Presbyterian Healthcare Services
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 172 procedure codes: 99285 at 2.8× median, 99284 at 2.6× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $135.17 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.2× the national median of $42.48.
Bills $299.41 per claim for 74177 (CT abdomen and pelvis with contrast) — 4.5× the national median of $65.76.
Bills $59.01 per claim for 93005 (Electrocardiogram, tracing only, without interpretation) — 7.9× the national median of $7.50.
Billing above the 90th percentile for 9 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Emergency Medicine Peers
Total spending distribution among 11 providers in this specialty
This provider's total spending of $345.5M is at the 99th percentile among 11 Emergency Medicine providers.
Above 99th percentile for this specialty — higher spending than 10 of 11 peers
Total Paid
$345.5M
$345,535,538
Total Claims
6.8M
Beneficiaries
6.1M
1.1 claims/patient
Avg Cost/Claim
$51
#202 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Presbyterian Healthcare Services is a Emergency Medicine provider based in Albuquerque, NM. From the 2018–2024 period, this provider received $345.5M in Medicaid payments across 6.8M claims.
Why This Matters
This provider received $345.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 43,191 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (99285 (Emergency dept visit, high/urgent complexity)) accounts for 16% of total spending.
$56.4M
234K claims
$240.33
$85.65
Emergency dept visit, high/urgent complexity
$56.4M
234K claims · 16.3%
$46.5M
258K claims
$180.13
$69.51
Emergency dept visit, high complexity
$46.5M
258K claims · 13.5%
$17.2M
127K claims
$135.17
$42.48
Emergency dept visit, moderate complexity
$17.2M
127K claims · 5.0%
CT abdomen and pelvis with contrast
$10.9M
37K claims · 3.2%
$9.4M
76K claims
$124.08
$97.61
Respiratory virus detection, 6-11 targets, nucleic acid
$9.4M
76K claims · 2.7%
$7.0M
2K claims · 2.0%
$7.0M
153K claims
$45.76
$26.41
Hospital outpatient clinic visit
$7.0M
153K claims · 2.0%
$6.7M
81K claims
$82.54
$63.08
Infectious disease detection (COVID-19)
$6.7M
81K claims · 1.9%
$5.9M
101K claims
$59.01
$7.50
Electrocardiogram, tracing only, without interpretation
$5.9M
101K claims · 1.7%
CT head/brain without contrast
$5.0M
31K claims · 1.4%
Upper GI endoscopy with biopsy
$4.5M
11K claims · 1.3%
$4.5M
9K claims
$500.88
$99.39
Hospital observation service, per hour
$4.5M
9K claims · 1.3%
$3.6M
25K claims
$147.29
$120.85
Prefabricated stainless steel crown, primary tooth
$3.6M
25K claims · 1.1%
$3.5M
93K claims
$38.17
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$3.5M
93K claims · 1.0%
$3.4M
28K claims
$121.42
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$3.4M
28K claims · 1.0%
$3.0M
399K claims
$7.61
$4.71
Complete blood count (CBC) with differential, automated
$3.0M
399K claims · 0.9%
$3.0M
63K claims
$48.00
$35.43
Drug test, presumptive, by chemistry analyzers
$3.0M
63K claims · 0.9%
$3.0M
61K claims
$48.70
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$3.0M
61K claims · 0.9%
Therapeutic exercises, each 15 min
$2.8M
64K claims · 0.8%
$2.8M
36K claims
$77.30
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.8M
36K claims · 0.8%
Chest X-ray, 2 views
$2.7M
55K claims · 0.8%
Basic metabolic panel
$2.4M
252K claims · 0.7%
$2.4M
68K claims
$34.74
$24.95
Chlamydia detection, nucleic acid, amplified probe
$2.4M
68K claims · 0.7%
$2.3M
68K claims
$34.42
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$2.3M
68K claims · 0.7%
$2.3M
805 claims · 0.7%
CT angiography, chest, with contrast
$2.2M
8K claims · 0.6%
Colonoscopy with biopsy
$2.2M
5K claims · 0.6%
$2.1M
3K claims
$769.33
$233.73
Polysomnography, sleep study, 6+ hours
$2.1M
3K claims · 0.6%
$2.0M
46K claims
$43.09
$35.80
Surgical pathology, gross and microscopic examination
$2.0M
46K claims · 0.6%
$1.9M
20K claims
$97.09
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.9M
20K claims · 0.6%
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