Statistical Outliers

Single-test outliers in Nevada 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

137

warning

328

info

4,236

Total

4,701

Outliers by Type

Severity Distribution

critical

137 (2.9%)

warning

328 (7.0%)

info

4,236 (90.1%)

3,615 results

criticalCost OutlierScore: 14.9

Cost-per-claim above average for 94760

OVER THE RAINBOW CARE LLC (1902333115) bills $56.09/claim for 94760 (Measure blood oxygen level) vs avg $1.60 (+14.9σ). $11,554 across 206 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.

OVER THE RAINBOW CARE LLCHENDERSONProvider total: $176.3K

criticalCost OutlierScore: 14.2

Cost-per-claim above average for Q5001

SOLACE CARE LLC (1841877826) bills $1,771.02/claim for Q5001 (Hospice or home hlth in home) vs avg $13.66 (+14.2σ). $106,261 across 60 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.

SOLACE CARE LLCLAS VEGASProvider total: $106.3K

criticalCost OutlierScore: 12.1

Cost-per-claim above average for 90792 (Psychiatric Diagnostic Evaluation with Medical Services)

STATE OF NEVADA - NNCAS PSYCH (1649400417) bills $1,008.74/claim for 90792 (Psych diag eval w/med srvcs) vs avg $82.28 (+12.1σ). $84,734 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.

STATE OF NEVADA - NNCAS PSYCHRENOProvider total: $1.2M

criticalCost OutlierScore: 11.6

Cost-per-claim above average for 85018

RICHARD COTTIERO (1295733988) bills $50.24/claim for 85018 (Hemoglobin) vs avg $1.76 (+11.5σ). $12,510 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.

RICHARD COTTIEROLAS VEGASProvider total: $297.1K

criticalCost OutlierScore: 11.0

Cost-per-claim above average for 90833

STATE OF NEVADA - NNCAS PSYCH (1649400417) bills $268.38/claim for 90833 (Psytx w pt w e/m 30 min) vs avg $35.20 (+11.0σ). $88,833 across 331 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 NEVADA - NNCAS PSYCHRENOProvider total: $1.2M

criticalCost OutlierScore: 10.9

Cost-per-claim above average for 90723

FRANCISCO PERAZA MD PC (1699962431) bills $7.57/claim for 90723 (Dtap-hep b-ipv vaccine im) vs avg $0.07 (+10.9σ). $12,571 across 1,660 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.

FRANCISCO PERAZA MD PCLAS VEGASProvider total: $7.8M

criticalCost OutlierScore: 10.4

Cost-per-claim above average for 96110

WILLIAM HOLM (1558556530) bills $65.55/claim for 96110 (Developmental screen w/score) vs avg $6.44 (+10.4σ). $71,386 across 1,089 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.

WILLIAM HOLMLAS VEGASProvider total: $243.1K

criticalCost OutlierScore: 10.3

Cost-per-claim above average for D2392 (Dental Filling, Composite/Resin (Two Surfaces, Posterior))

AARON OSGA (1275897332) bills $235.16/claim for D2392 (Resin composite - two surfaces posterior) vs avg $44.57 (+10.3σ). $36,450 across 155 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.

AARON OSGALAS VEGASProvider total: $144.1K

criticalCost OutlierScore: 10.2

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

MARK LEWIS (1205863941) bills $127.72/claim for D0150 (Comprehensive oral evaluation) vs avg $25.75 (+10.2σ). $74,845 across 586 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 LEWISLAS VEGASProvider total: $192.4K

criticalCost OutlierScore: 9.6

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

AARON OSGA (1275897332) bills $167.88/claim for D2391 (Resin composite - one surface posterior) vs avg $34.56 (+9.6σ). $21,321 across 127 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.

AARON OSGALAS VEGASProvider total: $144.1K

criticalCost OutlierScore: 9.5

Cost-per-claim above average for 99214 (Office Visit, Established Patient (30 min, Moderate Complexi)

STATE OF NEVADA (1740370006) bills $347.58/claim for 99214 (Office o/p est mod 30 min) vs avg $65.49 (+9.5σ). $115,745 across 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.

STATE OF NEVADALAUGHLINProvider total: $176.0K

criticalCost OutlierScore: 8.4

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

CPD SOUTH MEADOWS LLC (1891441762) bills $145.55/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $35.98 (+8.4σ). $47,302 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.

CPD SOUTH MEADOWS LLCRENOProvider total: $846.5K

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 80305 (Drug Screening, Presumptive (Instrument-Based))

CHRISTOPHER CRUZ (1295792182) bills $73.71/claim for 80305 (Drug test prsmv dir opt obs) vs avg $5.89 (+8.4σ). $44,153 across 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.

CHRISTOPHER CRUZLAS VEGASProvider total: $526.3K

criticalCost OutlierScore: 8.4

Cost-per-claim above average for D9230

SHONNA CURRY (1114907250) bills $67.73/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $14.79 (+8.4σ). $59,060 across 872 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.

SHONNA CURRYNORTH LAS VEGASProvider total: $1.4M

criticalCost OutlierScore: 7.8

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

SECOND CHANCE RESOURCES LLC (1437683232) bills $968.96/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $128.86 (+7.8σ). $17,441 across 18 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.

SECOND CHANCE RESOURCES LLCNORTH LAS VEGASProvider total: $40.5K

criticalCost OutlierScore: 7.7

Cost-per-claim above average for 70450 (CT Head without Contrast)

HUMBOLDT GENERAL HOSPITAL (1750498010) bills $267.22/claim for 70450 (Ct head/brain w/o dye) vs avg $51.30 (+7.7σ). $321,727 across 1,204 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.

HUMBOLDT GENERAL HOSPITALWINNEMUCCAProvider total: $4.4M

criticalCost OutlierScore: 7.5

Cost-per-claim above average for D0230 (Dental X-ray (Periapical, Each Additional))

STARS DENTAL (1275714875) bills $25.27/claim for D0230 (Intraoral - periapical each addl image) vs avg $5.76 (+7.5σ). $72,152 across 2,855 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.

STARS DENTALLAS VEGASProvider total: $360.1K

criticalCost OutlierScore: 7.5

Cost-per-claim above average for G0300

FAMILY HEALTH CARE SERVICES, INC (1346228350) bills $95.96/claim for G0300 (Hhs/hospice of lpn ea 15 min) vs avg $2.32 (+7.5σ). $380,099 across 3,961 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.

FAMILY HEALTH CARE SERVICES, INCLAS VEGASProvider total: $4.4M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for G0151

CHERISH HEALTHCARE (1760879894) bills $118.75/claim for G0151 (Hhcp-serv of pt,ea 15 min) vs avg $3.78 (+7.4σ). $14,250 across 120 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.

CHERISH HEALTHCARELAS VEGASProvider total: $328.0K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for H2014

DARYL CHRISTOPHER (1497350664) bills $1,658.97/claim for H2014 (Skills train and dev, 15 min) vs avg $92.96 (+7.3σ). $374,926 across 226 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.

DARYL CHRISTOPHERLAS VEGASProvider total: $1.7M

criticalCost OutlierScore: 7.3

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

DARYL CHRISTOPHER (1497350664) bills $914.74/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $128.86 (+7.3σ). $208,560 across 228 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.

DARYL CHRISTOPHERLAS VEGASProvider total: $1.7M

criticalCost OutlierScore: 7.3

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

CARSON TAHOE REGIONAL HEALTHCARE (1730739129) bills $70.64/claim for 71046 (X-ray exam chest 2 views) vs avg $12.30 (+7.3σ). $41,609 across 589 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.

CARSON TAHOE REGIONAL HEALTHCARECARSON CITYProvider total: $791.3K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for Q3014

STATE OF NEVADA (1740370006) bills $84.40/claim for Q3014 (Telehealth facility fee) vs avg $17.55 (+7.3σ). $43,552 across 516 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 NEVADALAUGHLINProvider total: $176.0K

criticalCost OutlierScore: 7.0

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

GENTLE TOUCH BEHAVIORAL HEALTH LLC (1346764081) bills $886.13/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $128.86 (+7.1σ). $4,946,379 across 5,582 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.

GENTLE TOUCH BEHAVIORAL HEALTH LLCNORTH LAS VEGASProvider total: $16.4M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for H0047

MEDTRANS (1871915892) bills $630.40/claim for H0047 (Alcohol/drug abuse svc nos) vs avg $71.86 (+6.7σ). $1,700,195 across 2,697 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.

MEDTRANSLAS VEGASProvider total: $20.5M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for S9480

HAND UP HOMES FOR YOUTH (1679639132) bills $1,109.77/claim for S9480 (Intensive outpatient psychia) vs avg $159.74 (+6.6σ). $737,997 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.

HAND UP HOMES FOR YOUTHRENOProvider total: $738.0K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for G0152

DESERT VIEW HOME HEALTH INC (1902090699) bills $100.25/claim for G0152 (Hhcp-serv of ot,ea 15 min) vs avg $3.25 (+6.5σ). $61,050 across 609 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.

DESERT VIEW HOME HEALTH INCLAS VEGASProvider total: $674.3K

criticalCost OutlierScore: 6.5

Cost-per-claim above average for 43239

SOUTHERN HILLS MEDICAL CENTER, LLC (1457306359) bills $822.75/claim for 43239 (Egd biopsy single/multiple) vs avg $132.79 (+6.5σ). $71,579 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.

SOUTHERN HILLS MEDICAL CENTER, LLCLAS VEGASProvider total: $19.8M

criticalCost OutlierScore: 6.5

Cost-per-claim above average for T1016 (Case Management (per 15 min))

ASSURANCE PROFESSIONAL MANAGEMENT SERVICES INC. (1932767944) bills $1,224.82/claim for T1016 (Case management) vs avg $97.38 (+6.5σ). $90,637 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.

ASSURANCE PROFESSIONAL MANAGEMENT SERVICES INC.LAS VEGASProvider total: $6.9M

criticalCost OutlierScore: 6.4

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

COUNTY OF NIAGARA (1841340569) bills $105.17/claim for 99212 (Office o/p est sf 10 min) vs avg $26.84 (+6.4σ). $13,146 across 125 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 NIAGARANIAGARA FALLSProvider total: $929.4K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for G0299

PERSPECTIVE HOME HEALTH INC (1932107281) bills $174.63/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $7.35 (+6.3σ). $1,034,307 across 5,923 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.

PERSPECTIVE HOME HEALTH INCLAS VEGASProvider total: $1.0M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for 90847 (Family Psychotherapy with Patient (50 min))

STATE OF NEVADA - SNCAS OUTPATIENT (1568539914) bills $253.79/claim for 90847 (Family psytx w/pt 50 min) vs avg $81.70 (+6.2σ). $1,493,304 across 5,884 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 NEVADA - SNCAS OUTPATIENTLAS VEGASProvider total: $1.6M

criticalCost OutlierScore: 6.2

Cost-per-claim above average for G0300

DESERT VIEW HOME HEALTH INC (1902090699) bills $79.82/claim for G0300 (Hhs/hospice of lpn ea 15 min) vs avg $2.32 (+6.2σ). $68,250 across 855 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.

DESERT VIEW HOME HEALTH INCLAS VEGASProvider total: $674.3K

criticalCost OutlierScore: 6.2

Cost-per-claim above average for H0034

LMS FRESHSTART LLC (1093249484) bills $1,222.56/claim for H0034 (Med trng & support per 15min) vs avg $129.68 (+6.2σ). $24,451 across 20 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.

LMS FRESHSTART LLCLAS VEGASProvider total: $28.7K

criticalCost OutlierScore: 6.2

Cost-per-claim above average for D0230 (Dental X-ray (Periapical, Each Additional))

TRI STATE DENTAL (1578153276) bills $21.81/claim for D0230 (Intraoral - periapical each addl image) vs avg $5.76 (+6.2σ). $43,891 across 2,012 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.

TRI STATE DENTALLAS VEGASProvider total: $209.5K

criticalCost OutlierScore: 6.1

Cost-per-claim above average for H0034

TOMIKO BARNES (1124386792) bills $1,208.86/claim for H0034 (Med trng & support per 15min) vs avg $129.68 (+6.1σ). $16,924 across 14 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.

TOMIKO BARNESLAS VEGASProvider total: $289.4K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 90671

CHING'S PEDIATRICS, PLLC. (1972079937) bills $112.53/claim for 90671 (Pcv15 vaccine im) vs avg $5.94 (+5.9σ). $64,816 across 576 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.

CHING'S PEDIATRICS, PLLC.LAS VEGASProvider total: $1.7M

criticalCost OutlierScore: 5.9

Cost-per-claim above average for J1756

DHAN KAUSHAL (1730186354) bills $138.93/claim for J1756 (Iron sucrose injection) vs avg $6.84 (+5.9σ). $10,976 across 79 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.

DHAN KAUSHALLAS VEGASProvider total: $82.0K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for S9480

HELPING OTHERS LLC (1922642867) bills $1,009.70/claim for S9480 (Intensive outpatient psychia) vs avg $159.74 (+5.9σ). $1,858,856 across 1,841 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.

HELPING OTHERS LLCRENOProvider total: $1.9M

criticalCost OutlierScore: 5.9

Cost-per-claim above average for D9222

FREDDIE MARTINEZ (1780968461) bills $305.44/claim for D9222 (Deep sedation/general anesthesia first 15 min) vs avg $51.11 (+5.9σ). $24,129 across 79 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.

FREDDIE MARTINEZLAS VEGASProvider total: $2.8M

criticalCost OutlierScore: 5.9

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

GENTLE TOUCH BEHAVIORAL HEALTH LLC (1346764081) bills $577.02/claim for H2017 (Psysoc rehab svc, per 15 min) vs avg $93.13 (+5.9σ). $2,208,246 across 3,827 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.

GENTLE TOUCH BEHAVIORAL HEALTH LLCNORTH LAS VEGASProvider total: $16.4M

criticalCost OutlierScore: 5.9

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

SPRING VALLEY MEDICAL CENTER (1669408928) bills $173.34/claim for 90853 (Group psychotherapy) vs avg $22.56 (+5.9σ). $336,794 across 1,943 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.

SPRING VALLEY MEDICAL CENTERLAS VEGASProvider total: $616.0K

criticalCost OutlierScore: 5.8

Cost-per-claim above average for 99283 (Emergency Dept Visit (Moderate Complexity))

PERSHING GENERAL HOSPITAL (1669490603) bills $136.96/claim for 99283 (Emergency dept visit low mdm) vs avg $53.01 (+5.8σ). $295,838 across 2,160 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.

PERSHING GENERAL HOSPITALLOVELOCKProvider total: $954.6K

criticalCost OutlierScore: 5.8

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

STATE OF NEVADA (1013099944) bills $248.46/claim for 90837 (Psytx w pt 60 minutes) vs avg $82.13 (+5.8σ). $32,797 across 132 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 NEVADAFERNLEYProvider total: $547.6K

criticalCost OutlierScore: 5.7

Cost-per-claim above average for D7210 (Tooth Extraction (Surgical, Erupted))

JEFFREY PEARSON (1013272624) bills $178.92/claim for D7210 (Extraction - surgical, erupted tooth) vs avg $52.45 (+5.7σ). $298,804 across 1,670 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.

JEFFREY PEARSONLAS VEGASProvider total: $796.0K

criticalCost OutlierScore: 5.6

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

MARK LEWIS (1205863941) bills $64.30/claim for D0120 (Periodic oral evaluation) vs avg $20.08 (+5.6σ). $18,839 across 293 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 LEWISLAS VEGASProvider total: $192.4K

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 99442 (Telephone E&M (11-20 min))

COUNTY OF NIAGARA (1841340569) bills $81.05/claim for 99442 (Code 99442) vs avg $8.95 (+5.6σ). $12,968 across 160 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 NIAGARANIAGARA FALLSProvider total: $929.4K

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 80305 (Drug Screening, Presumptive (Instrument-Based))

JOSE PARTIDA CORONA (1477518801) bills $51.32/claim for 80305 (Drug test prsmv dir opt obs) vs avg $5.89 (+5.6σ). $19,501 across 380 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.

JOSE PARTIDA CORONALAS VEGASProvider total: $291.2K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 87070 (Bacterial Culture (Aerobic))

SUNRISE MOUNTAIN VIEW HOSPITAL, INC. (1407405145) bills $30.01/claim for 87070 (Culture othr specimn aerobic) vs avg $4.02 (+5.5σ). $15,756 across 525 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.

SUNRISE MOUNTAIN VIEW HOSPITAL, INC.NORTH LAS VEGASProvider total: $769.7K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for S9480

IMPACT WELLNESS CENTER,INC (1902319411) bills $945.33/claim for S9480 (Intensive outpatient psychia) vs avg $159.74 (+5.5σ). $995,438 across 1,053 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 WELLNESS CENTER,INCLAS VEGASProvider total: $1.0M

Page 1 of 73