Phoenix Children's Hospital Hospital Standard File Pricing as of Jan. 1, 2020 Service Code Description Rev Code Price 37010001 GEN SURG LEV 1 1ST HR 360 4,222.00 37010002 GEN SURG LEV 1 ADD 1/2 HR 360 2,112.00 37010005 GEN SURG LEV 2 1ST HR 360 6,547.00 37010007 GEN SURG LEV 2 ADD 1/2 HR 360 3,273.00 37010009 GEN SURG LEV 3 1ST HR 360 8,325.00 37010010 GEN SURG LEV 3 ADD 1/2 HR 360 4,163.00 37010011 BAG AUTOTRANS ATRIUM 272 263.00 37010013 GEN SURG LEV 4 1ST HR 360 11,747.00 37010015 GEN SURG LEV 4 ADD 1/2 HR 360 5,874.00 37010019 GEN SURG LEV 5 ADD 1/2 HR 360 7,036.00 37010020 GEN SURG LEV 5 1ST HR 360 14,072.00 37010021 LITHOTRIPSY 1ST HR 790 7,672.00 37010023 LITHOTRIPSY ADD 1/2 HR 790 3,837.00 37010101 BLOOD TRANSFUSN 391 1,763.00 37010105 IV INF HYDRAT ADDL HR 260 305.00 37010107 IV INF EA ADDL HR 260 305.00 37010108 IV INF EA ADDL DRUG 260 339.00 37010116 CHEMO ADMIN IV PUSH INIT 331 687.00 37010117 CHEMO ADMIN IV PUSH ADD 331 418.00 37010118 CHEMO INF 1ST HR 335 1,071.00 37010119 CHEMO INF EA ADDL HR 335 415.00 37010121 CHEMO INF EA ADDL DRUG 335 631.00 37010231 US GUIDE NDL PLCMT S&I 402 1,008.00 37010233 US GUIDE VAD S&I 402 929.00 37010234 REP RECRRNT INCISI HERNIA 360 25,888.00 37010264 N BLCK INJ BRACHIAL PLEX 361 1,269.00 37010268 N BLCK INJ AXILLARY 361 1,269.00 37010270 N BLCK INJ SUPRASCAPULAR 361 1,269.00 37010282 N BLCK INJ SCIATIC SNG 361 1,269.00 37010284 N BLK INJ SCIATIC CONT IN 361 1,269.00 37010286 N BLCK INJ FEM SNGL 361 1,269.00 37010288 N BLCK INJ FEM CONT INF 361 1,269.00 37010292 N BLCK OTHER PERIPHERAL 361 1,269.00 37010294 N BLCK INJ PLANTAR DIGIT 361 1,269.00 37010295 IMPL/REPL SQ RSV EPID INF 361 8,793.00 37010300 BRONCH VISUAL OF WINDPIPE 361 2,328.00 37010301 DX BRONCHOSCPY/WASH 361 4,528.00 37010302 DX BRONCHSCPY/BRUSH 361 1,905.00 37010303 DX BRONCHOSCPY/LAVAGE 361 1,905.00 37010304 BRONCHOSCOPY W/BX 361 2,328.00 37010305 BRONCHSCPY/LUNG BX EACH 361 2,328.00 37010306 BRONCHSCPY/NDL BX EACH 361 2,328.00 37010307 BRONCHOSCPY/LUNG BX ADDTL 361 2,328.00 37010308 BRONCHSCPY/NDL BX ADDTL 361 2,328.00 37010309 AIRWAYS SURGICAL PROC 361 1,059.00 37010312 NJX INTERLAMINAR LMBR/SAC 361 1,220.00 37010313 EGD REM LESION W SNARE 361 6,064.00 37010314 COLSCPY FLX W/LES RMVL 361 6,064.00 37010828 BIT DRILL 2.5MM 310.25 272 572.00 37010832 BIT DRILL 3.5MM 310.35 272 606.00 37010837 DRILL BIT 310.63 5.0 CANC 272 2,432.00 37010838 BIT DRILL 310.65 3.2 CANC 272 2,417.00 37010839 BIT DRILL 310.67 2.7 CANN 272 2,457.00 37010840 BIT DRL 310.68 3.5 CAN QC 272 2,457.00 37010880 BLADE FULL RADIUS 2.9MM 272 416.00 37011106 LASR DSTR PROLF LESN<10CM 361 3,857.00 37011107 LASR DSTR PROLF LESN<50CM 361 3,857.00 37011108 LASR DSTR PROLF LESN>50CM 361 3,857.00 37011111 SKIN BIOPSY-DERMATOLOGY 361 794.00 37011112 REMOV SKIN LESION-SMPL 361 2,071.00 37011113 REMOV SKIN LESION-MODERAT 361 2,434.00 37011114 REMOV SKIN LESION-CMPLX 361 2,857.00 37011116 ESOPH REFLUX TEST PH NASL 750 1,905.00 37011117 ESOPH IMPED FNCTN TEST 750 1,905.00 37011118 ESOPH IMPED FNCTN TEST>1H 750 1,905.00 37011800 CHEMODNRV ANAL MUSC 361 424.00 37012004 TRACHEOBRONCH THRU TRACH 361 2,117.00 37012009 BRONCH W/WO CELL WASHING 361 2,328.00 37012010 DX BRONCHOSCOPE/BRUSH 361 2,509.00 37012014 BRONCH W BX 361 6,064.00 37012021 BRONCH TRACH/BRONCH DILAT 361 2,398.00 37012024 ESOPHAGOSCOPY BIOPSY 361 1,905.00 37012026 DILATE ESOPH UNGUID BOUGI 361 2,181.00 37012029 EGD BALLOON DILATION 361 3,214.00 37012034 EGD WIRE GUIDED DIL 361 3,214.00 37012039 UPPER EGD W/WO BRUSH/WASH 361 3,214.00 37012044 EGD BIOPSY 361 3,214.00 37012049 ESOPH SCOPE W/SCLEROS INJ 361 3,214.00 37012054 EGD DIL GASTRIC OUTLET OB 361 3,214.00 37012059 EGD TO PLACE PEG 361 3,214.00 37012064 EGD/REMOVAL FOREIGN BODY 361 3,214.00 37012069 EGD CONTROL OF BLEED 361 3,214.00 37012074 ERCP W/WO BRUSH 361 3,270.00 37012076 ERCP W/BX 361 3,175.00 37012079 ERCP/PAPILLOTOMY/SPHINCTE 361 4,604.00 37012081 ERCP W/ LITHO CALCULUS 361 3,175.00 37012084 ERCP RETRO INSRT STENT 361 3,270.00 37012085 ERCP REMOVE FB, STENT 361 3,270.00 37012086 ERCP BALLOON DILATION 361 3,270.00 37012089 G-TUBE CHNG 361 424.00 37012094 ILEOSCOPY THRU STOMA W/BI 361 2,858.00 37012099 PROCTOSIGMOID W/BX 361 1,905.00 37012104 SIGMOID W/BX 361 1,905.00 37012105 SIGMOIDOSCOPY W/RMVL FB 361 1,905.00 37012109 COLONOSCOPY W/WO BRUSH WA 361 2,434.00 37012114 COLONOSCOPY W/BX 361 3,286.00 37012115 COLONOSCOPY W/BLLN/STRICT 361 2,858.00 37012119 COLON REMOVE LESION SNARE 361 2,434.00 37012129 ANORECTAL MANOMETRY 750 1,977.00 37012134 RECTAL SUCTION BIOPSY 361 2,646.00 37012139 EGD GI TRACT PH PROBE 750 2,937.00 37012144 ESOPHAGEAL MANOMETRY 750 1,905.00 37012156 GI CAP ENDOSCOPY 750 3,704.00 37012159 BRONCH REMOVE FOREIGN BOD 361 2,328.00 37012164 EGD LIGATE ESOPH VARICES 361 3,214.00 37012174 COLON CONTROL OF BLEED 361 3,286.00 37012175 BX BONE MARR & ASP 361 1,588.00 37012179 COLON RMVL FB 361 2,434.00 37012189 COLON THRU STOMA W/BX 361 3,286.00 37012194 SIGMOID CONTROL OF BLEED 361 1,905.00 37012197 SCAN PROC CRANIAL INTRA 360 4,560.00 37012201 BRONCH W/ BAL/WASH 361 2,398.00 37012204 MINOR PROC 1ST 30MIN 361 1,363.00 37012205 MINOR PROC ADD 15MIN 361 662.00 37012324 BONE CANC CHIP 15CC 278 1,720.00 37012739 ENDO PEANUTS 5MM 272 180.00 37012835 REV EYE MUSC; 1 HORIZ MUS 360 11,022.00 37013001 ANESTH 1ST HR 370 1,542.00 37013003 ANESTH ADDL 1/2 HR 370 770.00 37013348 NAIL ELASTIC 475.920 2.0/ 278 1,723.00 37013349 NAIL ELASTIC 475.925 2.50 278 1,906.00 37013858 PLATE TIT 441.37 7H/85TBL 278 553.00 37013880 PLTE TUB 1/3 6H 241.36 7 278 388.00 37013882 PLTE TUB 1/3 8H 241.38 9 278 461.00 37013916 PORT REG 6.8FR R#060220 278 1,866.00 37014005 EXTND RECVRY/HR 710 144.00 37014205 SCRW CA 206.016 4.0/16 F 278 192.00 37014305 SCRW CA 205.018 3.5/18/6 278 1,379.00 37014306 SCRW CA 205.022 3.5/22/7 278 1,379.00 37014307 SCRW CA 205.026 3.5/26/8 278 1,379.00 37014308 SCRW CA 205.028 3.5/28/9 278 1,379.00 37014309 SCRW CA 205.030 3.5/30/10 278 1,379.00 37014310 SCRW CA 205.032 3.5/32/11 278 1,379.00 37014311 SCRW CA 205.034 3.5/34/11 278 1,379.00 37014312 SCRW CA 205.036 3.5/36/12 278 1,379.00 37014313 SCRW CA 205.038 3.5/38/12 278 1,379.00 37014314 SCRW CA 205.040 3.5/40/13 278 1,379.00 37014315 SCRW CA 205.044 3.5/44/14 278 1,379.00 37014316 SCRW CA 205.046 3.5/46/15 278 1,379.00 37014320 SCRW CA 205.220 3.5 278 1,379.00 37014321 SCRW CA 205.226 3.5/26 F 278 1,379.00 37014322 SCRW CA 205.232 3.5/32 F 278 1,379.00 37014326 SCRW CA 207.612 4.0/12 ST 278 1,181.00 37014327 SCRW CA 207.614 4.0/14 ST 278 1,243.00 37014328 SCRW CA 207.616 4.0/16 ST 278 1,454.00 37014329 SCRW CA 207.618 4.0/18 ST 278 1,181.00 37014330 SCRW CA 207.620 4.0/20 ST 278 1,345.00 37014331 SCRW CA 207.622 4.0/22 ST 278 1,345.00 37014332 SCRW CA 207.624 4.0/24 ST 278 1,345.00 37014333 SCRW CA 207.626 4.0/26 S 278 1,181.00 37014334 SCRW CA 207.628 4.0/28 S 278 1,181.00 37014335 SCRW CA 207.630 4.0/30 S 278 1,181.00 37014336 SCRW CA 207.632 4.0/32 S 278 1,454.00 37014337 SCRW CA 207.634 4.0/34 S 278 1,454.00 37014338 SCRW CA 207.636 4.0/36 S 278 1,454.00 37014339 SCRW CA 207.638 4.0/38 S 278 1,454.00 37014340 SCRW CA 207.640 4/40 ST 278 1,454.00 37014341 SCRW CA 207.642 4/42 ST 278 1,454.00 37014342 SCRW CA 207.644 4.0/44 S 278 1,454.00 37014343 SCRW CA 207.646 4.0/46 S 278 1,454.00 37014344 SCRW CA 207.650 4.0/50 S 278 1,454.00 37014345 SCRW CA 207.716 4.0/16 278 1,181.00 37014348 SCRW CA 207.722 4.0/22 278 1,038.00 37014349 SCRW CA 207.724 4.0/24 278 874.00 37014350 SCRW CA 207.726 4.0/26 278 1,181.00 37014351 SCRW CA 207.728 4.0/28 278 1,181.00 37014352 SCRW CA 207.730 4.0/30 278 1,181.00 37014353 SCRW CA 207.732 4.0/32 278 1,181.00 37014354 SCRW CA 207.734 4.0/34 278 1,379.00 37014355 SCRW CA 207.736 4.0/36 278 1,345.00 37014356 SCRW CA 207.738 4/38 278 1,181.00 37014357 SCRW CA 207.740 4.0/40 278 1,454.00 37014359 SCRW CA 207.746 4.0/46 278 1,345.00 37014360 SCRW CA 207.748 4.0/48 278 1,181.00 37014361 SCRW CA 207.750 4.0/50 278 1,242.00 37014392 SCRW CA 208.905 7.3/105 278 1,218.00 37014393 SCRW CA 208.910 7.3/110 278 1,368.00 37014394 SCRW CA 208.915 7.3/115 278 1,368.00 37014395 SCRW CA 208.920 7.3/120 278 1,368.00 37014440 SCRW CA 214.544 4.5/44/15 278 1,254.00 37014442 SCRW CA 214.548 4.5/48 PT 278 1,393.00 37014444 SCRW CA 214.552 4.5/52 278 1,393.00 37014446 SCRW CA 214.556 4.5/56/19 278 1,393.00 37014447 SCRW CA 214.560 4.5/60/20 278 1,254.00 37014521 SCRW CTX 204.812 3.5/12 S 278 202.00 37014522 SCRW CTX 204.814 3.5/14 S 278 202.00 37014523 SCRW CTX 204.816 3.5/16 S 278 202.00 37014524 SCRW CTX 204.818 3.5/18 S 278 202.00 37014525 SCRW CTX 204.820 3.5/20 S 278 202.00 37014526 SCRW CTX 204.822 3.5/22 S 278 202.00 37014687 SCREW 3.5MM TIT CTX 12MM 278 223.00 37014688 SCREW 3.5MM TIT CTX 14MM 278 223.00 37014689 SCREW 3.5MM TIT CTX 16MM 278 223.00 37014826 ENDOSHEAR MINI 5MM 272 473.00 37015001 PACU 1ST HR 710 2,164.00 37015003 PACU EA ADDL 1/2 HR 710 1,083.00 37015005 OPTIRAY 300-399 EA ML 636 4.00 37015480 STIMULATOR NERVE VARI STM 272 428.00 37015509 CAST 2 272 29.00 37015510 CAST 3IN BLUE FIBERGLASS 272 29.00 37015627 TUBE FEEDING 6F 272 99.00 37015891 WASHER 10.0 219.91 278 246.00 37015892 WASHER 13.0 219.99 LG 278 253.00 37015893 WASHER 7.0 219.98 SM 278 242.00 37015923 WIRE GUID 292.62 1.25 TH 278 276.00 37015927 WIRE GUID 292.68 2.8 THR 278 400.00 37015929 WIRE GUID 292.72 1.6/150T 278 312.00 37017416 SPONGE GELFOAM 100 272 376.00 37017741 NDL BX BONE MARROW PEDS 272 137.00 37017833 NDL INSUFFLATION 14G/100 272 153.00 37017942 PACK CYSTOSCOPY BASIC 272 165.00 37018819 TIP NDL MICRO BOVIE 272 415.00 37019000 ISOVUE300-61%-50ML PER ML 636 9.00 37019198