Statistical Outliers

Single-test outliers in West Virginia 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

135

warning

290

info

2,266

Total

2,691

Outliers by Type

Severity Distribution

critical

135 (5.0%)

warning

290 (10.8%)

info

2,266 (84.2%)

1,663 results

criticalCost OutlierScore: 15.4

Cost-per-claim above average for D1208

CHARLESTON AREA MEDICAL CENTER INC (1952390239) bills $764.81/claim for D1208 (Topical fluoride excluding varnish) vs avg $21.38 (+15.4σ). $52,007 across 68 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.

CHARLESTON AREA MEDICAL CENTER INCCHARLESTONProvider total: $199.8M

criticalCost OutlierScore: 9.2

Cost-per-claim above average for 96372

BECKLEY ONCOLOGY ASSOCIATES INC (1295747277) bills $204.01/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $18.09 (+9.2σ). $401,078 across 1,966 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.

BECKLEY ONCOLOGY ASSOCIATES INCBECKLEYProvider total: $5.0M

criticalCost OutlierScore: 8.7

Cost-per-claim above average for 99231 (Subsequent Hospital Care (Low Complexity))

PATEL & PATEL MD INC (1467535450) bills $407.18/claim for 99231 (Sbsq hosp ip/obs sf/low 25) vs avg $32.45 (+8.7σ). $14,251 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.

PATEL & PATEL MD INCSOUTH CHARLESTONProvider total: $4.0M

criticalCost OutlierScore: 7.7

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

POCAHONTAS MEMORIAL HOSPITAL (1609842251) bills $202.58/claim for 80305 (Drug test prsmv dir opt obs) vs avg $16.38 (+7.7σ). $25,323 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.

POCAHONTAS MEMORIAL HOSPITALBUCKEYEProvider total: $3.6M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 20610 (Joint Aspiration or Injection (Major Joint))

CHARLESTON HOSPITAL INC. (1891732889) bills $386.86/claim for 20610 (Drain/inj joint/bursa w/o us) vs avg $41.73 (+7.6σ). $15,861 across 41 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.

CHARLESTON HOSPITAL INC.CHARLESTONProvider total: $3.5M

criticalCost OutlierScore: 7.6

Cost-per-claim above average for 96374

RENAL CONSULTANTS, PLLC (1295720449) bills $1,229.85/claim for 96374 (Ther/proph/diag inj iv push) vs avg $69.07 (+7.6σ). $424,299 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.

RENAL CONSULTANTS, PLLCSOUTH CHARLESTONProvider total: $2.2M

criticalCost OutlierScore: 7.4

Cost-per-claim above average for T1002

OPEN DOORS FOR THE DEVELOPMENTALLY CHALLENGED, INC. (1508907338) bills $615.69/claim for T1002 (Rn services up to 15 minutes) vs avg $45.01 (+7.4σ). $972,176 across 1,579 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.

OPEN DOORS FOR THE DEVELOPMENTALLY CHALLENGED, INC.LEWISBURGProvider total: $25.2M

criticalCost OutlierScore: 6.7

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

WEST VIRGINIA HEALTH CARE COOPERATIVE INC (1043778319) bills $133.43/claim for 87804 (Influenza assay w/optic) vs avg $15.84 (+6.7σ). $111,416 across 835 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.

WEST VIRGINIA HEALTH CARE COOPERATIVE INCSUMMERSVILLEProvider total: $19.2M

criticalCost OutlierScore: 6.6

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

POTOMAC VALLEY HOSPITAL OF W VA, INC (1063649606) bills $172.40/claim for 99213 (Office o/p est low 20 min) vs avg $34.12 (+6.6σ). $29,653 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.

POTOMAC VALLEY HOSPITAL OF W VA, INCPIEDMONTProvider total: $575.8K

criticalCost OutlierScore: 6.4

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

CAITLIN CORBITT (1598055782) bills $233.03/claim for 99214 (Office o/p est mod 30 min) vs avg $47.64 (+6.4σ). $671,122 across 2,880 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.

CAITLIN CORBITTCLARKSBURGProvider total: $953.6K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for 90935

TOTAL RENAL CARE INC (1154722379) bills $933.98/claim for 90935 (Hemodialysis one evaluation) vs avg $76.61 (+6.2σ). $43,897 across 47 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 RENAL CARE INCSOUTH CHARLESTONProvider total: $1.2M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 92508 (Speech-Language Therapy (Group))

SUMMERS COUNTY BOARD OF EDUCATION (1841469145) bills $12.46/claim for 92508 (Tx sp lang voice comm group) vs avg $3.06 (+6.0σ). $14,819 across 1,189 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.

SUMMERS COUNTY BOARD OF EDUCATIONBECKLEYProvider total: $19.2K

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 93010

SOUND PHYSICIANS EMERGENCY MEDICINE OF WEST VIRGINIA PLLC (1396109567) bills $162.71/claim for 93010 (Electrocardiogram report) vs avg $13.35 (+6.0σ). $174,588 across 1,073 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.

SOUND PHYSICIANS EMERGENCY MEDICINE OF WEST VIRGINIA PLLCSOUTH CHARLESTONProvider total: $1.4M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 99215 (Office Visit, Established Patient (40 min, High Complexity))

CAITLIN CORBITT (1598055782) bills $328.28/claim for 99215 (Office o/p est hi 40 min) vs avg $69.81 (+6.0σ). $216,996 across 661 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.

CAITLIN CORBITTCLARKSBURGProvider total: $953.6K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 81003 (Urinalysis by Dipstick (Automated))

ALECTO HEALTHCARE SERVICES FAIRMONT LLC (1649688037) bills $83.31/claim for 81003 (Urinalysis auto w/o scope) vs avg $10.43 (+5.9σ). $51,983 across 624 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.

ALECTO HEALTHCARE SERVICES FAIRMONT LLCFAIRMONTProvider total: $11.7M

criticalCost OutlierScore: 5.8

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

TRI-STATE EMERGENCY PHYSICIANS LLP (1508313719) bills $480.31/claim for 99291 (Critical care first hour) vs avg $132.57 (+5.8σ). $14,890 across 31 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 EMERGENCY PHYSICIANS LLPWHEELINGProvider total: $5.3M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for D9310

ANISSA ANDERSON (1881792901) bills $1,114.31/claim for D9310 (Consultation diagnostic service by non-treating dentist) vs avg $81.13 (+5.7σ). $60,173 across 54 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.

ANISSA ANDERSONNEW MARTINSVILLEProvider total: $1.2M

criticalCost OutlierScore: 5.6

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

PRESTON MEMORIAL HOSPITAL CORPORATION (1013950054) bills $152.59/claim for 80305 (Drug test prsmv dir opt obs) vs avg $16.38 (+5.6σ). $66,989 across 439 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.

PRESTON MEMORIAL HOSPITAL CORPORATIONKINGWOODProvider total: $20.1M

criticalCost OutlierScore: 5.5

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

WEIRTON MEDICAL CENTER, INC (1619921947) bills $104.80/claim for 99212 (Office o/p est sf 10 min) vs avg $20.16 (+5.5σ). $30,496 across 291 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.

WEIRTON MEDICAL CENTER, INCWEIRTONProvider total: $27.7M

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 83036 (Hemoglobin A1c (Diabetes Monitoring))

ALECTO HEALTHCARE SERVICES FAIRMONT LLC (1649688037) bills $80.99/claim for 83036 (Hemoglobin glycosylated a1c) vs avg $13.41 (+5.5σ). $20,166 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.

ALECTO HEALTHCARE SERVICES FAIRMONT LLCFAIRMONTProvider total: $11.7M

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 76830

ST JOSEPHS HOSPITAL OF BUCKHANNON INC (1124005061) bills $351.80/claim for 76830 (Transvaginal us non-ob) vs avg $70.64 (+5.5σ). $306,421 across 871 claims.

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

ST JOSEPHS HOSPITAL OF BUCKHANNON INCBUCKHANNONProvider total: $41.9M

criticalCost OutlierScore: 5.5

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

NUSKOOL SCHOLARS (1417468745) bills $582.00/claim for T1016 (Case management) vs avg $100.96 (+5.5σ). $26,772 across 46 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.

NUSKOOL SCHOLARSBECKLEYProvider total: $26.8K

criticalCost OutlierScore: 5.5

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

STEVENSON, LLC (1265727291) bills $471.42/claim for 97530 (Therapeutic activities) vs avg $52.58 (+5.5σ). $32,528 across 69 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.

STEVENSON, LLCCHARLESTONProvider total: $42.4M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 71275

PRESTON MEMORIAL HOSPITAL CORPORATION (1013950054) bills $1,408.86/claim for 71275 (Ct angiography chest) vs avg $174.05 (+5.4σ). $39,448 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.

PRESTON MEMORIAL HOSPITAL CORPORATIONKINGWOODProvider total: $20.1M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for J1885

WETZEL COUNTY HOSPITAL ASSOCIATION (1750326880) bills $124.47/claim for J1885 (Ketorolac tromethamine inj) vs avg $15.27 (+5.4σ). $36,221 across 291 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.

WETZEL COUNTY HOSPITAL ASSOCIATIONNEW MARTINSVILLEProvider total: $3.0M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 81025

WETZEL COUNTY HOSPITAL ASSOCIATION (1750326880) bills $111.69/claim for 81025 (Urine pregnancy test) vs avg $16.35 (+5.3σ). $24,459 across 219 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.

WETZEL COUNTY HOSPITAL ASSOCIATIONNEW MARTINSVILLEProvider total: $3.0M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 93010

NICHOLAS EMERGENCY GROUP, PLLC (1124470778) bills $142.55/claim for 93010 (Electrocardiogram report) vs avg $13.35 (+5.2σ). $249,182 across 1,748 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.

NICHOLAS EMERGENCY GROUP, PLLCSUMMERSVILLEProvider total: $1.6M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 76816

ST JOSEPHS HOSPITAL OF BUCKHANNON INC (1124005061) bills $223.74/claim for 76816 (Ob us follow-up per fetus) vs avg $65.11 (+5.2σ). $161,766 across 723 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 JOSEPHS HOSPITAL OF BUCKHANNON INCBUCKHANNONProvider total: $41.9M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 93010

EMERGENCY SOLUTIONS INC (1801338298) bills $142.18/claim for 93010 (Electrocardiogram report) vs avg $13.35 (+5.2σ). $233,603 across 1,643 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.

EMERGENCY SOLUTIONS INCFAIRMONTProvider total: $2.9M

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 83735

ALECTO HEALTHCARE SERVICES WHEELING LLC (1437699584) bills $97.01/claim for 83735 (Assay of magnesium) vs avg $14.26 (+5.1σ). $45,788 across 472 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.

ALECTO HEALTHCARE SERVICES WHEELING LLCWHEELINGProvider total: $6.0M

criticalCost OutlierScore: 5.1

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

ALECTO HEALTHCARE SERVICES FAIRMONT LLC (1649688037) bills $117.59/claim for 80061 (Lipid panel) vs avg $22.46 (+5.1σ). $50,682 across 431 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.

ALECTO HEALTHCARE SERVICES FAIRMONT LLCFAIRMONTProvider total: $11.7M

criticalCost OutlierScore: 5.0

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

GRAFTON CITY HOSPITAL INC (1265484893) bills $66.81/claim for 90853 (Group psychotherapy) vs avg $17.98 (+5.0σ). $67,745 across 1,014 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.

GRAFTON CITY HOSPITAL INCGRAFTONProvider total: $6.4M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for H2036

SUMMIT BHC WEST VIRGINIA LLC (1578188322) bills $643.77/claim for H2036 (A/d tx program, per diem) vs avg $212.39 (+5.0σ). $2,244,819 across 3,487 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.

SUMMIT BHC WEST VIRGINIA LLCCHARLESTONProvider total: $5.1M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 96365

WAR MEMORIAL HOSPITAL, INC. (1467450353) bills $260.47/claim for 96365 (Ther/proph/diag iv inf init) vs avg $72.91 (+5.0σ). $17,191 across 66 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.

WAR MEMORIAL HOSPITAL, INC.BERKELEY SPRINGSProvider total: $4.6M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 3078F

LINCOLN COUNTY PRIMARY CARE CENTER, INC. (1033490149) bills $51.96/claim for 3078F vs avg $3.22 (+5.0σ). $35,593 across 685 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 PRIMARY CARE CENTER, INC.DELBARTONProvider total: $1.6M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 87635

BOONE MEMORIAL HOSPITAL, INC (1639135221) bills $160.60/claim for 87635 (Sars-cov-2 covid-19 amp prb) vs avg $33.45 (+5.0σ). $2,536,790 across 15,796 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.

BOONE MEMORIAL HOSPITAL, INCMADISONProvider total: $31.9M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 90472 (Immunization Administration (Each Additional Injection))

VALLEY HEALTH SYSTEMS INC (1104008481) bills $75.04/claim for 90472 (Immunization admin each add) vs avg $16.24 (+5.0σ). $36,243 across 483 claims.

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

VALLEY HEALTH SYSTEMS INCHUNTINGTONProvider total: $4.7M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for D0350

AMY SMITH (1841210010) bills $59.36/claim for D0350 (Oral/facial photographic image) vs avg $18.78 (+4.9σ). $257,391 across 4,336 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.

AMY SMITHPARKERSBURGProvider total: $1.3M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for T1002

SYCAMORE RUN, LLC (1073737706) bills $426.31/claim for T1002 (Rn services up to 15 minutes) vs avg $45.01 (+4.9σ). $687,211 across 1,612 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.

SYCAMORE RUN, LLCKEYSERProvider total: $13.5M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 1034F

MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC (1770697278) bills $30.42/claim for 1034F vs avg $1.83 (+4.9σ). $30,148 across 991 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.

MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INCFAIRMONTProvider total: $16.6M

criticalCost OutlierScore: 4.9

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

FMRS HEALTH SYSTEMS INC (1740406404) bills $429.09/claim for 97530 (Therapeutic activities) vs avg $52.58 (+4.9σ). $370,735 across 864 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.

FMRS HEALTH SYSTEMS INCBECKLEYProvider total: $5.9M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 3074F

LINCOLN COUNTY PRIMARY CARE CENTER, INC. (1033490149) bills $50.86/claim for 3074F vs avg $3.25 (+4.9σ). $39,159 across 770 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 PRIMARY CARE CENTER, INC.DELBARTONProvider total: $1.6M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 1159F

MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INC (1770697278) bills $14.98/claim for 1159F vs avg $0.73 (+4.9σ). $84,464 across 5,639 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.

MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTERS, INCFAIRMONTProvider total: $16.6M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for A4657

TOTAL RENAL CARE INC (1417484452) bills $263.51/claim for A4657 (Syringe w/wo needle) vs avg $24.29 (+4.9σ). $223,982 across 850 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 RENAL CARE INCWHEELINGProvider total: $2.1M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 88305

PRESTON MEMORIAL HOSPITAL CORPORATION (1013950054) bills $306.06/claim for 88305 (Tissue exam by pathologist) vs avg $64.92 (+4.9σ). $58,764 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.

PRESTON MEMORIAL HOSPITAL CORPORATIONKINGWOODProvider total: $20.1M

criticalCost OutlierScore: 4.8

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

NEW LIFECLINICS INC (1316354574) bills $143.20/claim for 90832 (Psytx w pt 30 minutes) vs avg $24.05 (+4.8σ). $514,669 across 3,594 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 LIFECLINICS INCPOINT PLEASANTProvider total: $6.5M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 00170

CURTIS CLARK (1962449017) bills $998.88/claim for 00170 (Anesth procedure on mouth) vs avg $170.49 (+4.8σ). $31,964 across 32 claims.

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

CURTIS CLARKGLEN DALEProvider total: $32.0K

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 96160

SIGNIFY HEALTH MEDICAL ASSOCIATES PLLC (1750845863) bills $300.00/claim for 96160 (Pt-focused hlth risk assmt) vs avg $16.67 (+4.8σ). $32,100 across 107 claims.

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

SIGNIFY HEALTH MEDICAL ASSOCIATES PLLCCLARKSBURGProvider total: $11.3M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 83970

ST JOSEPHS HOSPITAL OF BUCKHANNON INC (1124005061) bills $115.82/claim for 83970 (Assay of parathormone) vs avg $16.43 (+4.8σ). $29,881 across 258 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 JOSEPHS HOSPITAL OF BUCKHANNON INCBUCKHANNONProvider total: $41.9M

criticalCost OutlierScore: 4.7

Cost-per-claim above average for 3075F

LINCOLN COUNTY PRIMARY CARE CENTER, INC (1023331220) bills $66.32/claim for 3075F vs avg $4.67 (+4.7σ). $12,403 across 187 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 PRIMARY CARE CENTER, INCLOGANProvider total: $1.2M

Page 1 of 34