $9,060.87 $10,491.01 $12,331.28 $20,844.40 $17,549.94 $24,631.49 $5,690.87 $5,796.18 $18,473.62 $10,957.07 $4,823.10 $21,552.55 $4,715.50 $5,690.87 $11,298.89 $14,163.11 $9,399.29 $26,170.96 $4,728.53 $5,690.87 $5,975.41 $5,690.87 $3,664.37 $10,857.87 $4,775.82 $4,964.96 $5,002.45 $6,829.04 $4,917.67
195
0120 - Room & Board (Semi-Private 2 beds)
Included






































195
0250 - Pharmacy
Included






































195
0258 - Pharmacy: IV solutions
Included






































195
0300 - Laboratory - Clinical Diagnostic
Included






































195
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































195
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































195
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































195
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































195
0324 - Radiology - Diagnostic: Chest X-ray
Included






































195
0352 - CT Scan: Body
Included






































195
0450 - Emergency Room
Included






































195
0516 - Clinic: Urgent care clinic
Included






































195
0730 - EKG/ECG
Included






































195
0732 - EKG/ECG: Telemetry
Included






























































































































216 Cardiac Valve/Other W Cath W MCC/C Claim IP $333,257.65 $133,303.06 $64,526.60 $299,931.89 $129,834.05 $266,606.12 $66,067.66 $76,069.18 $299,931.89 $173,748.26 $64,723.09 $195,038.37 $221,460.95 $249,209.58 $225,615.43 $189,956.86 $266,606.12 $93,641.48 $80,755.93 $199,954.59 $165,216.76 $66,017.55 $233,280.36 $64,526.60 $93,641.48 $212,859.49 $153,298.52 $283,269.00 $283,269.00 $64,723.09 $93,641.48 $98,323.55 $93,641.48 $64,887.27 $193,828.90 $65,370.32 $67,959.24 $70,061.22 $112,369.78 $67,312.01
216
0110 - Room & Board (Private)
Included






































216
0120 - Room & Board (Semi-Private 2 beds)
Included






































216
0210 - Coronary care
Included






































216
0250 - Pharmacy
Included






































216
0258 - Pharmacy: IV solutions
Included






































216
0270 - Medical/Surgical Supplies
Included






































216
0271 - Medical/Surgical Supplies: Nonsterile supplies
Included






































216
0272 - Medical/Surgical Supplies: Sterile supplies
Included






































216
0275 - Medical/Surgical Supplies: Pacemaker
Included






































216
0278 - Medical/Surgical Supplies: Other implants
Included






































216
0300 - Laboratory - Clinical Diagnostic
Included






































216
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































216
0302 - Laboratory - Clinical Diagnostic: Immunology
Included






































216
0305 - Laboratory - Clinical Diagnostic: Hematology
Included






































216
0306 - Laboratory - Clinical Diagnostic: Bacteriology/microbiology
Included






































216
0307 - Laboratory - Clinical Diagnostic: Urology
Included






































216
0309 - Laboratory - Clinical Diagnostic: Other laboratory
Included






































216
0312 - Laboratory - Pathology: Histology
Included






































216
0320 - Radiology - Diagnostic
Included






































216
0324 - Radiology - Diagnostic: Chest X-ray
Included






































216
0352 - CT Scan: Body
Included






































216
0360 - Operating Room Services
Included






































216
0361 - Operating Room Services: Minor surgery
Included






































216
0370 - Anesthesia
Included






































216
0390 - Blood Storage/Processing
Included






































216
0391 - Blood Storage/Processing: Blood administration (eg. Transfusion)
Included






































216
0402 - Other Imaging Services: Ultrasound
Included






































216
0410 - Respiratory Services
Included






































216
0412 - Respiratory Services: Inhalation services
Included






































216
0420 - Physical Therapy
Included






































216
0424 - Physical Therapy: Evaluation/re-evaluation
Included






































216
0434 - Occupational Therapy: Evaluation/re-evaluation
Included






































216
0440 - Speech-Language Pathology
Included






































216
0444 - Speech-Language Pathology: Evaluation/ re-evaluation
Included






































216
0450 - Emergency Room
Included






































216
0460 - Pulmonary Function
Included






































216
0480 - Cardiology
Included






































216
0481 - Cardiology: Cardiac catheter lab
Included






































216
0710 - Recovery Room
Included






































216
0730 - EKG/ECG
Included






































216
0732 - EKG/ECG: Telemetry
Included






































216
0921 - Other Diagnostic Services: Peripheral vascular lab
Included






































216
0940 - Other Therapeutic Serv
Included






























































































































220 Cardiac Valve/Other Major Procedures w Compl Claim IP $157,306.62 $62,922.65 $34,957.65 $141,575.96 $69,904.47 $125,845.30 $35,791.68 $38,688.32 $141,575.96 $64,831.17 $35,063.44 $73,560.73 $85,171.31 $100,111.56 $106,496.58 $89,664.77 $125,845.30 $49,611.35 $43,697.90 $94,383.97 $88,955.02 $35,764.71 $110,114.63 $34,957.65 $49,611.35 $107,826.04 $72,361.05 $133,710.63 $133,710.63 $35,063.44 $49,611.35 $52,091.92 $49,611.35 $36,524.88 $88,149.63 $35,414.07 $36,816.61 $36,548.56 $59,533.62 $36,465.98
220
0110 - Room & Board (Private)
Included






































220
0210 - Coronary care
Included






































220
0250 - Pharmacy
Included






































220
0271 - Medical/Surgical Supplies: Nonsterile supplies
Included






































220
0272 - Medical/Surgical Supplies: Sterile supplies
Included






































220
0278 - Medical/Surgical Supplies: Other implants
Included






































220
0300 - Laboratory - Clinical Diagnostic
Included






































220
0301 - Laboratory - Clinical Diagnostic: Chemistry
Included






































220
0302 - Laboratory - Clinical Diagnostic: Immunology
Included