Patients & Visitors

Price Transparency

In 2013, the Arizona State Legislature approved HB 2045, which requires hospitals and health care providers with more than 50 beds to make available to the public, upon request, the Direct Pay Price for their 50 most used Diagnosis Related Group (DRG) codes. The Direct Pay Price is the price that Phoenix Children's Hospital charges for the identified service, regardless of the patient’s health insurance status, if the service is paid for directly, in full, either by a patient (directly or through a Health Savings Account) or by the patient’s employer (for instance, through a self-insured plan).

Health Care is Complicated

We understand that health care – and health care pricing – is complicated. Here’s some information that will help you understand the information provided:

  • APR-DRG stands for “All Patient Refined Diagnosis Related Groups.” These categories were created by 3MTM in a joint effort with the Children’s Hospital Association, to create consistency among children’s hospitals, allowing us to track outcomes as well as costs.
  • A patient is first assigned to a base APR-DRG (e.g.: APR 139, Other Pneumonia) similar to the assignment of a Medicare-based MS-DRG. This assignment is based primarily on the patient diagnosis but takes into account several other factors as well.
  • The patient is then separately assigned two distinct subclasses: severity of illness (SOI) and risk of mortality (ROM). SOI is defined as the extent of organ system derangement or physical decompensation for a patient.
  • Each subclass has four possible assignment levels:
  1. Minor

  2. Moderate

  3. Major

  4. Extreme

  • The SOI class provides a basis for evaluating hospital resource use or to establish patient care guidelines. Patients are assigned their SOI based on their specific diagnoses and procedures performed during their inpatient hospital stay. Patients with higher SOI (e.g. major or extreme) are more likely to consume greater health care resources and stay longer in hospitals than patients with lower SOI in the same DRG
  • If you come to Phoenix Children’s Hospital and you have a medical Emergency or are in labor, you have the right to receive, within the capabilities of Phoenix Children’s Hospital staff and facilities, an appropriate Medical Screening Examination, necessary stabilizing treatment (including treatment for an unborn child) and, if necessary, an appropriate transfer to another facility even if you cannot pay or do not have medical insurance.

 

Phoenix Children's Hospital
50 Most Used Inpatient Diagnosis Related Groups Codes

  Severity of Illness (SOI) 
1 - Minor 2 - Moderate 3 - Major 4 - Extreme

Rank

APR-DRG V30*

Category Description

Average Direct Pay Price

1 138 Bronchiolitis& RSV Pneumonia $12,235.00 $19,941.00 $38,429.00 $67,355.00
2 141 Asthma $12,565.92 $17,841.21 $39,031.58 $83,119.31
3 053 Seizure $20,414.69 $24,285.32 $30,029.15 $147,974.86
4 693 Chemotherapy $46,069.65 $48,522.99 $93,643.93 $267,464.87
5 139 Other Pneumonia $11,476.75 $18,918.11 $48,645.21 $85,802.34
6 254 Other Digestive System Diagnoses $18,980.38 $28,181.17 $42,734.41 $161,694.62
7 463 Kidney & Urinary Tract Infections $14,243.97 $19,090.51 $29,095.56 $43,538.38
8 753 Bipolar Disorders $21,467.98 $27,585.98 $33,699.23 -
9 054 Migraine & Other Headaches $21,690.61 $29,316.39 $39,700.18 -
10 640 Neonate Birthwt >2499g, Normal Newborn Or Neonate W/ Other Problem $10,706.46 $18,974.51 $35,618.14 $67,598.46
11 420 Diabetes $14,915.05 $21,534.04 $27,376.82 $316,888.59
12 113 Infections Of Upper Respiratory Tract $12,065.98 $18,294.94 $30,287.15 $42,083.17
13 383 Cellulitis & Other Bacterial Skin Infections $16,380.51 $23,655.21 $31,909.14 $102,892.51
14 722 Fever $11,279.44 $22,829.37 $29,739.95 $54,827.64
15 225 Appendectomy $30,842.76 $41,936.79 $75,557.15 $50,615.49
16 249 Non-Bacterial Gastroenteritis, Nausea & Vomiting $20,845.99 $24,832.87 $47,419.09 $63,127.00
17 660 Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul $24,938.98 $41,637.86 $65,236.91 $244,100.28
18 021 Craniotomy Except For Trauma $89,932.37 $148,813.96 $188,497.09 $448,206.73
19 309 Hip & Femur Procedures For Non-Trauma Except Joint Replacement $52,212.28 $64,380.30 $76,662.06 $342,476.87
20 443 Kidney & Urinary Tract Procedures For Nonmalignancy $32,039.37 $42,668.64 $97,172.75 $208,029.29
21 421 Malnutrition, Failure To Thrive & Other Nutritional Disorders $14,974.49 $19,389.22 $42,168.63 $54,741.12
22 812 Poisoning Of Medicinal Agents $10,715.53 $14,055.14 $21,603.38 $15,954.18
23 721 Post-Operative, Post-Traumatic, Other Device Infections $18,243.92 $34,000.26 $176,318.22 $97,412.35
24 346 Connective Tissue Disorders $27,140.53 $50,151.71 $75,294.55 $223,969.96
25 247 Intestinal Obstruction $12,559.17 $27,318.91 $34,430.66 $138,196.18
26 662 Sickle Cell Anemia Crisis $49,838.28 $69,330.83 $120,320.95 -
27 058 Other Disorders Of Nervous System $23,164.83 $31,128.44 $59,587.42 $44,058.56
28 137 Major Respiratory Infections & Inflammations $14,622.82 $31,300.86 $56,613.82 $95,089.11
29 663 Other Anemia & Disorders Of Blood & Blood-Forming Organs $23,423.20 $24,912.09 $33,317.92 $178,846.80
30 130 Respiratory System Diagnosis w/ Ventilator Support 96+ Hours $128,334.42 $149,013.53 $138,498.09 $211,546.82
31 160 Major Cardiothoracic Repair Of Heart Anomaly $142,640.45 $250,038.68 $238,425.74 $511,405.66
32 023 Spinal Procedures $62,960.54 $83,389.86 $215,668.74 $281,410.02
33 055 Head Trauma w/ Coma >1 Hr Or Hemorrhage $24,135.22 $33,997.93 $60,505.60 $140,080.76
34 723 Viral Illness $11,926.06 $19,423.70 $75,474.66 $35,279.66
35 221 Major Small & Large Bowel Procedures $50,372.91 $72,652.64 $117,044.03 $375,785.41
36 639 Neonate Birthwt >2499g w/ Other Significant Condition $81,609.61 $72,084.82 $114,804.83 $218,851.34
37 143 Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses $14,262.30 $39,548.37 $39,420.76 $96,876.99
38 303 Dorsal & Lumbar Fusion Proc For Curvature Of Back $206,220.54 $211,908.78 $207,360.04 $330,729.82
39 089 Major Cranial/Facial Bone Procedures $61,514.78 $84,188.81 $102,699.10 $665,152.91
40 248 Major Gastrointestinal & Peritoneal Infections $12,226.82 $31,245.23 $69,534.84 $86,720.74
41 144 Respiratory Signs, Symptoms &Amp; Minor Diagnoses $16,120.83 $36,792.38 $57,845.48 $80,679.81
42 022 Ventricular Shunt Procedures $46,973.07 $58,293.02 $69,605.98 $181,809.36
43 313 Knee & Lower Leg Procedures Except Foot $41,548.16 $66,761.46 $91,931.86 -
44 861 Signs, Symptoms & Other Factors Influencing Health Status $16,843.37 $27,664.09 $28,016.33 -
45 222 Other Stomach, Esophageal & Duodenal Procedures $23,647.18 $110,751.04 $81,884.61 $41,827.99
46 351 Other Musculoskeletal System & Connective Tissue Diagnoses $19,970.60 $23,539.63 $73,326.14 $234,851.74
47 057 Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma > 1 Hr Or No Coma $19,165.53 $26,086.58 $44,588.41 $45,868.55
48 634 Neonate, Birthwt >2499g W Resp Dist Synd/Oth Maj Resp Cond $45,027.92 $83,884.43 $151,576.14 $182,276.70
49 422 Hypovolemia & Related Electrolyte Disorders $13,026.23 $21,251.87 $41,763.53 $45,009.11
50 243 Other Esophageal Disorders $11,628.77 $25,507.86 $28,855.60 $44,731.52
*APR-DRG - All Patient Refined Diagnosis Related Groups

 


 

Phoenix Children's Hospital
50 Most Used Outpatient Services Codes

Rank HCPCS* HCPCS Desc Average Charge 
1 99233 Subsequent hospital care $280
2 99283 Emergency Visit Level 3 $776
3 99232 Subsequent hospital care $195
4 99284 Emergency Visit Level 4 $1,457
5 85025 Complete CBC w/auto diff wbc $67
6 J2405 Ondansetron hcl injection $35
7 81001 Urinalysis auto w/scope $48
8 G0378 Hospital observation per hr $712
9 99282 Emergency Visit Level 2 $399
10 99244 Office consultation $449
11 87086 Urine culture/colony count $77
12 80053 Comprehen metabolic panel $266
13 J7030 Normal saline solution infus $132
14 71020 Chest x-ray $393
15 99213 Established Outpatient Office Visit Level  3 $262
16 99243 Office consultation $323
17 J7050 Normal saline solution infus $106
18 J3490 Drugs unclassified injection $34
19 J7120 Ringers lactate infusion $75
20 90945 Dialysis one evaluation $1,468
21 J2175 Meperidine hydrochl /100 MG $15
22 93010 Electrocardiogram report $25
23 99291 Critical care first hour $744
24 94640 Airway inhalation treatment $135
25 87880 Strep a assay w/optic $83
26 99472 Ped critical care subsq $1,099
27 96374 Ther/proph/diag inj iv push $267
28 99245 Office consultation $517
29 99214 Established Outpatient Office Visit Level  4 $389
30 J2270 Morphine sulfate injection $30
31 80048 Metabolic panel total ca $209
32 J3010 Fentanyl citrate injeciton $8
33 94664 Evaluate pt use of inhaler $121
34 J1100 Dexamethasone sodium phos $23
35 99239 Hospital discharge day $284
36 99203 New Outpatient Office Visit Level  3 $262
37 J2250 Inj midazolam hydrochloride $16
38 76770 Us exam abdo back wall comp $963
39 99238 Hospital discharge day $194
40 94060 Evaluation of wheezing $504
41 87040 Blood culture for bacteria $129
42 92526 Oral function therapy $1,500
43 74020 X-ray exam of abdomen $474
44 83735 Assay of magnesium $47
45 36415 Routine venipuncture $48
46 J7611 Albuterol non-comp con $23
47 93005 Electrocardiogram tracing $364
48 99222 Initial hospital care $366
49 88305 Tissue exam by pathologist $2,813
50 99223 Initial hospital care $542
*Healthcare Common Procedure Coding System

 


 

What’s the cost for my child’s care?

Because every child is different, our Financial Counselors are happy to talk with you about your child’s individual needs. Upon request, they will work with you to provide a personalized estimate of charges in advance of care.

We’re here to help.

Our commitment is to ensure you understand the financial assistance processes at Phoenix Children's Hospital.  If you still have questions, please contact our Financial Counseling department at (602) 933-2000.

Learn more about our Financial Assistance Policy

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