Connecticut Children's Medical Center
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 96 procedure codes: 99285 at 22.8× median, 99283 at 5.6× 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.
Risk Assessment
Bills $1,951.24 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 22.8× the national median of $85.65.
Bills $235.83 per claim for 99283 (Emergency dept visit, moderate complexity) — 5.5× the national median of $42.48.
Bills $421.30 per claim for 99284 (Emergency dept visit, high complexity) — 6.1× the national median of $69.51.
Billing in the top 1% nationally for 4 procedure codes: 99285, 42820, G0379.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$248.9M
$248,942,412
Total Claims
2.5M
Beneficiaries
1.8M
1.4 claims/patient
Avg Cost/Claim
$101
#332 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Connecticut Children's Medical Center is a General Acute Care Hospital, Children provider based in Hartford, CT. From the 2018–2024 period, this provider received $248.9M in Medicaid payments across 2.5M claims.
Why This Matters
This provider received $248.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 31,117 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 17% of total spending.
$42.8M
22K claims
$1,951.24
$85.65
Emergency dept visit, high/urgent complexity
$42.8M
22K claims · 17.2%
$23.7M
101K claims
$235.83
$42.48
Emergency dept visit, moderate complexity
$23.7M
101K claims · 9.5%
$22.1M
53K claims
$421.30
$69.51
Emergency dept visit, high complexity
$22.1M
53K claims · 8.9%
$15.1M
8K claims
$1,998.14
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$15.1M
8K claims · 6.1%
$14.5M
3K claims
$5,093.81
$331.68
Tonsillectomy and adenoidectomy, under age 12
$14.5M
3K claims · 5.8%
$11.4M
84K claims
$135.78
$37.72
Emergency dept visit, low complexity
$11.4M
84K claims · 4.6%
Therapeutic exercises, each 15 min
$6.9M
93K claims · 2.8%
$6.9M
2K claims
$4,330.05
$4,027.41
Injection, vedolizumab, one milligram
$6.9M
2K claims · 2.8%
$5.4M
6K claims
$965.67
$233.73
Polysomnography, sleep study, 6+ hours
$5.4M
6K claims · 2.2%
$4.5M
2K claims
$2,155.84
$48.25
Direct admission to hospital observation
$4.5M
2K claims · 1.8%
Speech/hearing/language treatment
$4.3M
47K claims · 1.7%
$4.2M
84K claims
$49.74
$33.11
Therapeutic activities, each 15 min
$4.2M
84K claims · 1.7%
$4.0M
1K claims · 1.6%
Tympanostomy, general anesthesia
$3.5M
4K claims · 1.4%
$3.0M
10K claims
$311.48
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$3.0M
10K claims · 1.2%
$2.9M
6K claims
$455.12
$112.83
Echocardiography, transthoracic, limited
$2.9M
6K claims · 1.2%
$2.8M
6K claims
$484.48
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.8M
6K claims · 1.1%
$2.8M
3K claims · 1.1%
Upper GI endoscopy with biopsy
$2.8M
4K claims · 1.1%
$2.4M
19K claims
$123.48
$97.61
Respiratory virus detection, 6-11 targets, nucleic acid
$2.4M
19K claims · 1.0%
$2.2M
443 claims · 0.9%
$2.2M
12K claims
$178.33
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$2.2M
12K claims · 0.9%
$1.9M
4K claims · 0.8%
$1.9M
7K claims · 0.8%
Ultrasound, abdominal, limited
$1.9M
15K claims · 0.8%
$1.9M
1K claims · 0.8%
Hospital outpatient clinic visit
$1.7M
15K claims · 0.7%
$1.7M
12K claims
$142.87
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$1.7M
12K claims · 0.7%
Chest X-ray, 2 views
$1.7M
24K claims · 0.7%
$1.7M
7K claims
$237.49
$110.87
Evaluation of speech sound production with language comprehension
$1.7M
7K claims · 0.7%
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