Presbyterian Healthcare Services
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 64 procedure codes: 99391 at 1.5× median, 99232 at 2.1× 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.
Risk Assessment
Bills $42.63 per claim for 90472 (Immunization administration, each additional vaccine) — 3.6× the national median of $11.79.
Bills $42.72 per claim for 90461 (Immunization admin, additional vaccine, counseling) — 6.2× the national median of $6.93.
Billing above the 90th percentile for 9 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Surgery Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $240.2M is at the 99th percentile among 8 Surgery providers.
Above 99th percentile for this specialty — higher spending than 7 of 8 peers
Total Paid
$240.2M
$240,239,259
Total Claims
4.0M
Beneficiaries
3.7M
1.1 claims/patient
Avg Cost/Claim
$60
#348 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Presbyterian Healthcare Services is a Surgery provider based in Albuquerque, NM. From the 2018–2024 period, this provider received $240.2M in Medicaid payments across 4.0M claims.
Why This Matters
This provider received $240.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 30,029 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 28% of total spending.
$66.2M
792K claims
$83.53
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$66.2M
792K claims · 27.5%
$29.9M
470K claims
$63.54
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$29.9M
470K claims · 12.4%
$13.3M
97K claims
$137.64
$85.65
Emergency dept visit, high/urgent complexity
$13.3M
97K claims · 5.5%
$8.8M
81K claims
$107.53
$74.09
Office/outpatient visit, high complexity
$8.8M
81K claims · 3.6%
$7.2M
16K claims
$439.33
$470.36
Injection, onabotulinumtoxinA, 1 unit
$7.2M
16K claims · 3.0%
$7.2M
71K claims
$102.05
$69.35
Preventive medicine, established patient, infant (under 1)
$7.2M
71K claims · 3.0%
$6.4M
127K claims
$50.44
$23.99
Subsequent hospital care, per day, moderate complexity
$6.4M
127K claims · 2.7%
Emergency dept visit, high complexity
$6.4M
65K claims · 2.7%
$6.1M
61K claims
$101.26
$75.18
Preventive medicine, established patient, age 1-4
$6.1M
61K claims · 2.6%
$4.9M
37K claims
$132.55
$84.03
Office/outpatient visit, new patient, mod-high complexity
$4.9M
37K claims · 2.0%
$4.4M
57K claims
$77.25
$35.30
Subsequent hospital care, per day, high complexity
$4.4M
57K claims · 1.8%
$4.2M
42K claims
$100.94
$74.82
Preventive medicine, established patient, age 5-11
$4.2M
42K claims · 1.7%
$3.8M
42K claims
$89.15
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3.8M
42K claims · 1.6%
$3.5M
29K claims
$121.81
$101.24
Critical care, first 30-74 minutes
$3.5M
29K claims · 1.5%
$2.7M
27K claims
$100.82
$80.15
Preventive medicine, established patient, age 12-17
$2.7M
27K claims · 1.1%
$2.5M
58K claims
$42.63
$11.79
Immunization administration, each additional vaccine
$2.5M
58K claims · 1.0%
$2.5M
29K claims
$84.01
$43.85
Hospital discharge day management, more than 30 minutes
$2.5M
29K claims · 1.0%
Injection, omalizumab, 5 mg
$2.3M
1K claims · 1.0%
$2.3M
40K claims
$57.10
$42.48
Emergency dept visit, moderate complexity
$2.3M
40K claims · 0.9%
$2.1M
30K claims
$69.47
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.1M
30K claims · 0.9%
$2.0M
40K claims
$49.33
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$2.0M
40K claims · 0.8%
$2.0M
53K claims
$36.97
$28.46
Streptococcus Group A detection, nucleic acid, amplified probe
$2.0M
53K claims · 0.8%
$1.8M
92K claims
$20.10
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$1.8M
92K claims · 0.8%
$1.8M
42K claims
$42.72
$6.93
Immunization admin, additional vaccine, counseling
$1.8M
42K claims · 0.7%
$1.8M
10K claims
$182.62
$111.09
Office/outpatient visit, new patient, high complexity
$1.8M
10K claims · 0.7%
$1.7M
45K claims
$38.24
$25.06
Office/outpatient visit, low complexity
$1.7M
45K claims · 0.7%
$1.6M
12K claims
$134.73
$67.32
Initial hospital care, per day, high complexity
$1.6M
12K claims · 0.7%
$1.6M
15K claims
$104.71
$51.25
Initial hospital care, per day, moderate complexity
$1.6M
15K claims · 0.7%
$1.5M
217K claims
$7.11
$5.60
Electrocardiogram, interpretation and report only
$1.5M
217K claims · 0.6%
Psychotherapy, 60 minutes
$1.5M
15K claims · 0.6%
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