Statistical Outliers

Single-test outliers in New Jersey 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

650

warning

1,202

info

8,424

Total

10,276

Outliers by Type

Severity Distribution

critical

650 (6.3%)

warning

1,202 (11.7%)

info

8,424 (82.0%)

6,789 results

criticalCost OutlierScore: 38.0

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

OAK & MAIN SURGICENTER LLC (1902863723) bills $1,569.23/claim for D0120 (Periodic oral evaluation) vs avg $24.03 (+38.0σ). $20,400 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.

OAK & MAIN SURGICENTER LLCVINELANDProvider total: $5.2M

criticalCost OutlierScore: 27.2

Cost-per-claim above average for D0272 (Dental X-rays (Bitewings, 2 Films))

OAK & MAIN SURGICENTER LLC (1902863723) bills $1,558.33/claim for D0272 (Bitewings - two radiographic images) vs avg $11.66 (+27.2σ). $18,700 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.

OAK & MAIN SURGICENTER LLCVINELANDProvider total: $5.2M

criticalCost OutlierScore: 25.9

Cost-per-claim above average for D1120 (Child Dental Prophylaxis (Teeth Cleaning))

CHILDREN'S DENTAL SURGERY CENTER OF JACKSON LLC (1710552278) bills $614.53/claim for D1120 (Prophylaxis - child) vs avg $29.20 (+25.9σ). $249,500 across 406 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 DENTAL SURGERY CENTER OF JACKSON LLCJACKSONProvider total: $4.4M

criticalCost OutlierScore: 19.2

Cost-per-claim above average for D7140 (Tooth Extraction (Erupted Tooth, Simple))

OAK & MAIN SURGICENTER LLC (1902863723) bills $1,428.00/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $47.24 (+19.2σ). $35,700 across 25 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.

OAK & MAIN SURGICENTER LLCVINELANDProvider total: $5.2M

criticalCost OutlierScore: 16.8

Cost-per-claim above average for 99072

LILIYA BESEDINA (1326102609) bills $15.28/claim for 99072 (Addl supl matrl&staf tm phe) vs avg $0.12 (+16.8σ). $11,035 across 722 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.

LILIYA BESEDINABAYONNEProvider total: $718.3K

criticalCost OutlierScore: 16.4

Cost-per-claim below average for 99361

DEPARTMENT OF HEALTH AND SENIOR SERVICES (1326168840) bills $1,010.33/claim for 99361 (Code 99361) vs avg $1,785.66 (-16.4σ). $86,735,025 across 85,848 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.

DEPARTMENT OF HEALTH AND SENIOR SERVICESTRENTONProvider total: $1.1B

criticalCost OutlierScore: 13.1

Cost-per-claim above average for 82962

RENEX DIALYSIS CLINIC OF ORANGE, INC. (1588768352) bills $82.76/claim for 82962 (Glucose blood test) vs avg $2.02 (+13.1σ). $33,601 across 406 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.

RENEX DIALYSIS CLINIC OF ORANGE, INC.ORANGEProvider total: $5.4M

criticalCost OutlierScore: 12.0

Cost-per-claim above average for H2021

MORNING STAR SUPPORTIVE SERVICES CORPORATION (1679236764) bills $9,445.22/claim for H2021 (Com wrap-around sv, 15 min) vs avg $493.96 (+12.0σ). $2,106,285 across 223 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.

MORNING STAR SUPPORTIVE SERVICES CORPORATIONSOUTH PLAINFIELDProvider total: $5.8M

criticalCost OutlierScore: 10.8

Cost-per-claim above average for D9920

ANDREW MRAMOR (1932254877) bills $283.69/claim for D9920 (Behavior management by report) vs avg $24.75 (+10.8σ). $33,192 across 117 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.

ANDREW MRAMORVOORHEESProvider total: $33.2K

criticalCost OutlierScore: 10.8

Cost-per-claim above average for 96372

JERSEY CITY MEDICAL CENTER (1497825665) bills $117.94/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $9.06 (+10.8σ). $10,968 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.

JERSEY CITY MEDICAL CENTERJERSEY CITYProvider total: $422.6K

criticalCost OutlierScore: 10.7

Cost-per-claim above average for 97802

PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC LLC (1770901761) bills $622.35/claim for 97802 (Medical nutrition indiv in) vs avg $29.98 (+10.7σ). $16,803 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.

PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC LLCPASSAICProvider total: $56.2M

criticalCost OutlierScore: 10.7

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

SAINT PETER'S UNIVERSITY HOSPITAL (1114924834) bills $356.71/claim for 90853 (Group psychotherapy) vs avg $30.59 (+10.7σ). $9,447,144 across 26,484 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.

SAINT PETER'S UNIVERSITY HOSPITALNEW BRUNSWICKProvider total: $185.5M

criticalCost OutlierScore: 10.7

Cost-per-claim above average for A0090

GRACIOUS SERVICES INC. (1255703112) bills $852.30/claim for A0090 (Interest escort in non er) vs avg $33.17 (+10.7σ). $45,172 across 53 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.

GRACIOUS SERVICES INC.WESTFIELDProvider total: $3.2M

criticalCost OutlierScore: 10.6

Cost-per-claim above average for 97535

CD COMMUNITY-BASED OT SERVICES, LLC (1275250573) bills $482.84/claim for 97535 (Self care mngment training) vs avg $18.69 (+10.6σ). $55,527 across 115 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.

CD COMMUNITY-BASED OT SERVICES, LLCBELMARProvider total: $188.4K

criticalCost OutlierScore: 10.6

Cost-per-claim above average for T1019

TRINITY CARE XYZ (1386182152) bills $592.01/claim for T1019 (Personal care ser per 15 min) vs avg $102.80 (+10.6σ). $373,560 across 631 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.

TRINITY CARE XYZEDISONProvider total: $373.6K

criticalCost OutlierScore: 10.2

Cost-per-claim above average for D2930

CHILDREN'S DENTAL SURGERY CENTER OF JACKSON LLC (1710552278) bills $1,235.35/claim for D2930 (Prefabricated stainless steel crown primary) vs avg $115.23 (+10.2σ). $520,081 across 421 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 DENTAL SURGERY CENTER OF JACKSON LLCJACKSONProvider total: $4.4M

criticalCost OutlierScore: 9.9

Cost-per-claim above average for J3490

MEDILINK RXCARE HAMMONTON, LLC (1801495544) bills $482.14/claim for J3490 (Drugs unclassified injection) vs avg $8.47 (+9.9σ). $44,839 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.

MEDILINK RXCARE HAMMONTON, LLCHAMMONTONProvider total: $17.9M

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 99232 (Subsequent Hospital Care (Moderate Complexity))

ARNOLD S BACARRO MD PA (1265554760) bills $219.23/claim for 99232 (Sbsq hosp ip/obs moderate 35) vs avg $23.94 (+9.5σ). $19,073 across 87 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.

ARNOLD S BACARRO MD PAMAYS LANDINGProvider total: $82.9K

criticalCost OutlierScore: 9.4

Cost-per-claim above average for 96160

UNIVERSITY HOSPITAL (1215998323) bills $14.95/claim for 96160 (Pt-focused hlth risk assmt) vs avg $1.36 (+9.4σ). $239,623 across 16,029 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 HOSPITALNEWARKProvider total: $362.9M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 90837 (Psychotherapy (60 min))

PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATION (1689714255) bills $584.41/claim for 90837 (Psytx w pt 60 minutes) vs avg $47.33 (+9.3σ). $30,389 across 52 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.

PRINCETON HEALTHCARE SYSTEM, A NEW JERSEY NON-PROFIT CORPORATIONPLAINSBOROProvider total: $33.5M

criticalCost OutlierScore: 9.2

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

OPTIONS, INC. (1609036847) bills $416.29/claim for 90834 (Psytx w pt 45 minutes) vs avg $76.39 (+9.2σ). $29,973 across 72 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.

OPTIONS, INC.PATERSONProvider total: $199.3K

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 84100

ISD TRENTON LLC (1578015798) bills $234.15/claim for 84100 (Assay of phosphorus) vs avg $9.38 (+9.1σ). $41,210 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.

ISD TRENTON LLCLAWRENCEVILLEProvider total: $1.8M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for J1885

TRINITAS REGIONAL MEDICAL CENTER (1770583999) bills $16.48/claim for J1885 (Ketorolac tromethamine inj) vs avg $1.40 (+9.1σ). $319,339 across 19,381 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.

TRINITAS REGIONAL MEDICAL CENTERELIZABETHProvider total: $142.2M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 97112

MERIDIAN HOSPITALS CORPORATION (1346247368) bills $133.14/claim for 97112 (Neuromuscular reeducation) vs avg $8.62 (+9.1σ). $43,537 across 327 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.

MERIDIAN HOSPITALS CORPORATIONNEPTUNEProvider total: $11.8M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 80053 (Comprehensive Metabolic Panel (14 tests))

WOODLAND PARK DIALYSIS CENTER LLC (1942517073) bills $128.96/claim for 80053 (Comprehen metabolic panel) vs avg $8.33 (+9.1σ). $16,894 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.

WOODLAND PARK DIALYSIS CENTER LLCWOODLAND PARKProvider total: $1.3M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for 82565 (Creatinine Blood Test (Kidney Function))

ISD TRENTON LLC (1578015798) bills $212.32/claim for 82565 (Assay of creatinine) vs avg $8.89 (+9.1σ). $25,903 across 122 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.

ISD TRENTON LLCLAWRENCEVILLEProvider total: $1.8M

criticalCost OutlierScore: 9.0

Cost-per-claim above average for 90656

COOPER FAMILY MEDICINE, PC (1649217175) bills $90.68/claim for 90656 (Iiv3 vacc no prsv 0.5 ml im) vs avg $8.65 (+9.0σ). $90,951 across 1,003 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.

COOPER FAMILY MEDICINE, PCCHERRY HILLProvider total: $25.3M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for 94760

NEWARK BETH ISRAEL MEDICAL CENTER INC (1215027966) bills $97.29/claim for 94760 (Measure blood oxygen level) vs avg $3.12 (+8.8σ). $1,546,781 across 15,898 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.

NEWARK BETH ISRAEL MEDICAL CENTER INCNEWARKProvider total: $380.2M

criticalCost OutlierScore: 8.8

Cost-per-claim above average for S5102

MY HOME ADULT DAY CARE CENTER (1053597096) bills $252.28/claim for S5102 (Adult day care per diem) vs avg $80.38 (+8.8σ). $42,710,113 across 169,294 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.

MY HOME ADULT DAY CARE CENTERMAYWOODProvider total: $42.7M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 90656

COOPER CARE ALLIANCE, PC (1215551437) bills $88.13/claim for 90656 (Iiv3 vacc no prsv 0.5 ml im) vs avg $8.65 (+8.7σ). $22,651 across 257 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.

COOPER CARE ALLIANCE, PCCAMDENProvider total: $5.8M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 95117

HMH HOSPITALS CORPORATION (1457456279) bills $94.23/claim for 95117 (Immunotherapy injections) vs avg $8.71 (+8.7σ). $881,171 across 9,351 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.

HMH HOSPITALS CORPORATIONHACKENSACKProvider total: $333.0M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 90716

PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, LLC (1629348503) bills $135.66/claim for 90716 (Var vaccine live subq) vs avg $13.29 (+8.6σ). $31,338 across 231 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.

PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, LLCMONTVILLEProvider total: $540.6K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for 92015

RAJVI PATEL (1346850971) bills $103.54/claim for 92015 (Determine refractive state) vs avg $6.48 (+8.6σ). $152,625 across 1,474 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.

RAJVI PATELEAST BRUNSWICKProvider total: $343.5K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for J1200

MERIDIAN HOSPITALS CORPORATION (1346247368) bills $68.80/claim for J1200 (Diphenhydramine hcl injectio) vs avg $2.97 (+8.6σ). $16,236 across 236 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.

MERIDIAN HOSPITALS CORPORATIONNEPTUNEProvider total: $11.8M

criticalCost OutlierScore: 8.6

Cost-per-claim above average for 81002 (Urinalysis without Microscopy)

ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, INC (1346243375) bills $9.24/claim for 81002 (Urinalysis nonauto w/o scope) vs avg $0.89 (+8.6σ). $56,671 across 6,136 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 WOOD JOHNSON UNIVERSITY HOSPITAL, INCNEW BRUNSWICKProvider total: $198.3M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for A4657

RENAL CENTERS OF NORTH JERSEY, LLC (1215908926) bills $236.90/claim for A4657 (Syringe w/wo needle) vs avg $12.11 (+8.5σ). $13,740 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.

RENAL CENTERS OF NORTH JERSEY, LLCLINCOLN PARKProvider total: $391.0K

criticalCost OutlierScore: 8.4

Cost-per-claim above average for T2021

ALLEGRO SCHOOL, INC. (1932589140) bills $8,453.90/claim for T2021 (Day habil waiver per 15 min) vs avg $517.41 (+8.4σ). $6,543,319 across 774 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.

ALLEGRO SCHOOL, INC.MORRIS PLAINSProvider total: $28.5M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for J0887

BIO-MEDICAL APPLICATIONS OF NEW JERSEY, INC. (1821193608) bills $168.50/claim for J0887 (Epoetin beta esrd use) vs avg $5.94 (+8.4σ). $12,469 across 74 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.

BIO-MEDICAL APPLICATIONS OF NEW JERSEY, INC.JERSEY CITYProvider total: $1.4M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for D1330

NELFA CESPEDES (1336120559) bills $18.54/claim for D1330 (Oral hygiene instructions) vs avg $0.47 (+8.4σ). $11,937 across 644 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.

NELFA CESPEDESPASSAICProvider total: $498.0K

criticalCost OutlierScore: 8.3

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

ISD TRENTON LLC (1578015798) bills $141.27/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $6.45 (+8.3σ). $13,421 across 95 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.

ISD TRENTON LLCLAWRENCEVILLEProvider total: $1.8M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 83540

RENAL CENTERS OF NORTH JERSEY, LLC (1215908926) bills $259.26/claim for 83540 (Assay of iron) vs avg $14.23 (+8.3σ). $12,444 across 48 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.

RENAL CENTERS OF NORTH JERSEY, LLCLINCOLN PARKProvider total: $391.0K

criticalCost OutlierScore: 8.2

Cost-per-claim above average for H0019 (Behavioral Health Residential Treatment (Long-Term))

NATIONAL MENTOR HEALTHCARE, LLC (1376921296) bills $10,031.37/claim for H0019 (Behavioral health; long-term residential (non-medical, non-acute care in a) vs avg $616.62 (+8.2σ). $170,533 across 17 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.

NATIONAL MENTOR HEALTHCARE, LLCSOMERSETProvider total: $170.5K

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 85018

RCG SOUTHERN NEW JERSEY, LLC (1487758264) bills $168.68/claim for 85018 (Hemoglobin) vs avg $7.07 (+8.2σ). $30,868 across 183 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.

RCG SOUTHERN NEW JERSEY, LLCATLANTIC CITYProvider total: $636.5K

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 86592

TRINITAS REGIONAL MEDICAL CENTER (1669472882) bills $51.69/claim for 86592 (Syphilis test non-trep qual) vs avg $2.79 (+8.1σ). $16,954 across 328 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.

TRINITAS REGIONAL MEDICAL CENTERELIZABETHProvider total: $14.3M

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 93970

ST. LUKE'S WARREN HOSPITAL, INC. (1760488266) bills $875.48/claim for 93970 (Extremity study) vs avg $80.01 (+8.1σ). $10,506 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.

ST. LUKE'S WARREN HOSPITAL, INC.PHILLIPSBURGProvider total: $38.5M

criticalCost OutlierScore: 8.1

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

ATLANTICARE REGIONAL MEDICAL CENTER (1013919315) bills $275.99/claim for 90853 (Group psychotherapy) vs avg $30.59 (+8.1σ). $183,535 across 665 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.

ATLANTICARE REGIONAL MEDICAL CENTERPOMONAProvider total: $214.9M

criticalCost OutlierScore: 8.1

Cost-per-claim above average for H2016

ALLEGRO SCHOOL, INC. (1932589140) bills $17,250.25/claim for H2016 (Comp comm supp svc, per diem) vs avg $1,066.76 (+8.1σ). $21,838,811 across 1,266 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.

ALLEGRO SCHOOL, INC.MORRIS PLAINSProvider total: $28.5M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 97530 (Therapeutic Activities (per 15 min))

HBA MANAGEMENT, INC. (1689614927) bills $193.59/claim for 97530 (Therapeutic activities) vs avg $11.76 (+8.0σ). $10,239,304 across 52,891 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.

HBA MANAGEMENT, INC.MARLTONProvider total: $30.4M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 88313

GABRIEL LEVI (1205834140) bills $226.58/claim for 88313 (Special stains group 2) vs avg $21.79 (+8.0σ). $217,294 across 959 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.

GABRIEL LEVIBERKELEY HEIGHTSProvider total: $673.0K

criticalCost OutlierScore: 7.9

Cost-per-claim above average for 83550

RENAL CENTERS OF NORTH JERSEY, LLC (1215908926) bills $259.26/claim for 83550 (Iron binding test) vs avg $13.98 (+7.9σ). $12,444 across 48 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.

RENAL CENTERS OF NORTH JERSEY, LLCLINCOLN PARKProvider total: $391.0K

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