Holzer Hospital Foundation
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $105.23 per claim for G0463 (Hospital outpatient clinic visit), which is 4.0× the national median of $26.41.
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $105.23 per claim for G0463 (Hospital outpatient clinic visit) — 4.0× the national median of $26.41.
Bills $150.55 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.5× the national median of $42.48.
Bills $354.06 per claim for 96361 (IV infusion, hydration, each additional hour) — 9.1× the national median of $38.92.
Billing in the top 1% nationally for 3 procedure codes: U0003, 0240U, 96366.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$121.5M
$121,513,508
Total Claims
1.9M
Beneficiaries
1.6M
1.2 claims/patient
Avg Cost/Claim
$62
#983 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Holzer Hospital Foundation is a General Acute Care Hospital Rural provider based in Gallipolis, OH. From the 2018–2024 period, this provider received $121.5M in Medicaid payments across 1.9M claims.
Why This Matters
This provider received $121.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,189 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 (G0463 (Hospital outpatient clinic visit)) accounts for 61% of total spending.
Hospital outpatient clinic visit
$74.7M
710K claims · 61.5%
$5.0M
33K claims
$151.23
$69.51
Emergency dept visit, high complexity
$5.0M
33K claims · 4.1%
$4.7M
31K claims
$150.55
$42.48
Emergency dept visit, moderate complexity
$4.7M
31K claims · 3.8%
$2.8M
8K claims
$354.06
$38.92
IV infusion, hydration, each additional hour
$2.8M
8K claims · 2.3%
$2.4M
13K claims
$194.46
$91.47
Proprietary lab analysis, genomic sequencing
$2.4M
13K claims · 2.0%
CT head/brain without contrast
$1.6M
5K claims · 1.3%
Therapeutic exercises, each 15 min
$1.5M
16K claims · 1.3%
$1.4M
6K claims
$217.80
$63.08
Infectious disease detection (COVID-19)
$1.4M
6K claims · 1.1%
CT abdomen and pelvis with contrast
$1.3M
4K claims · 1.1%
Upper GI endoscopy with biopsy
$1.2M
3K claims · 1.0%
$1.2M
6K claims · 1.0%
Emergency dept visit, low complexity
$946K
7K claims · 0.8%
Tympanostomy, general anesthesia
$939K
462 claims · 0.8%
$750K
5K claims
$164.17
$85.65
Emergency dept visit, high/urgent complexity
$750K
5K claims · 0.6%
$749K
2K claims
$388.80
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$749K
2K claims · 0.6%
$748K
2K claims
$352.53
$60.19
CT abdomen and pelvis without contrast
$748K
2K claims · 0.6%
$706K
1K claims
$494.37
$470.36
Injection, onabotulinumtoxinA, 1 unit
$706K
1K claims · 0.6%
Comprehensive metabolic panel
$698K
47K claims · 0.6%
$697K
4K claims
$176.97
$169.17
Respiratory virus detection, 12-25 targets, nucleic acid
$697K
4K claims · 0.6%
$650K
4K claims
$171.00
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$650K
4K claims · 0.5%
$547K
5K claims
$118.96
$52.03
Emergency dept visit, minimal complexity
$547K
5K claims · 0.5%
$493K
641 claims
$768.87
$255.17
Colonoscopy with polyp removal, snare technique
$493K
641 claims · 0.4%
CT angiography, chest, with contrast
$483K
1K claims · 0.4%
Fetal non-stress test
$457K
3K claims · 0.4%
$432K
1K claims
$359.37
$54.68
Echocardiography, transthoracic, complete, with Doppler
$432K
1K claims · 0.4%
$404K
508 claims
$794.75
$233.73
Polysomnography, sleep study, 6+ hours
$404K
508 claims · 0.3%
$374K
90K claims
$4.15
$4.71
Complete blood count (CBC) with differential, automated
$374K
90K claims · 0.3%
Colonoscopy, diagnostic
$364K
446 claims · 0.3%
$333K
2K claims
$142.06
$29.03
Arthrocentesis, aspiration/injection, major joint
$333K
2K claims · 0.3%
$315K
108K claims
$2.92
$1.57
Collection of venous blood by venipuncture
$315K
108K claims · 0.3%
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