Statistical Outliers

Single-test outliers in Idaho 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

60

warning

122

info

2,046

Total

2,228

Outliers by Type

Severity Distribution

critical

60 (2.7%)

warning

122 (5.5%)

info

2,046 (91.8%)

1,782 results

criticalCost OutlierScore: 13.3

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

JAMES SKOUSEN (1073894523) bills $87.95/claim for D0220 (Intraoral - periapical first image) vs avg $1.47 (+13.3σ). $10,466 across 119 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.

JAMES SKOUSENTWIN FALLSProvider total: $13.8K

criticalCost OutlierScore: 9.8

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

ADAM BUNKER (1215193792) bills $97.96/claim for D0120 (Periodic oral evaluation) vs avg $3.18 (+9.8σ). $29,291 across 299 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.

ADAM BUNKERBOISEProvider total: $42.1K

criticalCost OutlierScore: 9.2

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

TRENT PRYOR (1780813691) bills $92.53/claim for D0120 (Periodic oral evaluation) vs avg $3.18 (+9.2σ). $358,165 across 3,871 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.

TRENT PRYORTWIN FALLSProvider total: $744.4K

criticalCost OutlierScore: 9.2

Cost-per-claim above average for H2017 (Psychosocial Rehabilitation (per 15 min))

BLAINE COUNTY SCHOOL DISTRICT (1205980950) bills $836.32/claim for H2017 (Psysoc rehab svc, per 15 min) vs avg $112.04 (+9.2σ). $47,670 across 57 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.

BLAINE COUNTY SCHOOL DISTRICTHAILEYProvider total: $215.1K

criticalCost OutlierScore: 8.9

Cost-per-claim above average for D0274 (Dental X-rays (Bitewings, 4 Films))

COURTNEY JACKSON (1972864825) bills $127.66/claim for D0274 (Bitewings - four radiographic images) vs avg $4.76 (+8.9σ). $20,297 across 159 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.

COURTNEY JACKSONREXBURGProvider total: $128.2K

criticalCost OutlierScore: 8.5

Cost-per-claim above average for D0274 (Dental X-rays (Bitewings, 4 Films))

CLUBHOUSE PEDIATRIC DENTISTRY OF MADISON (1306321351) bills $122.36/claim for D0274 (Bitewings - four radiographic images) vs avg $4.76 (+8.5σ). $308,481 across 2,521 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.

CLUBHOUSE PEDIATRIC DENTISTRY OF MADISONREXBURGProvider total: $1.9M

criticalCost OutlierScore: 8.1

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

NIGHT BOAT PLLC (1013188804) bills $59.41/claim for D1206 (Topical fluoride varnish) vs avg $1.97 (+8.1σ). $21,684 across 365 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.

NIGHT BOAT PLLCREXBURGProvider total: $234.7K

criticalCost OutlierScore: 8.0

Cost-per-claim above average for D9230

TRENT PRYOR (1780813691) bills $130.03/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $4.04 (+8.0σ). $42,261 across 325 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.

TRENT PRYORTWIN FALLSProvider total: $744.4K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for T1014

LIFEPATH SERVICES LLC (1477920270) bills $81.59/claim for T1014 (Telehealth transmit, per min) vs avg $18.08 (+7.3σ). $23,580 across 289 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.

LIFEPATH SERVICES LLCBOISEProvider total: $2.1M

criticalCost OutlierScore: 6.8

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

DAVID WILSON (1124231261) bills $114.14/claim for D0140 (Limited oral evaluation - problem focused) vs avg $19.35 (+6.8σ). $21,459 across 188 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.

DAVID WILSONIDAHO FALLSProvider total: $35.5K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for D1206 (Topical Fluoride Varnish Application)

SHANNON DRYER (1629482070) bills $47.38/claim for D1206 (Topical fluoride varnish) vs avg $1.97 (+6.4σ). $18,384 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.

SHANNON DRYERCOEUR D ALENEProvider total: $145.1K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for H0031

SUNSHINE THERAPY LLC (1164988267) bills $484.88/claim for H0031 (Mh health assess by non-md) vs avg $84.97 (+6.3σ). $28,608 across 59 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.

SUNSHINE THERAPY LLCTWIN FALLSProvider total: $5.7M

criticalCost OutlierScore: 6.2

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

FRONT LINE EMS LLC (1255802047) bills $955.41/claim for A0425 (Ground mileage) vs avg $88.44 (+6.2σ). $371,654 across 389 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.

FRONT LINE EMS LLCBOISEProvider total: $456.8K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for H0004 (Behavioral Health Counseling and Therapy (per 15 min))

ROLLING HILLS CHARTER SCHOOL (1558558379) bills $777.88/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $135.37 (+6.0σ). $206,916 across 266 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.

ROLLING HILLS CHARTER SCHOOLBOISEProvider total: $1.5M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for T1019

RES-CARE WASHINGTON, INC. (1437546199) bills $1,003.95/claim for T1019 (Personal care ser per 15 min) vs avg $115.40 (+6.0σ). $12,047 across 12 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.

RES-CARE WASHINGTON, INC.BOISEProvider total: $12.0K

criticalCost OutlierScore: 5.8

Cost-per-claim above average for S5130

STONEBRIDGE ASSISTED LIVING LLC (1326702549) bills $150.97/claim for S5130 (Homaker service nos per 15m) vs avg $27.76 (+5.8σ). $16,003 across 106 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.

STONEBRIDGE ASSISTED LIVING LLCGLENNS FERRYProvider total: $499.5K

criticalCost OutlierScore: 5.7

Cost-per-claim above average for 92507 (Speech-Language Therapy (Individual))

KIDSCARE HOME HEALTH OF IDAHO, LLC (1265902332) bills $165.39/claim for 92507 (Tx sp lang voice comm indiv) vs avg $43.93 (+5.7σ). $184,579 across 1,116 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.

KIDSCARE HOME HEALTH OF IDAHO, LLCBOISEProvider total: $284.8K

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 93010

NORTH CANYON MEDICAL CENTER INC. (1609046671) bills $28.91/claim for 93010 (Electrocardiogram report) vs avg $5.72 (+5.6σ). $11,303 across 391 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.

NORTH CANYON MEDICAL CENTER INC.GOODINGProvider total: $3.4M

criticalCost OutlierScore: 5.6

Cost-per-claim above average for D2930

IDAHO FALLS ASC (1174005235) bills $467.53/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $87.82 (+5.6σ). $138,388 across 296 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.

IDAHO FALLS ASCIDAHO FALLSProvider total: $386.4K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 97162 (Physical Therapy Evaluation (Moderate Complexity))

CURTIS MASON (1699833061) bills $273.06/claim for 97162 (Pt eval mod complex 30 min) vs avg $62.58 (+5.4σ). $10,376 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.

CURTIS MASONBURLEYProvider total: $24.5K

criticalCost OutlierScore: 5.3

Cost-per-claim above average for D1351 (Dental Sealant (per Tooth))

SEAN MCGUIRE (1245736610) bills $63.30/claim for D1351 (Sealant per tooth) vs avg $6.23 (+5.3σ). $62,098 across 981 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.

SEAN MCGUIREPOST FALLSProvider total: $2.2M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 99284 (Emergency Dept Visit (Moderate/High Complexity))

CARIBOU MEMORIAL HOSPITAL (1912998261) bills $452.56/claim for 99284 (Emergency dept visit mod mdm) vs avg $100.48 (+5.3σ). $248,001 across 548 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.

CARIBOU MEMORIAL HOSPITALSODA SPRINGSProvider total: $468.4K

criticalCost OutlierScore: 5.2

Cost-per-claim below average for 92340

ISAAC BELL (1396995239) bills $14.94/claim for 92340 (Fit spectacles monofocal) vs avg $22.94 (-5.1σ). $32,067 across 2,146 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.

ISAAC BELLLEWISTONProvider total: $185.5K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for D1208

MICHAEL PYSNAK (1922467992) bills $18.59/claim for D1208 (Topical fluoride excluding varnish) vs avg $0.81 (+5.1σ). $42,572 across 2,290 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.

MICHAEL PYSNAKNAMPAProvider total: $330.0K

criticalCost OutlierScore: 5.1

Cost-per-claim above average for H0032

SYRINGA FAMILY PARTNERSHIP, LLC (1962658500) bills $470.81/claim for H0032 (Mh svc plan dev by non-md) vs avg $78.76 (+5.1σ). $40,489 across 86 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.

SYRINGA FAMILY PARTNERSHIP, LLCCOEUR D ALENEProvider total: $10.4M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for G9002

TERRI JONES (1104033687) bills $147.57/claim for G9002 (Mccd,maintenance rate) vs avg $40.90 (+4.9σ). $433,276 across 2,936 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.

TERRI JONESPOCATELLOProvider total: $443.9K

criticalCost OutlierScore: 4.9

Cost-per-claim above average for D1999

COMMUNITY HEALTH ASSOCIATION OF SPOKANE (1497205652) bills $20.92/claim for D1999 (Unspecified preventive proc) vs avg $1.03 (+4.9σ). $16,168 across 773 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.

COMMUNITY HEALTH ASSOCIATION OF SPOKANEMOSCOWProvider total: $7.4M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 90633

VALLEY FAMILY HEALTH CARE INC (1407886484) bills $20.19/claim for 90633 (Hepa vacc ped/adol 2 dose im) vs avg $0.98 (+4.8σ). $20,531 across 1,017 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.

VALLEY FAMILY HEALTH CARE INCPAYETTEProvider total: $13.9M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for H0003

RAISE THE BOTTOM TRAINING & COUNSELING SERVICES, LLC (1962707166) bills $40.50/claim for H0003 (Alcohol and/or drug screenin) vs avg $14.71 (+4.8σ). $47,750 across 1,179 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.

RAISE THE BOTTOM TRAINING & COUNSELING SERVICES, LLCBOISEProvider total: $10.8M

criticalCost OutlierScore: 4.7

Cost-per-claim above average for 97110 (Therapeutic Exercise (per 15 min))

KIDSCARE HOME HEALTH OF IDAHO, LLC (1265902332) bills $123.22/claim for 97110 (Therapeutic exercises) vs avg $35.50 (+4.7σ). $50,151 across 407 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.

KIDSCARE HOME HEALTH OF IDAHO, LLCBOISEProvider total: $284.8K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for D2391 (Dental Filling, Composite/Resin (One Surface, Posterior))

SHANNON DRYER (1629482070) bills $161.49/claim for D2391 (Resin composite - one surface posterior) vs avg $33.66 (+4.7σ). $15,180 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.

SHANNON DRYERCOEUR D ALENEProvider total: $145.1K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for H2014

COUNTY OF MADISON SCHOOL DISTRICT 321 (1003960659) bills $400.72/claim for H2014 (Skills train and dev, 15 min) vs avg $70.20 (+4.7σ). $7,245,791 across 18,082 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.

COUNTY OF MADISON SCHOOL DISTRICT 321REXBURGProvider total: $17.1M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for D1208

CHILDRENS DENTISTRY OF FRUITLAND (1619634250) bills $16.74/claim for D1208 (Topical fluoride excluding varnish) vs avg $0.81 (+4.6σ). $34,879 across 2,083 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.

CHILDRENS DENTISTRY OF FRUITLANDFRUITLANDProvider total: $233.5K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90999

INLAND NW RENAL CARE GROUP - GRITMAN MEDICAL CENTER, LLC (1538306428) bills $196.26/claim for 90999 (Unlisted dialysis procedure) vs avg $30.69 (+4.6σ). $21,000 across 107 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.

INLAND NW RENAL CARE GROUP - GRITMAN MEDICAL CENTER, LLCMOSCOWProvider total: $21.0K

criticalCost OutlierScore: 4.5

Cost-per-claim below average for 98941

BENEWAH MEDICAL CENTER (1366637068) bills $11.58/claim for 98941 (Chiropract manj 3-4 regions) vs avg $30.60 (-4.5σ). $18,240 across 1,575 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.

BENEWAH MEDICAL CENTERPLUMMERProvider total: $25.5M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for S5125

9999999995 (9999999995) bills $1,210.81/claim for S5125 (Attendant care service /15m) vs avg $154.72 (+4.5σ). $2,597,187 across 2,145 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.

9999999995Provider total: $2.7M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for S5150

9999999995 (9999999995) bills $441.29/claim for S5150 (Unskilled respite care /15m) vs avg $94.01 (+4.5σ). $152,245 across 345 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.

9999999995Provider total: $2.7M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

EASTERN IDAHO PUBLIC HEALTH DISTRICT (1821205188) bills $250.12/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $37,768 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.

EASTERN IDAHO PUBLIC HEALTH DISTRICTIDAHO FALLSProvider total: $622.2K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

PUBLIC HEALTH DISTRICT 1 (1841212933) bills $250.12/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $633,554 across 2,533 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.

PUBLIC HEALTH DISTRICT 1HAYDENProvider total: $843.9K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

NORTH CENTRAL DISTRICT HEALTH DEPARTMENT (1225057813) bills $250.12/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $11,255 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.

NORTH CENTRAL DISTRICT HEALTH DEPARTMENTLEWISTONProvider total: $97.4K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

SOUTH CENTRAL PUBLIC HEALTH DISTRICT (1285794339) bills $249.63/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $379,932 across 1,522 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.

SOUTH CENTRAL PUBLIC HEALTH DISTRICTTWIN FALLSProvider total: $822.0K

criticalCost OutlierScore: 4.5

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

SHANNON DRYER (1629482070) bills $46.69/claim for D0120 (Periodic oral evaluation) vs avg $3.18 (+4.5σ). $13,959 across 299 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.

SHANNON DRYERCOEUR D ALENEProvider total: $145.1K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

SOUTHWEST DISTRICT HEALTH (1598748337) bills $249.36/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $508,949 across 2,041 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 DISTRICT HEALTHCALDWELLProvider total: $810.2K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for T1017

PUBLIC HEALTH DISTRICT IV (1326009648) bills $249.20/claim for T1017 (Targeted case management) vs avg $61.59 (+4.5σ). $472,477 across 1,896 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.

PUBLIC HEALTH DISTRICT IVBOISEProvider total: $746.5K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for D0274 (Dental X-rays (Bitewings, 4 Films))

SMILES 4 KIDS BLACKFOOT PLLC (1154799047) bills $66.57/claim for D0274 (Bitewings - four radiographic images) vs avg $4.76 (+4.5σ). $71,764 across 1,078 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.

SMILES 4 KIDS BLACKFOOT PLLCBLACKFOOTProvider total: $562.4K

criticalCost OutlierScore: 4.4

Cost-per-claim above average for T1017

STATE OF IDAHO (1063576445) bills $246.99/claim for T1017 (Targeted case management) vs avg $61.59 (+4.4σ). $118,557 across 480 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.

STATE OF IDAHOPOCATELLOProvider total: $385.4K

criticalCost OutlierScore: 4.4

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

KOOTENAI HEALTH, INC. (1992798409) bills $63.12/claim for 90853 (Group psychotherapy) vs avg $17.40 (+4.4σ). $31,750 across 503 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.

KOOTENAI HEALTH, INC.COEUR D ALENEProvider total: $6.9M

criticalCost OutlierScore: 4.4

Cost-per-claim above average for T1001

AMBITIONS OF IDAHO, INC (1750012399) bills $114.92/claim for T1001 (Nursing assessment/evaluatn) vs avg $52.61 (+4.4σ). $71,133 across 619 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.

AMBITIONS OF IDAHO, INCNAMPAProvider total: $74.8K

criticalCost OutlierScore: 4.3

Cost-per-claim above average for 93306

GRITMAN MEDICAL CENTER INC (1619988144) bills $803.87/claim for 93306 (Tte w/doppler complete) vs avg $120.88 (+4.3σ). $21,704 across 27 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.

GRITMAN MEDICAL CENTER INCMOSCOWProvider total: $3.7M

criticalCost OutlierScore: 4.2

Cost-per-claim above average for 90680

VALLEY FAMILY HEALTH CARE INC (1407886484) bills $19.22/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $1.18 (+4.2σ). $26,690 across 1,389 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.

VALLEY FAMILY HEALTH CARE INCPAYETTEProvider total: $13.9M

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