Statistical Outliers

Single-test outliers in Iowa 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

90

warning

300

info

3,482

Total

3,872

Outliers by Type

Severity Distribution

critical

90 (2.3%)

warning

300 (7.7%)

info

3,482 (89.9%)

2,931 results

criticalCost OutlierScore: 18.1

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

SPENCER MUNICIPAL HOSPITAL (1255328621) bills $949.52/claim for D0150 (Comprehensive oral evaluation) vs avg $25.66 (+18.0σ). $11,394 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.

SPENCER MUNICIPAL HOSPITALSPENCERProvider total: $3.2M

criticalCost OutlierScore: 17.7

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

CATHOLIC HEALTH INITIATIVES-IOWA CORP (1508964883) bills $511.20/claim for D1206 (Topical fluoride varnish) vs avg $16.65 (+17.7σ). $12,780 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.

CATHOLIC HEALTH INITIATIVES-IOWA CORPDES MOINESProvider total: $26.4M

criticalCost OutlierScore: 17.3

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

HANCOCK COUNTY HEALTH SYSTEM (1912938606) bills $141.41/claim for 36415 (Coll venous bld venipuncture) vs avg $3.71 (+17.3σ). $148,902 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.

HANCOCK COUNTY HEALTH SYSTEMBRITTProvider total: $496.8K

criticalCost OutlierScore: 17.0

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

CENTRAL IOWA HOSPITAL CORPORATION (1356433049) bills $492.60/claim for D1206 (Topical fluoride varnish) vs avg $16.65 (+17.0σ). $726,093 across 1,474 claims.

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

CENTRAL IOWA HOSPITAL CORPORATIONDES MOINESProvider total: $14.7M

criticalCost OutlierScore: 13.0

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

CATHOLIC HEALTH INITIATIVES-IOWA CORP (1508964883) bills $518.95/claim for D1120 (Prophylaxis - child) vs avg $29.32 (+13.0σ). $15,568 across 30 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.

CATHOLIC HEALTH INITIATIVES-IOWA CORPDES MOINESProvider total: $26.4M

criticalCost OutlierScore: 12.9

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

CENTRAL IOWA HOSPITAL CORPORATION (1356433049) bills $516.88/claim for D1120 (Prophylaxis - child) vs avg $29.32 (+12.9σ). $292,556 across 566 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 IOWA HOSPITAL CORPORATIONDES MOINESProvider total: $14.7M

criticalCost OutlierScore: 11.5

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

MESKWAKI PHARMACY (1902012305) bills $219.62/claim for 99212 (Office o/p est sf 10 min) vs avg $16.29 (+11.5σ). $45,682 across 208 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.

MESKWAKI PHARMACYTAMAProvider total: $80.1K

criticalCost OutlierScore: 10.7

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

MERCY HEALTH SERVICES-IOWA CORP (1467537886) bills $1,706.28/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $60.08 (+10.7σ). $899,211 across 527 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 HEALTH SERVICES-IOWA CORPMASON CITYProvider total: $45.7M

criticalCost OutlierScore: 10.0

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

CLARKE COUNTY PUBLIC HOSPITAL (1114954997) bills $286.84/claim for 99211 (Off/op est may x req phy/qhp) vs avg $15.83 (+10.0σ). $2,877,006 across 10,030 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.

CLARKE COUNTY PUBLIC HOSPITALOSCEOLAProvider total: $5.1M

criticalCost OutlierScore: 8.7

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

DEMI HENDRICKS (1336693290) bills $83.37/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+8.7σ). $35,098 across 421 claims.

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

DEMI HENDRICKSDAVENPORTProvider total: $50.3K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for 90670

STATE UNIVERSITY OF IOWA (1376544320) bills $63.45/claim for 90670 (Pcv13 vaccine im) vs avg $2.17 (+8.6σ). $122,513 across 1,931 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 UNIVERSITY OF IOWAIOWA CITYProvider total: $90.1M

criticalCost OutlierScore: 8.4

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

MERCY HEALTH SERVICES-IOWA CORP (1467537886) bills $535.88/claim for D1351 (Sealant per tooth) vs avg $28.84 (+8.4σ). $115,751 across 216 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 HEALTH SERVICES-IOWA CORPMASON CITYProvider total: $45.7M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

CENTRAL IOWA HOSPITAL CORPORATION (1396837951) bills $53.05/claim for 90471 (Immunization admin) vs avg $4.66 (+8.4σ). $33,796 across 637 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 IOWA HOSPITAL CORPORATIONDES MOINESProvider total: $58.1M

criticalCost OutlierScore: 8.0

Cost-per-claim above average for 87426 (SARS-CoV-2 / COVID-19 Antigen Test)

BURGESS HEALTH CENTER (1730253360) bills $253.46/claim for 87426 (Sarscov coronavirus ag ia) vs avg $31.44 (+8.0σ). $113,045 across 446 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.

BURGESS HEALTH CENTERONAWAProvider total: $2.9M

criticalCost OutlierScore: 8.0

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

MARK STUMPHY (1245607209) bills $78.63/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+8.0σ). $103,396 across 1,315 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.

MARK STUMPHYDAVENPORTProvider total: $166.5K

criticalCost OutlierScore: 7.3

Cost-per-claim above average for 90471 (Immunization Administration (Injection))

SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION (1689640500) bills $47.19/claim for 90471 (Immunization admin) vs avg $4.66 (+7.3σ). $47,994 across 1,017 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.

SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATIONPRIMGHARProvider total: $857.5K

criticalCost OutlierScore: 7.0

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

COVENANT MEDICAL CENTER INC (1700827896) bills $451.16/claim for D1351 (Sealant per tooth) vs avg $28.84 (+7.0σ). $33,837 across 75 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.

COVENANT MEDICAL CENTER INCWATERLOOProvider total: $63.1M

criticalCost OutlierScore: 6.8

Cost-per-claim above average for D0603

MARK STUMPHY (1245607209) bills $104.33/claim for D0603 (Caries risk assessment - high risk) vs avg $4.72 (+6.7σ). $21,179 across 203 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 STUMPHYDAVENPORTProvider total: $166.5K

criticalCost OutlierScore: 6.7

Cost-per-claim above average for T2021

FRIENDSHIP ARK, INC. (1194177220) bills $355.46/claim for T2021 (Day habil waiver per 15 min) vs avg $54.77 (+6.7σ). $821,470 across 2,311 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.

FRIENDSHIP ARK, INC.AMESProvider total: $20.9M

criticalCost OutlierScore: 6.7

Cost-per-claim above average for D0140 (Limited Oral Evaluation (Problem-Focused))

MARK STUMPHY (1245607209) bills $120.36/claim for D0140 (Limited oral evaluation - problem focused) vs avg $22.93 (+6.7σ). $16,128 across 134 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 STUMPHYDAVENPORTProvider total: $166.5K

criticalCost OutlierScore: 6.4

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

WINNESHIEK MEDICAL CENTER (1619922051) bills $126.54/claim for 99213 (Office o/p est low 20 min) vs avg $24.12 (+6.4σ). $290,402 across 2,295 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.

WINNESHIEK MEDICAL CENTERDECORAHProvider total: $1.2M

criticalCost OutlierScore: 6.3

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

SBH-DAVENPORT, LLC (1831720556) bills $146.80/claim for 90853 (Group psychotherapy) vs avg $44.85 (+6.3σ). $34,792 across 237 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.

SBH-DAVENPORT, LLCBETTENDORFProvider total: $229.6K

criticalCost OutlierScore: 6.2

Cost-per-claim above average for H2025

CENTERVILLE COMMUNITY BETTERMENT INC ZYLPHA PRICE HOUSE (1083791396) bills $2,034.94/claim for H2025 (Supp maint employ, 15 min) vs avg $431.71 (+6.2σ). $307,276 across 151 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.

CENTERVILLE COMMUNITY BETTERMENT INC ZYLPHA PRICE HOUSECENTERVILLEProvider total: $14.4M

criticalCost OutlierScore: 6.0

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

MAHASKA COUNTY HOSPITAL (1356320659) bills $179.29/claim for 99211 (Off/op est may x req phy/qhp) vs avg $15.83 (+6.1σ). $135,362 across 755 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.

MAHASKA COUNTY HOSPITALOSKALOOSAProvider total: $4.9M

criticalCost OutlierScore: 5.6

Cost-per-claim above average for 90670

CENTRAL IOWA HOSPITAL CORPORATION (1396837951) bills $42.08/claim for 90670 (Pcv13 vaccine im) vs avg $2.17 (+5.6σ). $113,111 across 2,688 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 IOWA HOSPITAL CORPORATIONDES MOINESProvider total: $58.1M

criticalCost OutlierScore: 5.6

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

ANUPAM SINGH (1356894752) bills $60.51/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+5.6σ). $44,659 across 738 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.

ANUPAM SINGHDAVENPORTProvider total: $129.5K

criticalCost OutlierScore: 5.6

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

CHRISTOPHER LIU (1336640713) bills $60.33/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+5.6σ). $41,872 across 694 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 LIUDAVENPORTProvider total: $62.3K

criticalCost OutlierScore: 5.5

Cost-per-claim above average for 92004

CHRISTOPHER SALES (1790005064) bills $156.28/claim for 92004 (Compre oph exam new pt 1/>) vs avg $83.04 (+5.5σ). $17,035 across 109 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 SALESIOWA CITYProvider total: $19.6K

criticalCost OutlierScore: 5.4

Cost-per-claim above average for D1354

MARLEE HANSEN (1528446606) bills $26.91/claim for D1354 (Interim caries arresting medicament) vs avg $4.14 (+5.4σ). $10,629 across 395 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.

MARLEE HANSENCEDAR RAPIDSProvider total: $433.5K

criticalCost OutlierScore: 5.3

Cost-per-claim above average for A0428 (BLS Non-Emergency Ambulance Transport)

DOLLY'S TAXI 2 (1275988099) bills $623.75/claim for A0428 (Bls) vs avg $61.42 (+5.3σ). $96,058 across 154 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.

DOLLY'S TAXI 2CEDAR FALLSProvider total: $2.4M

criticalCost OutlierScore: 5.3

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

VETERANS MEMORIAL HOSPITAL CITY OF WAUKON IA (1164599643) bills $163.75/claim for 80053 (Comprehen metabolic panel) vs avg $23.35 (+5.3σ). $31,276 across 191 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.

VETERANS MEMORIAL HOSPITAL CITY OF WAUKON IAWAUKONProvider total: $157.8K

criticalCost OutlierScore: 5.2

Cost-per-claim above average for 99281 (Emergency Dept Visit (Straightforward))

CLARKE COUNTY PUBLIC HOSPITAL (1114954997) bills $207.99/claim for 99281 (Emr dpt vst mayx req phy/qhp) vs avg $29.19 (+5.1σ). $224,003 across 1,077 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.

CLARKE COUNTY PUBLIC HOSPITALOSCEOLAProvider total: $5.1M

criticalCost OutlierScore: 5.1

Cost-per-claim above average for H2023

NEW HOPE VILLAGE, INC (1285729418) bills $597.47/claim for H2023 (Supported employ, per 15 min) vs avg $76.68 (+5.1σ). $982,242 across 1,644 claims.

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

NEW HOPE VILLAGE, INCCARROLLProvider total: $50.2M

criticalCost OutlierScore: 5.1

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

SAC & FOX OF THE MISS IN IOWA (1962618355) bills $503.13/claim for T1015 (Clinic service) vs avg $135.04 (+5.1σ). $19,659,857 across 39,075 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.

SAC & FOX OF THE MISS IN IOWATAMAProvider total: $19.7M

criticalCost OutlierScore: 5.0

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

KELSEY DEVER (1316477094) bills $56.05/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+5.0σ). $77,747 across 1,387 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.

KELSEY DEVERDAVENPORTProvider total: $115.6K

criticalCost OutlierScore: 5.0

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

GREATER REGIONAL MEDICAL CENTER (1902805062) bills $439.09/claim for 70450 (Ct head/brain w/o dye) vs avg $85.26 (+5.0σ). $24,589 across 56 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.

GREATER REGIONAL MEDICAL CENTERCRESTONProvider total: $10.0M

criticalCost OutlierScore: 5.0

Cost-per-claim above average for D9230

PRISCILLA LAVAGNOLLI (1033789987) bills $66.65/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $16.95 (+5.0σ). $22,260 across 334 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.

PRISCILLA LAVAGNOLLIIOWA CITYProvider total: $297.6K

criticalCost OutlierScore: 5.0

Cost-per-claim above average for A4657

VGM GROUP, INC. (1972916310) bills $8.60/claim for A4657 (Syringe w/wo needle) vs avg $0.47 (+5.0σ). $21,283 across 2,475 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.

VGM GROUP, INC.WATERLOOProvider total: $5.4M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for 0241U

BELMOND COMMUNITY HOSPITAL (1932142726) bills $405.84/claim for 0241U vs avg $114.98 (+4.9σ). $21,104 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.

BELMOND COMMUNITY HOSPITALBELMONDProvider total: $541.4K

criticalCost OutlierScore: 4.9

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

MERCY MEDICAL CENTER NEW HAMPTON (1770651515) bills $316.30/claim for 99283 (Emergency dept visit low mdm) vs avg $77.97 (+4.9σ). $231,218 across 731 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 MEDICAL CENTER NEW HAMPTONNEW HAMPTONProvider total: $1.1M

criticalCost OutlierScore: 4.9

Cost-per-claim above average for V2020

ELIZABETH GOERKE (1528162922) bills $41.86/claim for V2020 (Vision svcs frames purchases) vs avg $23.63 (+4.9σ). $51,618 across 1,233 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.

ELIZABETH GOERKEDES MOINESProvider total: $172.3K

criticalCost OutlierScore: 4.9

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

WAVERLY HEALTH CENTER (1447299953) bills $121.26/claim for 97530 (Therapeutic activities) vs avg $23.98 (+4.9σ). $10,549 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.

WAVERLY HEALTH CENTERWAVERLYProvider total: $649.5K

criticalCost OutlierScore: 4.8

Cost-per-claim above average for S5130

COVENANT MEDICAL CENTER INC (1437190527) bills $298.84/claim for S5130 (Homaker service nos per 15m) vs avg $59.45 (+4.9σ). $30,481 across 102 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.

COVENANT MEDICAL CENTER INCWATERLOOProvider total: $99.5K

criticalCost OutlierScore: 4.8

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

MANNING REGIONAL HEALTHCARE CENTER (1467509141) bills $73.49/claim for 80305 (Drug test prsmv dir opt obs) vs avg $9.95 (+4.8σ). $34,909 across 475 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.

MANNING REGIONAL HEALTHCARE CENTERMANNINGProvider total: $1.2M

criticalCost OutlierScore: 4.8

Cost-per-claim above average for H2015

RECOVER HEALTH OF IOWA, INC. (1093087231) bills $2,079.00/claim for H2015 (Comp comm supp svc, 15 min) vs avg $306.76 (+4.8σ). $24,948 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.

RECOVER HEALTH OF IOWA, INC.WEST DES MOINESProvider total: $785.7K

criticalCost OutlierScore: 4.8

Cost-per-claim above average for 90716

COUNTY OF LINN (1972873073) bills $69.17/claim for 90716 (Var vaccine live subq) vs avg $5.08 (+4.7σ). $86,812 across 1,255 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 LINNCEDAR RAPIDSProvider total: $548.5K

criticalCost OutlierScore: 4.7

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

WINNESHIEK MEDICAL CENTER (1619922051) bills $99.03/claim for 99212 (Office o/p est sf 10 min) vs avg $16.29 (+4.7σ). $139,932 across 1,413 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.

WINNESHIEK MEDICAL CENTERDECORAHProvider total: $1.2M

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 74177 (CT Abdomen and Pelvis with Contrast)

MERCY MEDICAL CENTER-CENTERVILLE (1356391635) bills $617.13/claim for 74177 (Ct abd & pelvis w/contrast) vs avg $122.54 (+4.6σ). $12,960 across 21 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 MEDICAL CENTER-CENTERVILLECENTERVILLEProvider total: $3.2M

criticalCost OutlierScore: 4.6

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

REEM OWEIS (1861883670) bills $52.77/claim for D0120 (Periodic oral evaluation) vs avg $18.34 (+4.6σ). $92,134 across 1,746 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.

REEM OWEISDAVENPORTProvider total: $286.8K

criticalCost OutlierScore: 4.6

Cost-per-claim above average for 90461 (Immunization Administration (Each Additional Component))

THE DUBUQUE VISITING NURSE ASSOCIATION (1518051812) bills $38.53/claim for 90461 (Im admin each addl component) vs avg $4.95 (+4.6σ). $12,752 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.

THE DUBUQUE VISITING NURSE ASSOCIATIONDUBUQUEProvider total: $1.6M

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