Statistical Outliers

Single-test outliers in Colorado Medicaid data. These are individual statistical flags — most are informational.

Important context: These findings identify statistically unusual billing patterns, not determinations of wrongdoing. Cost-per-claim comparisons may flag hospital outpatient departments whose reimbursements include facility fees, bundled services, or all-inclusive rates. High claims-per-beneficiary ratios may reflect legitimate care patterns at behavioral health facilities, pediatric specialty centers, or residential care programs. Additional investigation and clinical context are required before drawing any conclusions.

For provider level analytics using multiple independent tests, see the Watchlist — which flags providers only when 2+ different detection methods agree. These single-test outliers below are primarily informational; only Cost Outliers and Overutilization are flagged as critical/warning.

critical

333

warning

681

info

7,508

Total

8,522

Outliers by Type

Severity Distribution

critical

333 (3.9%)

warning

681 (8.0%)

info

7,508 (88.1%)

6,501 results

criticalCost OutlierScore: 15.3

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

GRAND RIVER HOSPITAL DISTRICT (1851347223) bills $273.64/claim for 96127 (Brief emotional/behav assmt) vs avg $9.66 (+15.3σ). $188,813 across 690 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GRAND RIVER HOSPITAL DISTRICTPARACHUTEProvider total: $4.9M

criticalCost OutlierScore: 14.5

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

IFEANYICHUKWU NWOBODO MD LLC (1831510536) bills $1,080.55/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $57.67 (+14.5σ). $144,794 across 134 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

IFEANYICHUKWU NWOBODO MD LLCAURORAProvider total: $146.8K

criticalCost OutlierScore: 13.5

Cost-per-claim above average for 91300

UPPER SAN JUAN HEALTH SERVICE DISTRICT (1245401561) bills $26.94/claim for 91300 (Code 91300) vs avg $0.21 (+13.5σ). $10,130 across 376 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

UPPER SAN JUAN HEALTH SERVICE DISTRICTPAGOSA SPRINGSProvider total: $1.7M

criticalCost OutlierScore: 13.3

Cost-per-claim above average for 36415 (Blood Draw (Venipuncture))

DOLORES COUNTY HEALTH ASSOCIATION (1710954433) bills $90.34/claim for 36415 (Coll venous bld venipuncture) vs avg $2.53 (+13.3σ). $13,642 across 151 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

DOLORES COUNTY HEALTH ASSOCIATIONDOVE CREEKProvider total: $1.1M

criticalCost OutlierScore: 13.2

Cost-per-claim above average for D0120 (Periodic Oral Evaluation (Established Patient))

MARK BAKER (1811242340) bills $116.83/claim for D0120 (Periodic oral evaluation) vs avg $24.02 (+13.2σ). $78,861 across 675 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARK BAKERDENVERProvider total: $144.1K

criticalCost OutlierScore: 13.2

Cost-per-claim above average for 92014

SOUTHERN UTE INDIAN TRIBE (1407883309) bills $548.00/claim for 92014 (Compre oph exam est pt 1/>) vs avg $84.89 (+13.2σ). $51,512 across 94 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHERN UTE INDIAN TRIBEIGNACIOProvider total: $3.1M

criticalCost OutlierScore: 12.6

Cost-per-claim above average for 81025

CHILDREN'S HOSPITAL COLORADO (1336245828) bills $80.41/claim for 81025 (Urine pregnancy test) vs avg $5.17 (+12.6σ). $358,161 across 4,454 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CHILDREN'S HOSPITAL COLORADOAURORAProvider total: $114.9M

criticalCost OutlierScore: 12.5

Cost-per-claim above average for D0220 (Dental X-ray (Periapical, First Film))

ROBERT HAMBLIN (1407922651) bills $54.93/claim for D0220 (Intraoral - periapical first image) vs avg $11.99 (+12.5σ). $11,754 across 214 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ROBERT HAMBLINLONGMONTProvider total: $35.7K

criticalCost OutlierScore: 11.8

Cost-per-claim above average for 96372

AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC. (1962846840) bills $252.35/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $13.81 (+11.8σ). $33,058 across 131 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER, INC.AURORAProvider total: $5.0M

criticalCost OutlierScore: 11.7

Cost-per-claim above average for D2930

ANIMAS SURGICAL HOSPITAL, LLC (1508842964) bills $978.70/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $134.95 (+11.7σ). $63,616 across 65 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ANIMAS SURGICAL HOSPITAL, LLCDURANGOProvider total: $677.3K

criticalCost OutlierScore: 11.4

Cost-per-claim above average for 99173

GRAND RIVER HOSPITAL DISTRICT (1124074042) bills $399.93/claim for 99173 (Visual acuity screen) vs avg $9.55 (+11.4σ). $33,594 across 84 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GRAND RIVER HOSPITAL DISTRICTRIFLEProvider total: $14.0M

criticalCost OutlierScore: 11.3

Cost-per-claim above average for G8510

SUMMIT COMMUNITY CARE CLINIC, INC. (1639595986) bills $73.57/claim for G8510 (Scr dep neg, no plan reqd) vs avg $5.01 (+11.3σ). $18,320 across 249 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SUMMIT COMMUNITY CARE CLINIC, INC.BRECKENRIDGEProvider total: $2.1M

criticalCost OutlierScore: 10.8

Cost-per-claim above average for E1399

WESTPEAK MOBILITY LLC (1003359704) bills $3,895.25/claim for E1399 (Durable medical equipment, miscellaneous) vs avg $131.40 (+10.8σ). $58,429 across 15 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

WESTPEAK MOBILITY LLCCOLORADO SPRINGSProvider total: $700.5K

criticalCost OutlierScore: 10.4

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

SOUTHWEST HEALTH SYSTEM INC (1649241571) bills $28.25/claim for 81003 (Urinalysis auto w/o scope) vs avg $1.40 (+10.4σ). $45,171 across 1,599 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHWEST HEALTH SYSTEM INCCORTEZProvider total: $9.2M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for 96127 (Brief Emotional/Behavioral Assessment)

GRAND RIVER HOSPITAL DISTRICT (1124074042) bills $184.62/claim for 96127 (Brief emotional/behav assmt) vs avg $9.66 (+10.1σ). $495,892 across 2,686 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GRAND RIVER HOSPITAL DISTRICTRIFLEProvider total: $14.0M

criticalCost OutlierScore: 9.9

Cost-per-claim above average for A0425 (Ground Ambulance Mileage (per mile))

MEDIC TRANSPORTATION LLC (1083302566) bills $2,472.32/claim for A0425 (Ground mileage) vs avg $100.86 (+9.9σ). $187,896 across 76 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MEDIC TRANSPORTATION LLCAURORAProvider total: $195.6K

criticalCost OutlierScore: 9.9

Cost-per-claim above average for 97155

ACTUALIZE BEHAVIOR ALTERNATIVES (1902251705) bills $2,633.36/claim for 97155 (Adapt behavior tx phys/qhp) vs avg $183.65 (+9.9σ). $2,064,558 across 784 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ACTUALIZE BEHAVIOR ALTERNATIVESLITTLETONProvider total: $6.4M

criticalCost OutlierScore: 9.8

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC (1447630504) bills $141.86/claim for 90471 (Immunization admin) vs avg $14.69 (+9.9σ). $14,612 across 103 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHWEST COLORADO MENTAL HEALTH CENTER, INCCORTEZProvider total: $3.3M

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 0064A

DENVER INDIAN HEALTH AND FAMILY SERVICES INC. (1073561270) bills $195.91/claim for 0064A vs avg $31.96 (+9.5σ). $18,416 across 94 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

DENVER INDIAN HEALTH AND FAMILY SERVICES INC.DENVERProvider total: $1.7M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 90460 (Immunization Administration (First Component))

METRO COMMUNITY PROVIDER NETWORK INC (1396510947) bills $253.39/claim for 90460 (Im admin 1st/only component) vs avg $32.82 (+9.3σ). $32,687 across 129 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

METRO COMMUNITY PROVIDER NETWORK INCAURORAProvider total: $58.6K

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 99406

MARILLAC CLINIC, INC. (1518239219) bills $120.80/claim for 99406 (Behav chng smoking 3-10 min) vs avg $9.45 (+9.1σ). $1,191,832 across 9,866 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARILLAC CLINIC, INC.GRAND JUNCTIONProvider total: $38.3M

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 90670

VAXCARE COLORADO LLC (1164800082) bills $189.63/claim for 90670 (Pcv13 vaccine im) vs avg $7.11 (+9.0σ). $15,549 across 82 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

VAXCARE COLORADO LLCCOLORADO SPRINGSProvider total: $1.3M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

SOUTHERN UTE INDIAN TRIBE (1407883309) bills $490.20/claim for 99213 (Office o/p est low 20 min) vs avg $62.56 (+8.9σ). $1,663,261 across 3,393 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHERN UTE INDIAN TRIBEIGNACIOProvider total: $3.1M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for T1017

AHOD SERVICES LLC (1912461179) bills $1,315.74/claim for T1017 (Targeted case management) vs avg $99.16 (+8.9σ). $482,876 across 367 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

AHOD SERVICES LLCCOLORADO SPRINGSProvider total: $482.9K

criticalCost OutlierScore: 8.8

Cost-per-claim above average for D0150 (Comprehensive Oral Evaluation (New or Established Patient))

MARK BAKER (1811242340) bills $131.66/claim for D0150 (Comprehensive oral evaluation) vs avg $38.68 (+8.8σ). $51,085 across 388 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARK BAKERDENVERProvider total: $144.1K

criticalCost OutlierScore: 8.7

Cost-per-claim above average for Q9967

GRAND RIVER HOSPITAL DISTRICT (1649218991) bills $78.96/claim for Q9967 (Locm 300-399mg/ml iodine,1ml) vs avg $4.14 (+8.7σ). $31,899 across 404 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

GRAND RIVER HOSPITAL DISTRICTRIFLEProvider total: $3.6M

criticalCost OutlierScore: 8.6

Cost-per-claim above average for J3490

APEX PHYSICAL MEDICINE AND REHABILITATION PROFESSIONAL LLC (1326229287) bills $207.98/claim for J3490 (Drugs unclassified injection) vs avg $4.30 (+8.6σ). $114,389 across 550 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

APEX PHYSICAL MEDICINE AND REHABILITATION PROFESSIONAL LLCCOLORADO SPRINGSProvider total: $4.5M

criticalCost OutlierScore: 8.5

Cost-per-claim above average for 1160F

MARILLAC CLINIC, INC. (1518239219) bills $10.38/claim for 1160F vs avg $0.18 (+8.5σ). $76,552 across 7,376 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARILLAC CLINIC, INC.GRAND JUNCTIONProvider total: $38.3M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 90853 (Group Psychotherapy)

ARAPAHOE MENTAL HEALTH CENTER, INC (1568078517) bills $326.85/claim for 90853 (Group psychotherapy) vs avg $36.56 (+8.3σ). $23,206 across 71 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ARAPAHOE MENTAL HEALTH CENTER, INCLITTLETONProvider total: $202.7K

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 71046 (Chest X-ray (2 views, Frontal and Lateral))

ROCKY MOUNTAIN HEALTH CARE SERVICES (1992850689) bills $247.33/claim for 71046 (X-ray exam chest 2 views) vs avg $18.05 (+8.2σ). $143,700 across 581 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ROCKY MOUNTAIN HEALTH CARE SERVICESCOLORADO SPRINGSProvider total: $38.5M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 93000

ROCKY MOUNTAIN HEALTH CARE SERVICES (1992850689) bills $150.00/claim for 93000 (Electrocardiogram complete) vs avg $14.60 (+8.2σ). $36,000 across 240 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ROCKY MOUNTAIN HEALTH CARE SERVICESCOLORADO SPRINGSProvider total: $38.5M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 94010

LAKEWOOD VILLA OPERATIONS, LLC (1073957908) bills $439.51/claim for 94010 (Breathing capacity test) vs avg $30.59 (+8.1σ). $233,820 across 532 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

LAKEWOOD VILLA OPERATIONS, LLCLAKEWOODProvider total: $406.1K

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

METRO COMMUNITY PROVIDER NETWORK INC (1437799616) bills $117.44/claim for 90471 (Immunization admin) vs avg $14.69 (+8.0σ). $52,966 across 451 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

METRO COMMUNITY PROVIDER NETWORK INCAURORAProvider total: $1.4M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 82075

PURPLE MOUNTAIN RECOVERY INC (1932953445) bills $726.85/claim for 82075 (Assay of breath ethanol) vs avg $29.32 (+8.0σ). $194,070 across 267 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PURPLE MOUNTAIN RECOVERY INCCOLORADO SPRINGSProvider total: $194.1K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for 1159F

MARILLAC CLINIC, INC. (1093345886) bills $38.18/claim for 1159F vs avg $0.91 (+7.8σ). $13,516 across 354 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARILLAC CLINIC, INC.GRAND JUNCTIONProvider total: $222.0K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for 94760

LOIS LANE OPERATIONS, LLC (1912331604) bills $33.45/claim for 94760 (Measure blood oxygen level) vs avg $2.26 (+7.8σ). $10,905 across 326 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

LOIS LANE OPERATIONS, LLCCOLORADO SPRINGSProvider total: $261.1K

criticalCost OutlierScore: 7.7

Cost-per-claim above average for H2014

INFINITI HOME HEALTH CARE AGENCY, LLC (1316257363) bills $2,625.73/claim for H2014 (Skills train and dev, 15 min) vs avg $182.45 (+7.7σ). $73,520 across 28 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

INFINITI HOME HEALTH CARE AGENCY, LLCAURORAProvider total: $2.6M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 99215 (Office Visit, Established Patient (40 min, High Complexity))

CENTENNIAL MENTAL HEALTH CENTER, INC. (1558094458) bills $494.73/claim for 99215 (Office o/p est hi 40 min) vs avg $101.05 (+7.6σ). $453,665 across 917 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

CENTENNIAL MENTAL HEALTH CENTER, INC.FORT MORGANProvider total: $25.8M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 1036F

MARILLAC CLINIC, INC. (1093345886) bills $136.89/claim for 1036F vs avg $3.26 (+7.6σ). $18,207 across 133 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

MARILLAC CLINIC, INC.GRAND JUNCTIONProvider total: $222.0K

criticalCost OutlierScore: 7.4

Cost-per-claim above average for 90686 (Influenza Vaccine (Quadrivalent))

OLATHE COMMUNITY CLINIC INC. (1245600493) bills $127.52/claim for 90686 (Iiv4 vacc no prsv 0.5 ml im) vs avg $10.06 (+7.4σ). $16,578 across 130 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

OLATHE COMMUNITY CLINIC INC.MONTROSEProvider total: $6.6M

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 97153

THE GEM CENTER (1811474380) bills $4,711.51/claim for 97153 (Adaptive behavior tx by tech) vs avg $332.68 (+7.3σ). $664,323 across 141 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

THE GEM CENTERPARKERProvider total: $664.3K

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

PEAK VISTA COMMUNITY HEALTH CENTERS (1689977365) bills $108.09/claim for 90471 (Immunization admin) vs avg $14.69 (+7.2σ). $37,616 across 348 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PEAK VISTA COMMUNITY HEALTH CENTERSCOLORADO SPRINGSProvider total: $21.7M

criticalCost OutlierScore: 7.2

Cost-per-claim above average for H0032

PEER CONNECT LLC (1083371512) bills $344.54/claim for H0032 (Mh svc plan dev by non-md) vs avg $45.82 (+7.2σ). $21,017 across 61 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

PEER CONNECT LLCCOLORADO SPRINGSProvider total: $3.9M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for 99285 (Emergency Dept Visit (High Complexity))

ELIZABETH GOLDBERG (1164651592) bills $569.92/claim for 99285 (Emergency dept visit hi mdm) vs avg $118.72 (+7.1σ). $15,958 across 28 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ELIZABETH GOLDBERGAURORAProvider total: $21.9K

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 97153

ERICA OOSTHOEK (1033566179) bills $4,501.62/claim for 97153 (Adaptive behavior tx by tech) vs avg $332.68 (+7.0σ). $58,521 across 13 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ERICA OOSTHOEKCOLORADO SPRINGSProvider total: $72.7K

criticalCost OutlierScore: 6.8

Cost-per-claim above average for A0425 (Ground Ambulance Mileage (per mile))

ZION LIMOS LLC (1851003073) bills $1,718.82/claim for A0425 (Ground mileage) vs avg $100.86 (+6.8σ). $113,442 across 66 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ZION LIMOS LLCCOMMERCE CITYProvider total: $121.3K

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY (1821057860) bills $101.11/claim for 90471 (Immunization admin) vs avg $14.69 (+6.7σ). $162,073 across 1,603 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEYANTONITOProvider total: $2.8M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for H0032

AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER (1720685423) bills $322.17/claim for H0032 (Mh svc plan dev by non-md) vs avg $45.82 (+6.7σ). $15,142 across 47 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

AURORA COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTERAURORAProvider total: $2.7M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for D0350

ELITE DENTAL GROUP AURORA INC (1366002131) bills $339.49/claim for D0350 (Oral/facial photographic image) vs avg $52.42 (+6.7σ). $12,901 across 38 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

ELITE DENTAL GROUP AURORA INCAURORAProvider total: $46.8K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 99213 (Office Visit, Established Patient (20 min, Low Complexity))

SOUTHERN COLORADO UTE SERVICE UNIT (1255422788) bills $375.44/claim for 99213 (Office o/p est low 20 min) vs avg $62.56 (+6.5σ). $16,895 across 45 claims.

This provider charges significantly more (or less) per claim for a specific procedure code compared to peers in the same state. This can indicate upcoding, incorrect billing, or specialty services.

SOUTHERN COLORADO UTE SERVICE UNITTOWAOCProvider total: $710.0K

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