Phoenix Children's Hospital
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $356.51 per claim for 99283 (Emergency dept visit, moderate complexity), which is 8.4× the national median of $42.48.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 209 procedure codes: 99284 at 9.1× median, 99285 at 10.6× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $635.16 per claim for 99284 (Emergency dept visit, high complexity) — 9.1× the national median of $69.51.
Bills $910.94 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 10.6× the national median of $85.65.
Bills $356.51 per claim for 99283 (Emergency dept visit, moderate complexity) — 8.4× the national median of $42.48.
Billing in the top 1% nationally for 10 procedure codes: 99284, 99285, 93303.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Children Peers
Total spending distribution among 16 providers in this specialty
This provider's total spending of $555.7M is at the 90th percentile among 16 General Acute Care Hospital Children providers.
Above 90th percentile for this specialty — higher spending than 14 of 16 peers
Total Paid
$555.7M
$555,705,726
Total Claims
4.2M
Beneficiaries
3.6M
1.1 claims/patient
Avg Cost/Claim
$133
#102 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Phoenix Children's Hospital is a General Acute Care Hospital Children provider based in Phoenix, AZ. From the 2018–2024 period, this provider received $555.7M in Medicaid payments across 4.2M claims.
Why This Matters
This provider received $555.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 69,463 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99284 (Emergency dept visit, high complexity)) accounts for 15% of total spending.
$82.4M
130K claims
$635.16
$69.51
Emergency dept visit, high complexity
$82.4M
130K claims · 14.8%
$68.0M
75K claims
$910.94
$85.65
Emergency dept visit, high/urgent complexity
$68.0M
75K claims · 12.2%
$63.2M
177K claims
$356.51
$42.48
Emergency dept visit, moderate complexity
$63.2M
177K claims · 11.4%
$20.1M
6K claims
$3,511.73
$331.68
Tonsillectomy and adenoidectomy, under age 12
$20.1M
6K claims · 3.6%
$16.5M
21K claims
$785.45
$112.83
Echocardiography, transthoracic, limited
$16.5M
21K claims · 3.0%
$14.4M
3K claims · 2.6%
$11.7M
6K claims
$1,929.05
$134.97
Percutaneous allergy skin tests, each
$11.7M
6K claims · 2.1%
$11.1M
3K claims · 2.0%
$10.2M
16K claims
$628.06
$54.68
Echocardiography, transthoracic, complete, with Doppler
$10.2M
16K claims · 1.8%
$9.5M
13K claims
$716.26
$35.80
Surgical pathology, gross and microscopic examination
$9.5M
13K claims · 1.7%
$9.0M
2K claims
$5,621.79
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$9.0M
2K claims · 1.6%
$8.4M
3K claims · 1.5%
$8.3M
3K claims · 1.5%
$7.5M
18K claims · 1.3%
$7.2M
41K claims
$175.08
$99.39
Hospital observation service, per hour
$7.2M
41K claims · 1.3%
Emergency dept visit, low complexity
$7.1M
45K claims · 1.3%
$6.7M
6K claims
$1,132.62
$233.73
Polysomnography, sleep study, 6+ hours
$6.7M
6K claims · 1.2%
Tympanostomy, general anesthesia
$6.6M
5K claims · 1.2%
Comprehensive metabolic panel
$6.2M
92K claims · 1.1%
MRI brain without contrast
$6.1M
14K claims · 1.1%
$5.4M
3K claims
$1,981.51
$470.36
Injection, onabotulinumtoxinA, 1 unit
$5.4M
3K claims · 1.0%
$5.3M
3K claims · 1.0%
Therapeutic activities, each 15 min
$4.8M
51K claims · 0.9%
$4.6M
6K claims
$755.29
$133.68
MRI brain without contrast, then with contrast
$4.6M
6K claims · 0.8%
$4.1M
159K claims
$25.67
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4.1M
159K claims · 0.7%
$4.0M
11K claims · 0.7%
$3.9M
1K claims · 0.7%
Upper GI endoscopy with biopsy
$3.8M
8K claims · 0.7%
$3.3M
33K claims
$101.00
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$3.3M
33K claims · 0.6%
$3.3M
18K claims
$186.48
$38.92
IV infusion, hydration, each additional hour
$3.3M
18K claims · 0.6%
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