Statistical Outliers

Single-test outliers in Maryland 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

257

warning

553

info

5,654

Total

6,464

Outliers by Type

Severity Distribution

critical

257 (4.0%)

warning

553 (8.6%)

info

5,654 (87.5%)

5,058 results

criticalCost OutlierScore: 19.4

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

KLEIN AND ASSOCIATES MD PA (1962434449) bills $518.46/claim for 36415 (Coll venous bld venipuncture) vs avg $5.08 (+19.4σ). $20,220 across 39 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.

KLEIN AND ASSOCIATES MD PAHAGERSTOWNProvider total: $77.3K

criticalCost OutlierScore: 16.9

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

ERIC ENDRES (1861968430) bills $78.33/claim for D0220 (Intraoral - periapical first image) vs avg $8.88 (+16.9σ). $13,316 across 170 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.

ERIC ENDRESBURTONSVILLEProvider total: $27.8K

criticalCost OutlierScore: 12.4

Cost-per-claim above average for 85025 (Complete Blood Count (CBC) with Differential)

ARTHRITIS AND RHEUMATISM ASSOCIATES PC (1447259866) bills $136.01/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $4.03 (+12.4σ). $725,343 across 5,333 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.

ARTHRITIS AND RHEUMATISM ASSOCIATES PCROCKVILLEProvider total: $2.8M

criticalCost OutlierScore: 12.3

Cost-per-claim above average for 87635

1326447939 (1326447939) bills $471.65/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $36.10 (+12.3σ). $83,011 across 176 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $872.4K

criticalCost OutlierScore: 12.2

Cost-per-claim above average for H0005

CHASE BREXTON HEALTH SERVICES, INC. (1588606305) bills $274.19/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+12.2σ). $105,291 across 384 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.

CHASE BREXTON HEALTH SERVICES, INC.BALTIMOREProvider total: $87.2M

criticalCost OutlierScore: 12.2

Cost-per-claim above average for 90832 (Psychotherapy (30 min))

SILVER OAK ACADEMY, INC. (1467917195) bills $335.89/claim for 90832 (Psytx w pt 30 minutes) vs avg $54.13 (+12.2σ). $11,756 across 35 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.

SILVER OAK ACADEMY, INC.KEYMARProvider total: $39.5K

criticalCost OutlierScore: 12.1

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

SILVER OAK ACADEMY, INC. (1467917195) bills $274.47/claim for 90853 (Group psychotherapy) vs avg $40.86 (+12.1σ). $15,096 across 55 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.

SILVER OAK ACADEMY, INC.KEYMARProvider total: $39.5K

criticalCost OutlierScore: 10.8

Cost-per-claim above average for 71045 (Chest X-ray (Single View))

1326447939 (1326447939) bills $181.67/claim for 71045 (X-ray exam chest 1 view) vs avg $6.31 (+10.8σ). $16,169 across 89 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.

GUAM HEALTHCARE DEVELOPMENT INCORPORATEDDEDEDOProvider total: $872.4K

criticalCost OutlierScore: 10.0

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

DIMENSIONS HEALTH CORPORATION (1891706271) bills $108.91/claim for 87804 (Influenza assay w/optic) vs avg $11.08 (+10.0σ). $22,545 across 207 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.

DIMENSIONS HEALTH CORPORATIONLAURELProvider total: $2.5M

criticalCost OutlierScore: 9.8

Cost-per-claim above average for 97150 (Group Therapeutic Procedure)

SD CARTER ENTERPRISE, LLC (1750761011) bills $2,578.36/claim for 97150 (Group therapeutic procedures) vs avg $35.52 (+9.8σ). $812,185 across 315 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.

SD CARTER ENTERPRISE, LLCLAURELProvider total: $10.8M

criticalCost OutlierScore: 9.8

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

THE JOHNS HOPKINS HOSPITAL (1578597993) bills $336.50/claim for 99213 (Office o/p est low 20 min) vs avg $62.52 (+9.8σ). $21,200 across 63 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 JOHNS HOPKINS HOSPITALBALTIMOREProvider total: $19.9M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 96372

GREATER BALTIMORE MEDICAL CENTER, INC. (1396774238) bills $407.34/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.31 (+9.7σ). $127,497 across 313 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.

GREATER BALTIMORE MEDICAL CENTER, INC.BALTIMOREProvider total: $9.4M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for V2784

BRUCE LAZEROW (1306996269) bills $53.23/claim for V2784 (Lens polycarb or equal) vs avg $5.40 (+9.4σ). $34,066 across 640 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.

BRUCE LAZEROWPOTOMACProvider total: $743.7K

criticalCost OutlierScore: 9.1

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

RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLC (1801829932) bills $247.22/claim for 36415 (Coll venous bld venipuncture) vs avg $5.08 (+9.1σ). $10,631 across 43 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.

RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLCBALTIMOREProvider total: $339.5K

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 90651 (HPV Vaccine (9-Valent))

UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PA (1528163912) bills $98.66/claim for 90651 (9vhpv vaccine 2/3 dose im) vs avg $21.52 (+8.7σ). $10,063 across 102 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.

UNIVERSITY OF MARYLAND PEDIATRIC ASSOCIATES, PABALTIMOREProvider total: $25.7M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 90834 (Psychotherapy (45 min))

LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC (1598740821) bills $336.24/claim for 90834 (Psytx w pt 45 minutes) vs avg $89.41 (+8.7σ). $94,484 across 281 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.

LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INCBALTIMOREProvider total: $147.9K

criticalCost OutlierScore: 8.7

Cost-per-claim above average for D8670

JIM LEE (1003259631) bills $468.66/claim for D8670 (Periodic orthodontic treatment visit) vs avg $78.47 (+8.7σ). $15,934 across 34 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.

JIM LEEFREDERICKProvider total: $15.9K

criticalCost OutlierScore: 8.5

Cost-per-claim above average for A4657

MEDI-RENTS & SALES, INC. (1861480048) bills $30.07/claim for A4657 (Syringe w/wo needle) vs avg $0.86 (+8.5σ). $802,428 across 26,683 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.

MEDI-RENTS & SALES, INC.BALTIMOREProvider total: $85.8M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 3078F

LUMINIS HEALTH MEDICAL GROUP, LLC (1942834551) bills $14.71/claim for 3078F vs avg $0.48 (+8.5σ). $10,722 across 729 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.

LUMINIS HEALTH MEDICAL GROUP, LLCLANHAMProvider total: $776.9K

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 96372

TIDALHEALTH SPECIALTY CARE, LLC (1619504735) bills $341.57/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.31 (+8.1σ). $253,790 across 743 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.

TIDALHEALTH SPECIALTY CARE, LLCSALISBURYProvider total: $11.7M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

PARK WEST HEALTH SYSTEMS INCORPORATED (1205896719) bills $256.15/claim for 99212 (Office o/p est sf 10 min) vs avg $42.16 (+8.0σ). $1,540,771 across 6,015 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.

PARK WEST HEALTH SYSTEMS INCORPORATEDBALTIMOREProvider total: $12.8M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for H0005

HEALTH CARE FOR THE HOMELESS, INC (1003819665) bills $196.66/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+8.0σ). $1,101,102 across 5,599 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.

HEALTH CARE FOR THE HOMELESS, INCBALTIMOREProvider total: $26.8M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 81001 (Urinalysis with Microscopy)

ARTHRITIS AND RHEUMATISM ASSOCIATES PC (1447259866) bills $79.46/claim for 81001 (Urinalysis auto w/scope) vs avg $3.49 (+8.0σ). $13,667 across 172 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.

ARTHRITIS AND RHEUMATISM ASSOCIATES PCROCKVILLEProvider total: $2.8M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 99211 (Office Visit, Established Patient (May not require physician)

PARK WEST HEALTH SYSTEMS INCORPORATED (1205896719) bills $210.22/claim for 99211 (Off/op est may x req phy/qhp) vs avg $22.68 (+7.9σ). $28,380 across 135 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.

PARK WEST HEALTH SYSTEMS INCORPORATEDBALTIMOREProvider total: $12.8M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 36416 (Capillary Blood Collection (Finger/Heel Stick))

IMPACT DIAGNOSTIC LAB & HEALTH SERVICES (1821728031) bills $32.79/claim for 36416 (Collj capillary blood spec) vs avg $1.10 (+7.9σ). $29,580 across 902 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.

IMPACT DIAGNOSTIC LAB & HEALTH SERVICESLANHAMProvider total: $55.0K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for G8427

RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLC (1801829932) bills $91.08/claim for G8427 (Docrev cur meds by elig clin) vs avg $5.13 (+7.9σ). $19,400 across 213 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.

RHEUMATOLOGY ASSOCIATES OF BALTIMORE LLCBALTIMOREProvider total: $339.5K

criticalCost OutlierScore: 7.8

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

ST. AGNES HEALTHCARE, INC. (1245274901) bills $280.15/claim for 99213 (Office o/p est low 20 min) vs avg $62.52 (+7.8σ). $10,926 across 39 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.

ST. AGNES HEALTHCARE, INC.BALTIMOREProvider total: $5.4M

criticalCost OutlierScore: 7.7

Cost-per-claim above average for 99000

YEHEYIS T. NEGUSSIE MD PC (1932310851) bills $8.99/claim for 99000 (Specimen handling office-lab) vs avg $0.40 (+7.7σ). $13,100 across 1,457 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.

YEHEYIS T. NEGUSSIE MD PCSILVER SPRINGProvider total: $710.8K

criticalCost OutlierScore: 7.6

Cost-per-claim above average for H0005

TOTAL HEALTH CARE INC (1972597425) bills $189.52/claim for H0005 (Alcohol and/or drug services; group counseling by a clinician) vs avg $48.68 (+7.6σ). $1,798,771 across 9,491 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.

TOTAL HEALTH CARE INCBALTIMOREProvider total: $67.5M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

CHASE BREXTON HEALTH SERVICES, INC. (1588606305) bills $245.39/claim for 99212 (Office o/p est sf 10 min) vs avg $42.16 (+7.6σ). $1,296,171 across 5,282 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.

CHASE BREXTON HEALTH SERVICES, INC.BALTIMOREProvider total: $87.2M

criticalCost OutlierScore: 7.5

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

SINAI HOSPITAL OF BALTIMORE INC (1255359782) bills $62.16/claim for 90471 (Immunization admin) vs avg $7.69 (+7.5σ). $10,443 across 168 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.

SINAI HOSPITAL OF BALTIMORE INCBALTIMOREProvider total: $6.4M

criticalCost OutlierScore: 7.5

Cost-per-claim above average for 87651 (Strep A DNA/RNA Test (Molecular/PCR))

DIMENSIONS HEALTH CORPORATION (1720099286) bills $223.26/claim for 87651 (Strep a dna amp probe) vs avg $24.83 (+7.5σ). $36,168 across 162 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.

DIMENSIONS HEALTH CORPORATIONUPPER MARLBOROProvider total: $29.6M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for 97140 (Manual Therapy (per 15 min))

DANIEL SEUBERT (1417323833) bills $81.32/claim for 97140 (Manual therapy 1/> regions) vs avg $14.10 (+7.4σ). $473,770 across 5,826 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.

DANIEL SEUBERTBALTIMOREProvider total: $908.8K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for A4657

JOHNS HOPKINS HOME CARE GROUP, INC (1457772535) bills $25.99/claim for A4657 (Syringe w/wo needle) vs avg $0.86 (+7.3σ). $25,338 across 975 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.

JOHNS HOPKINS HOME CARE GROUP, INCBALTIMOREProvider total: $43.0M

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 99490

MCS, PC (1538717723) bills $209.02/claim for 99490 (Chrnc care mgmt staff 1st 20) vs avg $8.93 (+7.2σ). $1,757,625 across 8,409 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.

MCS, PCSILVER SPRINGProvider total: $14.5M

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 80061 (Lipid Panel (Cholesterol, HDL, LDL, Triglycerides))

NIKKI GARREN (1265888036) bills $65.94/claim for 80061 (Lipid panel) vs avg $6.77 (+7.2σ). $11,012 across 167 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.

NIKKI GARRENLAURELProvider total: $37.8K

criticalCost OutlierScore: 7.1

Cost-per-claim above average for 96372

ARTHRITIS AND RHEUMATISM ASSOCIATES PC (1447259866) bills $304.14/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.31 (+7.1σ). $511,570 across 1,682 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.

ARTHRITIS AND RHEUMATISM ASSOCIATES PCROCKVILLEProvider total: $2.8M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for A0427 (ALS Emergency Ambulance Transport)

WASHINGTON HOSPITAL CENTER CORPORATION (1588621833) bills $439.88/claim for A0427 (Als1-emergency) vs avg $85.39 (+7.1σ). $270,967 across 616 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.

WASHINGTON HOSPITAL CENTER CORPORATIONLANHAMProvider total: $2.5M

criticalCost OutlierScore: 6.9

Cost-per-claim above average for J3010

WHITE SQUARE VASCULAR SURGERY PA (1285666008) bills $157.94/claim for J3010 (Fentanyl citrate injection) vs avg $3.85 (+6.9σ). $114,822 across 727 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.

WHITE SQUARE VASCULAR SURGERY PABALTIMOREProvider total: $786.9K

criticalCost OutlierScore: 6.8

Cost-per-claim above average for 87804 (Rapid Influenza Test (Optical/Immunoassay))

DIMENSIONS HEALTH CORPORATION (1720099286) bills $77.45/claim for 87804 (Influenza assay w/optic) vs avg $11.08 (+6.8σ). $87,515 across 1,130 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.

DIMENSIONS HEALTH CORPORATIONUPPER MARLBOROProvider total: $29.6M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for 82947 (Blood Glucose Test)

SINAI HOSPITAL OF BALTIMORE, INC. (1285672204) bills $122.05/claim for 82947 (Assay glucose blood quant) vs avg $4.89 (+6.7σ). $11,351 across 93 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.

SINAI HOSPITAL OF BALTIMORE, INC.BALTIMOREProvider total: $10.2M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for G8428

USACS INTEGRATED ACUTE CARE SERVICES OF MARYLAND, LLC (1922598929) bills $18.54/claim for G8428 (Cur meds not document) vs avg $0.56 (+6.7σ). $18,739 across 1,011 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.

USACS INTEGRATED ACUTE CARE SERVICES OF MARYLAND, LLCELKTONProvider total: $7.7M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 93010

CHRISTIANA CARE EMERGENCY PHYSICIANS LLC (1871375899) bills $36.66/claim for 93010 (Electrocardiogram report) vs avg $5.62 (+6.6σ). $12,683 across 346 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.

CHRISTIANA CARE EMERGENCY PHYSICIANS LLCELKTONProvider total: $188.3K

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 99212 (Office Visit, Established Patient (10 min, Straightforward))

MOBILE MEDICAL CARE, INC. (1184006447) bills $218.78/claim for 99212 (Office o/p est sf 10 min) vs avg $42.16 (+6.6σ). $12,689 across 58 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.

MOBILE MEDICAL CARE, INC.SILVER SPRINGProvider total: $754.6K

criticalCost OutlierScore: 6.6

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

OZARK CENTRAL AMBULANCE DISTRICT (1336209030) bills $368.53/claim for A0425 (Ground mileage) vs avg $53.76 (+6.6σ). $136,357 across 370 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.

OZARK CENTRAL AMBULANCE DISTRICTBELLEProvider total: $139.5K

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 88305

CHESAPEAKE UROLOGY ASSOCIATES, LLC (1700153921) bills $428.87/claim for 88305 (Tissue exam by pathologist) vs avg $56.79 (+6.6σ). $15,439 across 36 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.

CHESAPEAKE UROLOGY ASSOCIATES, LLCSILVER SPRINGProvider total: $1.1M

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 96160

SANGJIN OH MD PA (1730745159) bills $22.00/claim for 96160 (Pt-focused hlth risk assmt) vs avg $2.79 (+6.5σ). $10,209 across 464 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.

SANGJIN OH MD PAGLEN BURNIEProvider total: $574.3K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 94010

JOHNS HOPKINS BAYVIEW MEDICAL CENTER INC (1790700904) bills $203.52/claim for 94010 (Breathing capacity test) vs avg $27.16 (+6.4σ). $107,664 across 529 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.

JOHNS HOPKINS BAYVIEW MEDICAL CENTER INCBALTIMOREProvider total: $9.2M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 99490

MINDOULA HEALTH INC. (1558843813) bills $185.04/claim for 99490 (Chrnc care mgmt staff 1st 20) vs avg $8.93 (+6.4σ). $3,171,685 across 17,141 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.

MINDOULA HEALTH INC.SILVER SPRINGProvider total: $29.0M

criticalCost OutlierScore: 6.4

Cost-per-claim above average for J2250

WHITE SQUARE VASCULAR SURGERY PA (1285666008) bills $219.91/claim for J2250 (Inj midazolam hydrochloride) vs avg $6.85 (+6.4σ). $153,278 across 697 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.

WHITE SQUARE VASCULAR SURGERY PABALTIMOREProvider total: $786.9K

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