Statistical Outliers

Single-test outliers in Washington 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

341

warning

559

info

5,437

Total

6,337

Outliers by Type

Severity Distribution

critical

341 (5.4%)

warning

559 (8.8%)

info

5,437 (85.8%)

4,119 results

criticalCost OutlierScore: 21.9

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

WILSON, ALLEN AND ASSOCIATES (1417237512) bills $292.11/claim for D1206 (Topical fluoride varnish) vs avg $15.79 (+21.9σ). $234,568 across 803 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.

WILSON, ALLEN AND ASSOCIATESSPOKANEProvider total: $1.3M

criticalCost OutlierScore: 19.1

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

VP SURGERY CENTER OF AUBURN LLC (1932530284) bills $161.41/claim for D0272 (Bitewings - two radiographic images) vs avg $9.11 (+19.1σ). $42,934 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.

VP SURGERY CENTER OF AUBURN LLCAUBURNProvider total: $567.0K

criticalCost OutlierScore: 18.7

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

WILSON, ALLEN AND ASSOCIATES (1417237512) bills $300.42/claim for D0120 (Periodic oral evaluation) vs avg $22.57 (+18.7σ). $563,588 across 1,876 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.

WILSON, ALLEN AND ASSOCIATESSPOKANEProvider total: $1.3M

criticalCost OutlierScore: 17.1

Cost-per-claim above average for D2393

MULTICARE HEALTH SYSTEM (1366556227) bills $1,691.79/claim for D2393 (Resin composite - three surfaces posterior) vs avg $82.25 (+17.1σ). $20,302 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.

MULTICARE HEALTH SYSTEMTACOMAProvider total: $162.2M

criticalCost OutlierScore: 16.7

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

MULTICARE HEALTH SYSTEM (1326564071) bills $1,819.24/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $56.64 (+16.7σ). $49,120 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.

MULTICARE HEALTH SYSTEMCOVINGTONProvider total: $23.2M

criticalCost OutlierScore: 16.7

Cost-per-claim above average for D9999

APEX ANESTHESIA SERVICES PC (1023467958) bills $846.07/claim for D9999 (Adjunctive procedure) vs avg $25.51 (+16.7σ). $597,326 across 706 claims.

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

APEX ANESTHESIA SERVICES PCSPOKANE VALLEYProvider total: $6.1M

criticalCost OutlierScore: 14.3

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

WILSON, ALLEN AND ASSOCIATES (1417237512) bills $300.22/claim for D0150 (Comprehensive oral evaluation) vs avg $32.36 (+14.3σ). $45,934 across 153 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.

WILSON, ALLEN AND ASSOCIATESSPOKANEProvider total: $1.3M

criticalCost OutlierScore: 14.1

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

CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 (1306845557) bills $100.12/claim for 96127 (Brief emotional/behav assmt) vs avg $4.01 (+14.1σ). $372,642 across 3,722 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.

CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2PORT ANGELESProvider total: $68.9M

criticalCost OutlierScore: 14.0

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

VPA PC (1699392787) bills $304.95/claim for 99212 (Office o/p est sf 10 min) vs avg $27.91 (+14.0σ). $278,112 across 912 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.

VPA PCRENTONProvider total: $2.1M

criticalCost OutlierScore: 13.1

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

SEATTLE CHILDREN'S HOSPITAL (1467536276) bills $500.16/claim for D2391 (Resin composite - one surface posterior) vs avg $48.81 (+13.1σ). $217,068 across 434 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.

SEATTLE CHILDREN'S HOSPITALSEATTLEProvider total: $219.5M

criticalCost OutlierScore: 12.8

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

MULTICARE HEALTH SYSTEM (1306952726) bills $491.99/claim for D2391 (Resin composite - one surface posterior) vs avg $48.81 (+12.8σ). $30,012 across 61 claims.

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

MULTICARE HEALTH SYSTEMTACOMAProvider total: $108.5M

criticalCost OutlierScore: 12.3

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

BICYCLE HEALTH MEDICAL GROUP PA (1194342162) bills $434.10/claim for 99211 (Off/op est may x req phy/qhp) vs avg $17.67 (+12.3σ). $282,601 across 651 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.

BICYCLE HEALTH MEDICAL GROUP PASEATTLEProvider total: $2.5M

criticalCost OutlierScore: 11.2

Cost-per-claim above average for 92015

THUNYA WALKER (1790097731) bills $46.30/claim for 92015 (Determine refractive state) vs avg $9.04 (+11.2σ). $15,973 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.

THUNYA WALKERKENMOREProvider total: $35.4K

criticalCost OutlierScore: 11.0

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

ADAMS COUNTY PUBLIC HOSPITAL DISTRICT 3 (1811108822) bills $159.33/claim for D1351 (Sealant per tooth) vs avg $20.64 (+11.0σ). $124,917 across 784 claims.

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

ADAMS COUNTY PUBLIC HOSPITAL DISTRICT 3OTHELLOProvider total: $15.8M

criticalCost OutlierScore: 10.6

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

LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1 (1073524690) bills $46.27/claim for 36415 (Coll venous bld venipuncture) vs avg $3.59 (+10.6σ). $39,237 across 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.

LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1ODESSAProvider total: $258.4K

criticalCost OutlierScore: 10.6

Cost-per-claim above average for G0008 (Influenza Virus Vaccine Administration)

RENAL TREATMENT CENTERS WEST INC (1831153980) bills $57.01/claim for G0008 (Admin influenza virus vac) vs avg $1.44 (+10.6σ). $10,945 across 192 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 TREATMENT CENTERS WEST INCYAKIMAProvider total: $6.1M

criticalCost OutlierScore: 10.6

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

GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 3 (1811979610) bills $179.76/claim for 80305 (Drug test prsmv dir opt obs) vs avg $11.16 (+10.5σ). $385,042 across 2,142 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.

GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 3EPHRATAProvider total: $8.8M

criticalCost OutlierScore: 10.1

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

REBECKA HAATS (1174044895) bills $221.01/claim for D0150 (Comprehensive oral evaluation) vs avg $32.36 (+10.1σ). $68,956 across 312 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.

REBECKA HAATSYAKIMAProvider total: $248.7K

criticalCost OutlierScore: 10.0

Cost-per-claim above average for H0046

NEW ERA MENTAL HEALTH PLLC (1073198602) bills $169.63/claim for H0046 (Mental health service, nos) vs avg $8.02 (+10.0σ). $12,213 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.

NEW ERA MENTAL HEALTH PLLCLYNNWOODProvider total: $1.7M

criticalCost OutlierScore: 9.8

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

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $205.27/claim for 97140 (Manual therapy 1/> regions) vs avg $22.75 (+9.8σ). $513,802 across 2,503 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.

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTONSNOQUALMIEProvider total: $9.2M

criticalCost OutlierScore: 9.7

Cost-per-claim above average for 90670

THE VANCOUVER CLINIC INC PS (1992759427) bills $113.35/claim for 90670 (Pcv13 vaccine im) vs avg $11.20 (+9.7σ). $336,546 across 2,969 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 VANCOUVER CLINIC INC PSVANCOUVERProvider total: $28.3M

criticalCost OutlierScore: 9.4

Cost-per-claim above average for 96110

WENATCHEE VALLEY HOSPITAL (1295071520) bills $565.90/claim for 96110 (Developmental screen w/score) vs avg $12.78 (+9.4σ). $353,685 across 625 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.

WENATCHEE VALLEY HOSPITALWENATCHEEProvider total: $22.8M

criticalCost OutlierScore: 9.3

Cost-per-claim above average for 96110

CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION (1306883228) bills $564.39/claim for 96110 (Developmental screen w/score) vs avg $12.78 (+9.3σ). $531,087 across 941 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.

CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATIONWENATCHEEProvider total: $63.4M

criticalCost OutlierScore: 9.1

Cost-per-claim above average for D9222

JESSICA BAUERLE (1043531494) bills $850.00/claim for D9222 (Deep sedation/general anesthesia first 15 min) vs avg $89.86 (+9.1σ). $11,900 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.

JESSICA BAUERLESPOKANEProvider total: $44.2K

criticalCost OutlierScore: 8.8

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

CITY OF ILWACO (1609501931) bills $484.12/claim for A0425 (Ground mileage) vs avg $51.49 (+8.8σ). $13,555 across 28 claims.

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

CITY OF ILWACOILWACOProvider total: $17.3K

criticalCost OutlierScore: 8.7

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

MULTICARE HEALTH SYSTEM (1306952726) bills $373.10/claim for D2392 (Resin composite - two surfaces posterior) vs avg $62.36 (+8.7σ). $38,430 across 103 claims.

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

MULTICARE HEALTH SYSTEMTACOMAProvider total: $108.5M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for G0299

OPTUM INFUSION SERVICES 501 INC (1841832466) bills $698.61/claim for G0299 (Hhs/hospice of rn ea 15 min) vs avg $27.88 (+8.4σ). $111,078 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.

OPTUM INFUSION SERVICES 501 INCWOODINVILLEProvider total: $3.3M

criticalCost OutlierScore: 8.4

Cost-per-claim above average for 99202 (Office Visit, New Patient (15 min, Straightforward))

VPA PC (1699392787) bills $241.91/claim for 99202 (Office o/p new sf 15 min) vs avg $43.47 (+8.4σ). $1,182,196 across 4,887 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.

VPA PCRENTONProvider total: $2.1M

criticalCost OutlierScore: 8.4

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

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $1,313.79/claim for 99284 (Emergency dept visit mod mdm) vs avg $128.56 (+8.4σ). $1,569,983 across 1,195 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 HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTONSNOQUALMIEProvider total: $9.2M

criticalCost OutlierScore: 8.2

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

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTON (1902846546) bills $374.50/claim for 71046 (X-ray exam chest 2 views) vs avg $25.66 (+8.2σ). $44,565 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.

PUBLIC HOSPITAL DISTRICT NO 4 KING COUNTY WASHINGTONSNOQUALMIEProvider total: $9.2M

criticalCost OutlierScore: 8.2

Cost-per-claim above average for 92551

PEACEHEALTH (1073510277) bills $98.89/claim for 92551 (Pure tone hearing test air) vs avg $7.28 (+8.2σ). $17,801 across 180 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.

PEACEHEALTHLONGVIEWProvider total: $48.3M

criticalCost OutlierScore: 7.9

Cost-per-claim above average for A7031

PEACEHEALTH (1720056187) bills $191.51/claim for A7031 (Replacement facemask interfa) vs avg $30.22 (+7.9σ). $27,003 across 141 claims.

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

PEACEHEALTHLONGVIEWProvider total: $12.4M

criticalCost OutlierScore: 7.9

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

THE VILLA HEALTH PLLC (1508566647) bills $345.07/claim for 90837 (Psytx w pt 60 minutes) vs avg $76.20 (+7.9σ). $87,648 across 254 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 VILLA HEALTH PLLCVANCOUVERProvider total: $215.9K

criticalCost OutlierScore: 7.8

Cost-per-claim above average for T1002

PEDIATRIC SERVICES OF AMERICA, LLC (1811925308) bills $5,620.83/claim for T1002 (Rn services up to 15 minutes) vs avg $159.49 (+7.8σ). $14,619,776 across 2,601 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.

PEDIATRIC SERVICES OF AMERICA, LLCVANCOUVERProvider total: $18.9M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for H2011

LAURIE JONES (1285719849) bills $1,120.94/claim for H2011 (Crisis interven svc, 15 min) vs avg $21.26 (+7.6σ). $353,097 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.

LAURIE JONESSELAHProvider total: $374.6K

criticalCost OutlierScore: 7.6

Cost-per-claim above average for A7038

PEACEHEALTH (1720056187) bills $28.24/claim for A7038 (Pos airway pressure filter) vs avg $6.40 (+7.6σ). $10,110 across 358 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.

PEACEHEALTHLONGVIEWProvider total: $12.4M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for Q5001

TRI-CITIES CHAPLAINCY (1407891088) bills $2,454.08/claim for Q5001 (Hospice or home hlth in home) vs avg $106.98 (+7.6σ). $265,041 across 108 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-CITIES CHAPLAINCYRICHLANDProvider total: $265.3K

criticalCost OutlierScore: 7.5

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

GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICT (1255429957) bills $102.22/claim for 85025 (Complete cbc w/auto diff wbc) vs avg $8.61 (+7.5σ). $229,494 across 2,245 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.

GARFIELD COUNTY MEMORIAL HOSPITAL DISTRICTPOMEROYProvider total: $1.1M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for 51798

TRI-STATE MEMORIAL HOSPITAL (1760485221) bills $67.29/claim for 51798 (Us urine capacity measure) vs avg $5.19 (+7.4σ). $42,053 across 625 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 MEMORIAL HOSPITALCLARKSTONProvider total: $14.5M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for D4341

SAIRA AHMED (1114571262) bills $229.40/claim for D4341 (Periodontal scaling/root planing per quad) vs avg $33.76 (+7.4σ). $26,840 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.

SAIRA AHMEDBELLINGHAMProvider total: $136.5K

criticalCost OutlierScore: 7.4

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

COLUMBIA COUNTY HOSPITAL DISTRICT (1134128911) bills $217.66/claim for 92507 (Tx sp lang voice comm indiv) vs avg $43.92 (+7.4σ). $72,915 across 335 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.

COLUMBIA COUNTY HOSPITAL DISTRICTDAYTONProvider total: $5.5M

criticalCost OutlierScore: 7.2

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

COMMUNITY INTEGRATED HEALTH SERVICES, LLC (1942840160) bills $191.15/claim for 99213 (Office o/p est low 20 min) vs avg $39.99 (+7.2σ). $585,116 across 3,061 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 INTEGRATED HEALTH SERVICES, LLCCENTRALIAProvider total: $4.8M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for 70498

PUBLIC HOSPITAL DISTRICT NO 1 OF MASON COUNTY (1760568752) bills $1,108.72/claim for 70498 (Ct angiography neck) vs avg $70.18 (+7.1σ). $55,436 across 50 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 HOSPITAL DISTRICT NO 1 OF MASON COUNTYSHELTONProvider total: $72.3M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for H2015

DUNGARVIN WASHINGTON CHILDREN'S SERVICES, LLC (1083917165) bills $304.59/claim for H2015 (Comp comm supp svc, 15 min) vs avg $19.31 (+7.1σ). $2,191,850 across 7,196 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.

DUNGARVIN WASHINGTON CHILDREN'S SERVICES, LLCSPOKANEProvider total: $21.3M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for 90670

COSTCO WHOLESALE CORPORATION (1629348636) bills $86.07/claim for 90670 (Pcv13 vaccine im) vs avg $11.20 (+7.1σ). $18,763 across 218 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.

COSTCO WHOLESALE CORPORATIONISSAQUAHProvider total: $18.8K

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99203 (Office Visit, New Patient (30 min, Low Complexity))

COLUMBIA WELLNESS (1487659579) bills $218.19/claim for 99203 (Office o/p new low 30 min) vs avg $59.64 (+7.0σ). $59,566 across 273 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.

COLUMBIA WELLNESSLONGVIEWProvider total: $32.3M

criticalCost OutlierScore: 7.0

Cost-per-claim above average for 99291 (Critical Care, First 30-74 min)

SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION (1225033814) bills $795.17/claim for 99291 (Critical care first hour) vs avg $98.44 (+7.0σ). $18,289 across 23 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.

SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATIONSUNNYSIDEProvider total: $55.1M

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 83655

PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY (1306897681) bills $51.20/claim for 83655 (Assay of lead) vs avg $11.75 (+6.9σ). $35,381 across 691 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.

PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTYPROSSERProvider total: $50.7M

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 99204 (Office Visit, New Patient (45 min, Moderate Complexity))

VPA PC (1093117574) bills $345.00/claim for 99204 (Office o/p new mod 45 min) vs avg $85.49 (+6.9σ). $17,940 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.

VPA PCRENTONProvider total: $258.2K

criticalCost OutlierScore: 6.9

Cost-per-claim above average for 99177

CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2 (1306845557) bills $222.04/claim for 99177 (Ocular instrumnt screen bil) vs avg $8.19 (+6.9σ). $11,324 across 51 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.

CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT 2PORT ANGELESProvider total: $68.9M

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