Statistical Outliers

Single-test outliers in Oklahoma 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

182

warning

195

info

4,806

Total

5,183

Outliers by Type

Severity Distribution

critical

182 (3.5%)

warning

195 (3.8%)

info

4,806 (92.7%)

4,262 results

criticalCost OutlierScore: 17.2

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

JAMISON METCALF (1679829477) bills $445.72/claim for D0150 (Comprehensive oral evaluation) vs avg $30.00 (+17.2σ). $18,274 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.

JAMISON METCALFOKLAHOMA CITYProvider total: $83.7K

criticalCost OutlierScore: 17.0

Cost-per-claim above average for D0330 (Dental Panoramic X-ray)

SHAWN DAVIS (1518000421) bills $350.54/claim for D0330 (Panoramic radiographic image) vs avg $46.73 (+17.0σ). $33,301 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.

SHAWN DAVISOKLAHOMA CITYProvider total: $99.5K

criticalCost OutlierScore: 16.2

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

GRADY MEMORIAL HOSPITAL (1164859260) bills $179.36/claim for 90471 (Immunization admin) vs avg $16.70 (+16.2σ). $434,939 across 2,425 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.

GRADY MEMORIAL HOSPITALCHICKASHAProvider total: $4.4M

criticalCost OutlierScore: 16.1

Cost-per-claim above average for D9230

NICHOLAS J SCHELLATI DDS PLLC (1669777389) bills $143.06/claim for D9230 (Inhalation of nitrous oxide/analgesia) vs avg $26.31 (+16.1σ). $96,423 across 674 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 J SCHELLATI DDS PLLCOKLAHOMA CITYProvider total: $544.9K

criticalCost OutlierScore: 15.6

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

ANADARKO INDIAN HEALTH CENTER (1881637403) bills $298.16/claim for 96127 (Brief emotional/behav assmt) vs avg $5.83 (+15.5σ). $488,089 across 1,637 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.

ANADARKO INDIAN HEALTH CENTERANADARKOProvider total: $20.4M

criticalCost OutlierScore: 13.6

Cost-per-claim above average for 90670

OU MEDICINE INC. (1649794157) bills $241.56/claim for 90670 (Pcv13 vaccine im) vs avg $1.66 (+13.6σ). $66,429 across 275 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.

OU MEDICINE INC.OKLAHOMA CITYProvider total: $63.0M

criticalCost OutlierScore: 12.5

Cost-per-claim above average for 96110

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY (1407230790) bills $146.68/claim for 96110 (Developmental screen w/score) vs avg $10.11 (+12.5σ). $452,346 across 3,084 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.

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITYALTUSProvider total: $4.2M

criticalCost OutlierScore: 11.8

Cost-per-claim above average for 96160

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC. (1407969728) bills $532.89/claim for 96160 (Pt-focused hlth risk assmt) vs avg $6.61 (+11.8σ). $15,987 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.

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.OKLAHOMA CITYProvider total: $79.5M

criticalCost OutlierScore: 11.8

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

1437215134 (1437215134) bills $149.75/claim for D7140 (Extraction erupted tooth or exposed root) vs avg $65.44 (+11.8σ). $87,007 across 581 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $1.8M

criticalCost OutlierScore: 11.4

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

1437215134 (1437215134) bills $142.58/claim for D2391 (Resin composite - one surface posterior) vs avg $58.09 (+11.5σ). $90,110 across 632 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.

FREDERIKSTED HEALTH CARE, INC.FREDERIKSTEDProvider total: $1.8M

criticalCost OutlierScore: 11.3

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

MODOC TRIBE OF OKLAHOMA (1265083380) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3σ). $18,694 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.

MODOC TRIBE OF OKLAHOMAWYANDOTTEProvider total: $2.7M

criticalCost OutlierScore: 11.3

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

KEETOOWAH CHEROKEE TREATMENT SERVICES (1225647746) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3σ). $40,983 across 57 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.

KEETOOWAH CHEROKEE TREATMENT SERVICESTULSAProvider total: $1.7M

criticalCost OutlierScore: 11.3

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

ANADARKO INDIAN HEALTH CENTER (1881637403) bills $719.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+11.3σ). $44,578 across 62 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.

ANADARKO INDIAN HEALTH CENTERANADARKOProvider total: $20.4M

criticalCost OutlierScore: 10.1

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

PAWNEE INDIAN HEALTH CENTER (1629174081) bills $676.01/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+10.1σ). $89,234 across 132 claims.

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

PAWNEE INDIAN HEALTH CENTERPAWNEEProvider total: $502.0K

criticalCost OutlierScore: 10.1

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

CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC. (1407969728) bills $639.33/claim for 90837 (Psytx w pt 60 minutes) vs avg $62.20 (+10.1σ). $36,442 across 57 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 OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.OKLAHOMA CITYProvider total: $79.5M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for H0031

MODOC NATION BEHAVIORAL HEALTH (1821636358) bills $686.50/claim for H0031 (Mh health assess by non-md) vs avg $96.64 (+10.1σ). $16,476 across 24 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.

MODOC NATION BEHAVIORAL HEALTHMIAMIProvider total: $6.5M

criticalCost OutlierScore: 10.1

Cost-per-claim above average for 92340

OSU CENTER FOR HEALTH SCIENCES (1306561709) bills $52.58/claim for 92340 (Fit spectacles monofocal) vs avg $30.13 (+10.1σ). $29,758 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.

OSU CENTER FOR HEALTH SCIENCESTULSAProvider total: $547.5K

criticalCost OutlierScore: 9.6

Cost-per-claim above average for 99406

CHEROKEE NATION (1326054081) bills $453.33/claim for 99406 (Behav chng smoking 3-10 min) vs avg $19.29 (+9.6σ). $21,760 across 48 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.

CHEROKEE NATIONSALINAProvider total: $119.0K

criticalCost OutlierScore: 9.4

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

KEETOOWAH - CHEROKEE TREATMENT SERVICES (1124228127) bills $612.14/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+9.4σ). $431,562 across 705 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.

KEETOOWAH - CHEROKEE TREATMENT SERVICESTULSAProvider total: $29.0M

criticalCost OutlierScore: 9.3

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

INDIAN HEALTH CARE RESOURCE CENTER (1427034958) bills $629.24/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+9.3σ). $574,498 across 913 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.

INDIAN HEALTH CARE RESOURCE CENTERTULSAProvider total: $2.4M

criticalCost OutlierScore: 9.2

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

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE (1578708475) bills $619.97/claim for 99214 (Office o/p est mod 30 min) vs avg $89.04 (+9.2σ). $88,036 across 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.

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICEOKLAHOMA CITYProvider total: $1.3M

criticalCost OutlierScore: 8.9

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

AHS CLAREMORE REGIONAL HOSPITAL LLC (1356974687) bills $501.04/claim for 99203 (Office o/p new low 30 min) vs avg $91.29 (+8.9σ). $27,056 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.

AHS CLAREMORE REGIONAL HOSPITAL LLCCLAREMOREProvider total: $1.5M

criticalCost OutlierScore: 8.9

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

INDIAN HEALTH CARE RESOURCE CENTER (1427034958) bills $567.72/claim for 90837 (Psytx w pt 60 minutes) vs avg $62.20 (+8.9σ). $52,798 across 93 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.

INDIAN HEALTH CARE RESOURCE CENTERTULSAProvider total: $2.4M

criticalCost OutlierScore: 8.7

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

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE (1578708475) bills $572.91/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+8.7σ). $984,266 across 1,718 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.

DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICEOKLAHOMA CITYProvider total: $1.3M

criticalCost OutlierScore: 8.7

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

SHAWN DAVIS (1518000421) bills $239.98/claim for D0150 (Comprehensive oral evaluation) vs avg $30.00 (+8.7σ). $32,637 across 136 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.

SHAWN DAVISOKLAHOMA CITYProvider total: $99.5K

criticalCost OutlierScore: 8.6

Cost-per-claim above average for T1017

KEETOOWAH CHEROKEE TREATMENT SERVICES (1225647746) bills $719.00/claim for T1017 (Targeted case management) vs avg $39.79 (+8.6σ). $47,454 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.

KEETOOWAH CHEROKEE TREATMENT SERVICESTULSAProvider total: $1.7M

criticalCost OutlierScore: 8.6

Cost-per-claim above average for T1017

ECHOTA BEHAVIORAL HEALTH SERVICES, LLC (1437914777) bills $719.00/claim for T1017 (Targeted case management) vs avg $39.79 (+8.6σ). $26,603 across 37 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.

ECHOTA BEHAVIORAL HEALTH SERVICES, LLCJAYProvider total: $286.2K

criticalCost OutlierScore: 8.5

Cost-per-claim above average for G2211

CHEROKEE NATION (1275799645) bills $612.31/claim for G2211 (Complex e/m visit add on) vs avg $10.47 (+8.5σ). $45,311 across 74 claims.

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

CHEROKEE NATIONTAHLEQUAHProvider total: $6.4M

criticalCost OutlierScore: 8.3

Cost-per-claim above average for H0032

CHEROKEE NATION (1841207156) bills $617.14/claim for H0032 (Mh svc plan dev by non-md) vs avg $70.06 (+8.3σ). $17,280 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.

CHEROKEE NATIONMUSKOGEEProvider total: $608.7K

criticalCost OutlierScore: 8.1

Cost-per-claim above average for 83690

INTEGRIS GROVE HOSPITAL (1467473579) bills $26.75/claim for 83690 (Assay of lipase) vs avg $6.03 (+8.1σ). $17,975 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.

INTEGRIS GROVE HOSPITALGROVEProvider total: $5.8M

criticalCost OutlierScore: 7.8

Cost-per-claim above average for T1017

OSAGE NATION (1659615904) bills $654.00/claim for T1017 (Targeted case management) vs avg $39.79 (+7.8σ). $24,852 across 38 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.

OSAGE NATIONPAWHUSKAProvider total: $3.9M

criticalCost OutlierScore: 7.8

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

LAWTON INDIAN HOSPITAL (1760489223) bills $517.31/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+7.8σ). $474,895 across 918 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.

LAWTON INDIAN HOSPITALLAWTONProvider total: $1.1M

criticalCost OutlierScore: 7.3

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

SALLISAW PUBLIC SCHOOL (1053511337) bills $30.49/claim for 92508 (Tx sp lang voice comm group) vs avg $21.03 (+7.3σ). $21,555 across 707 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.

SALLISAW PUBLIC SCHOOLSALLISAWProvider total: $31.9K

criticalCost OutlierScore: 7.2

Cost-per-claim above average for 92551

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY (1407230790) bills $171.00/claim for 92551 (Pure tone hearing test air) vs avg $13.33 (+7.2σ). $451,269 across 2,639 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.

JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITYALTUSProvider total: $4.2M

criticalCost OutlierScore: 7.1

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

PAWNEE INDIAN HEALTH CENTER (1629174081) bills $479.00/claim for 99213 (Office o/p est low 20 min) vs avg $68.19 (+7.1σ). $19,160 across 40 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.

PAWNEE INDIAN HEALTH CENTERPAWNEEProvider total: $502.0K

criticalCost OutlierScore: 7.1

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

CHELSEA ANDERSON (1952788622) bills $102.36/claim for 92507 (Tx sp lang voice comm indiv) vs avg $66.88 (+7.1σ). $307,281 across 3,002 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.

CHELSEA ANDERSONTULSAProvider total: $307.3K

criticalCost OutlierScore: 7.1

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

INTEGRIS HEALTH PONCA CITY HOSPITAL INC (1548047616) bills $38.73/claim for 80053 (Comprehen metabolic panel) vs avg $9.88 (+7.1σ). $38,730 across 1,000 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.

INTEGRIS HEALTH PONCA CITY HOSPITAL INCPONCA CITYProvider total: $817.8K

criticalCost OutlierScore: 7.0

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

ECHOTA BEHAVIORAL HEALTH SERVICES, LLC (1700641057) bills $719.00/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+7.0σ). $754,231 across 1,049 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.

ECHOTA BEHAVIORAL HEALTH SERVICES, LLCKANSASProvider total: $893.0K

criticalCost OutlierScore: 7.0

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

ECHOTA BEHAVIORAL HEALTH SERVICES, LLC (1437914777) bills $719.00/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+7.0σ). $259,559 across 361 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.

ECHOTA BEHAVIORAL HEALTH SERVICES, LLCJAYProvider total: $286.2K

criticalCost OutlierScore: 6.6

Cost-per-claim above average for 00170

NORMAN ANESTHESIA PROVIDERS, P.C. (1881652667) bills $1,037.14/claim for 00170 (Anesth procedure on mouth) vs avg $293.24 (+6.6σ). $14,520 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.

NORMAN ANESTHESIA PROVIDERS, P.C.NORMANProvider total: $995.0K

criticalCost OutlierScore: 6.5

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

CHOCTAW NATION OF OKLAHOMA (1659347623) bills $664.40/claim for A0425 (Ground mileage) vs avg $99.26 (+6.5σ). $187,361 across 282 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.

CHOCTAW NATION OF OKLAHOMATALIHINAProvider total: $83.5M

criticalCost OutlierScore: 6.4

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

CHEROKEE NATION (1659388965) bills $660.99/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+6.4σ). $95,843 across 145 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.

CHEROKEE NATIONJAYProvider total: $103.3K

criticalCost OutlierScore: 6.4

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

CHEROKEE NATION (1558377226) bills $656.72/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+6.4σ). $340,179 across 518 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.

CHEROKEE NATIONVINITAProvider total: $433.8K

criticalCost OutlierScore: 6.3

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

CHEROKEE NATION (1326054081) bills $654.00/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+6.3σ). $11,772 across 18 claims.

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

CHEROKEE NATIONSALINAProvider total: $119.0K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for D9222

JAMISON METCALF (1679829477) bills $407.92/claim for D9222 (Deep sedation/general anesthesia first 15 min) vs avg $84.70 (+6.3σ). $43,240 across 106 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.

JAMISON METCALFOKLAHOMA CITYProvider total: $83.7K

criticalCost OutlierScore: 6.3

Cost-per-claim above average for J3301

SAINT MEDICAL GROUP, LLC (1033755426) bills $36.58/claim for J3301 (Triamcinolone acet inj nos) vs avg $4.94 (+6.3σ). $24,178 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.

SAINT MEDICAL GROUP, LLCOKLAHOMA CITYProvider total: $550.6K

criticalCost OutlierScore: 6.3

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

CARNEGIE INDIAN HEALTH CENTER (1457459158) bills $577.10/claim for 99211 (Off/op est may x req phy/qhp) vs avg $36.10 (+6.2σ). $1,843,829 across 3,195 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.

CARNEGIE INDIAN HEALTH CENTERCARNEGIEProvider total: $1.8M

criticalCost OutlierScore: 6.3

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

CHEROKEE NATION (1992711345) bills $646.20/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+6.2σ). $158,964 across 246 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.

CHEROKEE NATIONSTILWELLProvider total: $176.6K

criticalCost OutlierScore: 6.2

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

PAWHUSKA HOSPITAL INC (1871092494) bills $379.79/claim for 99203 (Office o/p new low 30 min) vs avg $91.29 (+6.2σ). $60,387 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.

PAWHUSKA HOSPITAL INCPAWHUSKAProvider total: $2.8M

criticalCost OutlierScore: 6.2

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

ECHOTA BEHAVIORAL HEALTH SERVICES, LLC (1407477920) bills $643.02/claim for H0004 (Behavioral health counseling and therapy, per 15 minutes) vs avg $71.58 (+6.2σ). $74,590 across 116 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.

ECHOTA BEHAVIORAL HEALTH SERVICES, LLCTAHLEQUAHProvider total: $74.6K

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