Statistical Outliers

Single-test outliers in Alabama 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

92

warning

234

info

3,858

Total

4,184

Outliers by Type

Severity Distribution

critical

92 (2.2%)

warning

234 (5.6%)

info

3,858 (92.2%)

3,210 results

criticalCost OutlierScore: 31.0

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

ALABAMA DEPARTMENT OF REHABILITATION SERVICES (1891849725) bills $1,810.83/claim for 99213 (Office o/p est low 20 min) vs avg $34.79 (+31.0σ). $7,542,087 across 4,165 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.

ALABAMA DEPARTMENT OF REHABILITATION SERVICESMONTGOMERYProvider total: $68.0M

criticalCost OutlierScore: 30.4

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

ALABAMA DEPARTMENT OF REHABILITATION SERVICES (1891849725) bills $1,873.62/claim for 99214 (Office o/p est mod 30 min) vs avg $47.04 (+30.4σ). $1,259,075 across 672 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.

ALABAMA DEPARTMENT OF REHABILITATION SERVICESMONTGOMERYProvider total: $68.0M

criticalCost OutlierScore: 22.1

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

ALABAMA DEPARTMENT OF REHABILITATION SERVICES (1891849725) bills $1,835.09/claim for 99212 (Office o/p est sf 10 min) vs avg $21.74 (+22.1σ). $17,117,763 across 9,328 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.

ALABAMA DEPARTMENT OF REHABILITATION SERVICESMONTGOMERYProvider total: $68.0M

criticalCost OutlierScore: 12.9

Cost-per-claim above average for T1015 (Clinic Service)

MERCY LIFE OF ALABAMA (1952609059) bills $2,990.45/claim for T1015 (Clinic service) vs avg $94.94 (+12.9σ). $11,504,267 across 3,847 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.

MERCY LIFE OF ALABAMAMOBILEProvider total: $11.5M

criticalCost OutlierScore: 12.7

Cost-per-claim above average for 99173

REHAB EARLY INTERVENTION (1811043649) bills $36.18/claim for 99173 (Visual acuity screen) vs avg $3.02 (+12.7σ). $39,073 across 1,080 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.

REHAB EARLY INTERVENTIONMONTGOMERYProvider total: $39.2M

criticalCost OutlierScore: 8.9

Cost-per-claim above average for 92015

MARY WILSON (1396090163) bills $42.09/claim for 92015 (Determine refractive state) vs avg $7.34 (+8.9σ). $107,666 across 2,558 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.

MARY WILSONMOBILEProvider total: $422.3K

criticalCost OutlierScore: 8.7

Cost-per-claim above average for G9008

ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION (1346846037) bills $372.43/claim for G9008 (Mccd,phys coor-care ovrsght) vs avg $56.97 (+8.7σ). $576,143 across 1,547 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.

ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATIONMONTGOMERYProvider total: $2.9M

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 99205 (Office Visit, New Patient (60 min, High Complexity))

UNIVERSITY OF ALABAMA AT BIRMINGHAM (1447445135) bills $909.12/claim for 99205 (Office o/p new hi 60 min) vs avg $140.04 (+8.1σ). $1,404,595 across 1,545 claims.

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

UNIVERSITY OF ALABAMA AT BIRMINGHAMBIRMINGHAMProvider total: $4.8M

criticalCost OutlierScore: 7.7

Cost-per-claim above average for T1015 (Clinic Service)

ALABAMA DEPARTMENT OF REHABILITATION SERVICES (1811171614) bills $1,808.59/claim for T1015 (Clinic service) vs avg $94.94 (+7.7σ). $3,942,728 across 2,180 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.

ALABAMA DEPARTMENT OF REHABILITATION SERVICESMONTGOMERYProvider total: $3.9M

criticalCost OutlierScore: 7.1

Cost-per-claim above average for A4657

DIALYSIS CLINIC INC. (1063445443) bills $12.15/claim for A4657 (Syringe w/wo needle) vs avg $0.87 (+7.1σ). $25,312 across 2,083 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.

DIALYSIS CLINIC INC.CULLMANProvider total: $348.2K

criticalCost OutlierScore: 7.1

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

UNIVERSITY OF ALABAMA AT BIRMINGHAM (1447445135) bills $903.94/claim for 99215 (Office o/p est hi 40 min) vs avg $74.88 (+7.1σ). $1,627,997 across 1,801 claims.

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

UNIVERSITY OF ALABAMA AT BIRMINGHAMBIRMINGHAMProvider total: $4.8M

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 90710

PHYSICIAN MANAGEMENT SERVICES OF ALABAMA LLC (1568901742) bills $248.57/claim for 90710 (Mmrv vaccine sc) vs avg $18.78 (+6.6σ). $174,496 across 702 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 ALABAMA LLCDOTHANProvider total: $4.2M

criticalCost OutlierScore: 6.5

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

THE CHILDREN'S HOSPITAL OF ALABAMA (1447369525) bills $333.27/claim for A0425 (Ground mileage) vs avg $46.97 (+6.5σ). $369,927 across 1,110 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 CHILDREN'S HOSPITAL OF ALABAMABIRMINGHAMProvider total: $2.7M

criticalCost OutlierScore: 6.4

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

JANNA ROUTH (1629563119) bills $27.66/claim for D0230 (Intraoral - periapical each addl image) vs avg $8.45 (+6.4σ). $22,708 across 821 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.

JANNA ROUTHENTERPRISEProvider total: $156.5K

criticalCost OutlierScore: 6.4

Cost-per-claim above average for 90723

PHYSICIAN MANAGEMENT SERVICES OF ALABAMA LLC (1568901742) bills $86.71/claim for 90723 (Dtap-hep b-ipv vaccine im) vs avg $13.89 (+6.4σ). $181,398 across 2,092 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 ALABAMA LLCDOTHANProvider total: $4.2M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for 99406

USA HCA OBGYN SERVICES LLC (1689141665) bills $17.79/claim for 99406 (Behav chng smoking 3-10 min) vs avg $0.69 (+6.3σ). $19,569 across 1,100 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.

USA HCA OBGYN SERVICES LLCMOBILEProvider total: $1.8M

criticalCost OutlierScore: 6.3

Cost-per-claim above average for T1019

ALABAMA DEPARTMENT OF SENIOR SERVICES (1285025411) bills $754.11/claim for T1019 (Personal care ser per 15 min) vs avg $31.59 (+6.3σ). $2,396,564 across 3,178 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.

ALABAMA DEPARTMENT OF SENIOR SERVICESMONTGOMERYProvider total: $3.1M

criticalCost OutlierScore: 6.2

Cost-per-claim above average for 99309 (Subsequent Nursing Facility Care (Moderate Complexity))

JAVIER TAPIA (1629066691) bills $73.54/claim for 99309 (Sbsq nf care moderate mdm 30) vs avg $8.64 (+6.2σ). $114,939 across 1,563 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.

JAVIER TAPIAGREENVILLEProvider total: $114.9K

criticalCost OutlierScore: 6.1

Cost-per-claim above average for S5130

RIVIERA HEALTH SERVICES, LLC (1710356217) bills $52.36/claim for S5130 (Homaker service nos per 15m) vs avg $1.64 (+6.1σ). $12,619 across 241 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.

RIVIERA HEALTH SERVICES, LLCMOBILEProvider total: $14.5M

criticalCost OutlierScore: 6.0

Cost-per-claim above average for 99394 (Preventive Visit, Established Patient (Ages 12-17))

CLAY COUNTY HEALTH DEPT EPSDT (1124161591) bills $286.83/claim for 99394 (Prev visit est age 12-17) vs avg $47.38 (+6.0σ). $32,986 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.

CLAY COUNTY HEALTH DEPT EPSDTLINEVILLEProvider total: $56.8K

criticalCost OutlierScore: 5.9

Cost-per-claim above average for 99391 (Preventive Visit, Established Patient (Infant, <1 year))

JEFFERSON COUNTY BOARD OF HEALTH (1447285390) bills $255.06/claim for 99391 (Per pm reeval est pat infant) vs avg $49.18 (+5.9σ). $1,738,501 across 6,816 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.

JEFFERSON COUNTY BOARD OF HEALTHBIRMINGHAMProvider total: $11.7M

criticalCost OutlierScore: 5.8

Cost-per-claim above average for 59426

OB-GYN ASSOCIATES OF MONTGOMERY, P.C. (1932278652) bills $453.23/claim for 59426 (Antepartum care only) vs avg $17.34 (+5.8σ). $11,784 across 26 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.

OB-GYN ASSOCIATES OF MONTGOMERY, P.C.MONTGOMERYProvider total: $2.6M

criticalCost OutlierScore: 5.8

Cost-per-claim above average for G9003

ALABAMA DEPARTMENT OF MENTAL HEALTH (1215577051) bills $563.52/claim for G9003 (Mccd, risk adj hi, initial) vs avg $62.60 (+5.8σ). $1,456,146 across 2,584 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.

ALABAMA DEPARTMENT OF MENTAL HEALTHMONTGOMERYProvider total: $2.2M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

JEFFERSON COUNTY BOARD OF HEALTH (1447285390) bills $251.99/claim for 99392 (Prev visit est age 1-4) vs avg $49.15 (+5.7σ). $1,515,468 across 6,014 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.

JEFFERSON COUNTY BOARD OF HEALTHBIRMINGHAMProvider total: $11.7M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for Q9967

HOUSTON COUNTY HEALTHCARE AUTHORITY (1164403861) bills $21.01/claim for Q9967 (Locm 300-399mg/ml iodine,1ml) vs avg $3.55 (+5.7σ). $24,409 across 1,162 claims.

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

HOUSTON COUNTY HEALTHCARE AUTHORITYDOTHANProvider total: $4.9M

criticalCost OutlierScore: 5.7

Cost-per-claim above average for Q4081

DVA RENAL HEALTHCARE INC (1629415609) bills $156.37/claim for Q4081 (Epoetin alfa, 100 units esrd) vs avg $20.49 (+5.7σ). $49,414 across 316 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.

DVA RENAL HEALTHCARE INCBIRMINGHAMProvider total: $767.3K

criticalCost OutlierScore: 5.7

Cost-per-claim above average for 99391 (Preventive Visit, Established Patient (Infant, <1 year))

JEFFERSON COUNTY BOARD OF HEALTH (1942235825) bills $246.42/claim for 99391 (Per pm reeval est pat infant) vs avg $49.18 (+5.7σ). $1,377,979 across 5,592 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.

JEFFERSON COUNTY BOARD OF HEALTHMIDFIELDProvider total: $10.7M

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

JEFFERSON COUNTY BOARD OF HEALTH (1942235825) bills $244.99/claim for 99392 (Prev visit est age 1-4) vs avg $49.15 (+5.5σ). $1,219,584 across 4,978 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.

JEFFERSON COUNTY BOARD OF HEALTHMIDFIELDProvider total: $10.7M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 99393 (Preventive Visit, Established Patient (Ages 5-11))

CLAY COUNTY HEALTH DEPT EPSDT (1124161591) bills $247.95/claim for 99393 (Prev visit est age 5-11) vs avg $46.56 (+5.4σ). $23,804 across 96 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.

CLAY COUNTY HEALTH DEPT EPSDTLINEVILLEProvider total: $56.8K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 90697

HUNTSVILLE PEDIATRIC ASSOCIATES, LLC (1922246842) bills $150.85/claim for 90697 (Dtap-ipv-hib-hepb vaccine im) vs avg $15.04 (+5.4σ). $14,331 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.

HUNTSVILLE PEDIATRIC ASSOCIATES, LLCHUNTSVILLEProvider total: $4.8M

criticalCost OutlierScore: 5.4

Cost-per-claim above average for 90698

PHYSICIAN MANAGEMENT SERVICES OF ALABAMA LLC (1568901742) bills $108.12/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $16.56 (+5.4σ). $38,815 across 359 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 ALABAMA LLCDOTHANProvider total: $4.2M

criticalCost OutlierScore: 5.3

Cost-per-claim above average for 59426

OBSTETRICS & GYNECOLOGY ASSOCIATES OF NORTHWEST ALABAMA, P.C. (1578669081) bills $412.44/claim for 59426 (Antepartum care only) vs avg $17.34 (+5.3σ). $10,311 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.

OBSTETRICS & GYNECOLOGY ASSOCIATES OF NORTHWEST ALABAMA, P.C.FLORENCEProvider total: $97.0K

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 99392 (Preventive Visit, Established Patient (Ages 1-4))

JEFFERSON COUNTY BOARD OF HEALTH (1336167196) bills $233.22/claim for 99392 (Prev visit est age 1-4) vs avg $49.15 (+5.2σ). $1,877,857 across 8,052 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.

JEFFERSON COUNTY BOARD OF HEALTHBIRMINGHAMProvider total: $12.2M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 97535

ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION (1982757688) bills $36.80/claim for 97535 (Self care mngment training) vs avg $3.19 (+5.1σ). $310,529 across 8,438 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.

ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATIONMONTGOMERYProvider total: $2.3B

criticalCost OutlierScore: 5.1

Cost-per-claim above average for 99393 (Preventive Visit, Established Patient (Ages 5-11))

JEFFERSON COUNTY BOARD OF HEALTH (1336167196) bills $234.93/claim for 99393 (Prev visit est age 5-11) vs avg $46.56 (+5.1σ). $1,401,135 across 5,964 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.

JEFFERSON COUNTY BOARD OF HEALTHBIRMINGHAMProvider total: $12.2M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for 90791 (Psychiatric Diagnostic Evaluation)

LANECHA CONNER (1003337635) bills $220.48/claim for 90791 (Psych diagnostic evaluation) vs avg $57.94 (+5.0σ). $89,293 across 405 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.

LANECHA CONNERHUNTSVILLEProvider total: $89.3K

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 90698

CHILDREN'S MEDICAL GROUP, P.A. (1689639312) bills $100.57/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $16.56 (+4.9σ). $295,171 across 2,935 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 MEDICAL GROUP, P.A.MOBILEProvider total: $7.4M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 88312

1467786467 (1467786467) bills $415.11/claim for 88312 (Special stains group 1) vs avg $34.12 (+4.9σ). $617,270 across 1,487 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.

NORTHWEST PATHOLOGY CSPMANATIProvider total: $1.4M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 90698

HUNTSVILLE PEDIATRIC ASSOCIATES, LLC (1922246842) bills $99.48/claim for 90698 (Dtap-ipv/hib vaccine im) vs avg $16.56 (+4.9σ). $202,248 across 2,033 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.

HUNTSVILLE PEDIATRIC ASSOCIATES, LLCHUNTSVILLEProvider total: $4.8M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 99233 (Subsequent Hospital Care (High Complexity))

SELF-RECOVERY, LLC (1255409447) bills $209.13/claim for 99233 (Sbsq hosp ip/obs high 50) vs avg $39.62 (+4.8σ). $551,258 across 2,636 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.

SELF-RECOVERY, LLCLANETTProvider total: $899.9K

criticalCost OutlierScore: 4.8

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

UNIVERSITY OF ALABAMA AT BIRMINGHAM (1073679692) bills $258.38/claim for A0425 (Ground mileage) vs avg $46.97 (+4.8σ). $318,323 across 1,232 claims.

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

UNIVERSITY OF ALABAMA AT BIRMINGHAMBIRMINGHAMProvider total: $524.4K

criticalCost OutlierScore: 4.7

Cost-per-claim above average for A4253 (Blood Glucose Test Strips (per 50))

AIM PLUS MEDICAL SUPPLIES, LLC (1912145541) bills $102.85/claim for A4253 (Blood glucose/reagent strips) vs avg $25.47 (+4.7σ). $8,221,183 across 79,933 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.

AIM PLUS MEDICAL SUPPLIES, LLCTUSCALOOSAProvider total: $24.1M

criticalCost OutlierScore: 4.6

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

DELTA REHAB SERVICES LLC (1245720002) bills $138.49/claim for 97530 (Therapeutic activities) vs avg $20.68 (+4.6σ). $63,567 across 459 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.

DELTA REHAB SERVICES LLCMONTGOMERYProvider total: $63.6K

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 96372

UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY (1508392432) bills $31.58/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $5.41 (+4.6σ). $11,210 across 355 claims.

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

UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITYMOBILEProvider total: $3.9M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 96372

UNIVERSITY OF SOUTH ALABAMA (1265891857) bills $31.47/claim for 96372 (Ther/proph/diag inj sc/im) vs avg $5.41 (+4.6σ). $26,720 across 849 claims.

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

UNIVERSITY OF SOUTH ALABAMAMOBILEProvider total: $4.0M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90670

BRUCE A PETITT M.D. P.C. (1013077205) bills $216.60/claim for 90670 (Pcv13 vaccine im) vs avg $24.84 (+4.5σ). $30,107 across 139 claims.

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

BRUCE A PETITT M.D. P.C.TUSCALOOSAProvider total: $939.2K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90680

BIRMINGHAM PEDIATRIC ASSOC (1174611081) bills $87.24/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $16.83 (+4.5σ). $31,320 across 359 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.

BIRMINGHAM PEDIATRIC ASSOCBIRMINGHAMProvider total: $2.5M

criticalCost OutlierScore: 4.5

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

NYKKOL ALDRIDGE (1730330796) bills $60.39/claim for D0150 (Comprehensive oral evaluation) vs avg $22.08 (+4.5σ). $10,447 across 173 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.

NYKKOL ALDRIDGEMONTGOMERYProvider total: $32.8K

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90716

CHILDREN'S MEDICAL GROUP, P.A. (1689639312) bills $140.39/claim for 90716 (Var vaccine live subq) vs avg $21.60 (+4.5σ). $224,904 across 1,602 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 MEDICAL GROUP, P.A.MOBILEProvider total: $7.4M

criticalCost OutlierScore: 4.5

Cost-per-claim above average for 90680

CHILDREN'S MEDICAL GROUP, P.A. (1689639312) bills $86.56/claim for 90680 (Rv5 vacc 3 dose live oral) vs avg $16.83 (+4.5σ). $179,445 across 2,073 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.

CHILDREN'S MEDICAL GROUP, P.A.MOBILEProvider total: $7.4M

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