Dayton Children's Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 176 procedure codes: 99214 at 2.8× median, 99213 at 3.6× 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 $137.37 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 3.6× the national median of $37.81.
Bills $145.50 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.4× the national median of $42.48.
Bills $218.81 per claim for U0004 (COVID-19 test, nucleic acid detection, CDC lab only) — 3.6× the national median of $60.05.
Billing in the top 1% nationally for 7 procedure codes: U0004, 96361, D2930.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$290.6M
$290,632,681
Total Claims
3.0M
Beneficiaries
2.5M
1.2 claims/patient
Avg Cost/Claim
$96
#257 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Dayton Children's Hospital is a General Acute Care Hospital, Children provider based in Dayton, OH. From the 2018–2024 period, this provider received $290.6M in Medicaid payments across 3.0M claims.
Why This Matters
This provider received $290.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 36,329 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 13% of total spending.
$37.8M
254K claims
$148.66
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$37.8M
254K claims · 13.0%
$37.8M
275K claims
$137.37
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$37.8M
275K claims · 13.0%
$29.9M
176K claims
$170.28
$69.51
Emergency dept visit, high complexity
$29.9M
176K claims · 10.3%
$23.2M
159K claims
$145.50
$42.48
Emergency dept visit, moderate complexity
$23.2M
159K claims · 8.0%
Speech/hearing/language treatment
$17.8M
162K claims · 6.1%
$10.0M
46K claims
$218.81
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$10.0M
46K claims · 3.4%
$9.0M
48K claims
$186.20
$85.65
Emergency dept visit, high/urgent complexity
$9.0M
48K claims · 3.1%
Tympanostomy, general anesthesia
$8.4M
4K claims · 2.9%
Therapeutic exercises, each 15 min
$6.7M
54K claims · 2.3%
$5.6M
34K claims
$163.31
$74.09
Office/outpatient visit, high complexity
$5.6M
34K claims · 1.9%
$5.5M
11K claims
$503.30
$38.92
IV infusion, hydration, each additional hour
$5.5M
11K claims · 1.9%
Therapeutic activities, each 15 min
$4.9M
36K claims · 1.7%
$4.6M
3K claims
$1,449.70
$331.68
Tonsillectomy and adenoidectomy, under age 12
$4.6M
3K claims · 1.6%
$3.9M
5K claims
$755.44
$120.85
Prefabricated stainless steel crown, primary tooth
$3.9M
5K claims · 1.3%
Psychotherapy, 45 minutes
$3.0M
15K claims · 1.0%
Emergency dept visit, low complexity
$2.7M
21K claims · 0.9%
$2.4M
15K claims
$166.80
$10.88
Pressurized or nonpressurized inhalation treatment
$2.4M
15K claims · 0.8%
$2.3M
26K claims
$89.31
$99.39
Hospital observation service, per hour
$2.3M
26K claims · 0.8%
$2.2M
4K claims
$566.44
$57.39
Extraction, erupted tooth or exposed root
$2.2M
4K claims · 0.8%
$2.1M
3K claims
$647.15
$763.43
Unlisted procedure, dentoalveolar structures
$2.1M
3K claims · 0.7%
$2.1M
16K claims
$129.56
$75.18
Preventive medicine, established patient, age 1-4
$2.1M
16K claims · 0.7%
$2.1M
17K claims
$124.26
$69.35
Preventive medicine, established patient, infant (under 1)
$2.1M
17K claims · 0.7%
$2.0M
7K claims
$296.09
$9.10
Developmental screening, per standardized instrument
$2.0M
7K claims · 0.7%
$1.9M
9K claims
$214.92
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.9M
9K claims · 0.7%
$1.7M
2K claims
$995.95
$233.73
Polysomnography, sleep study, 6+ hours
$1.7M
2K claims · 0.6%
$1.5M
3K claims
$442.71
$54.68
Echocardiography, transthoracic, complete, with Doppler
$1.5M
3K claims · 0.5%
$1.5M
749 claims
$1,936.18
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$1.5M
749 claims · 0.5%
Psychiatric diagnostic evaluation
$1.4M
4K claims · 0.5%
$1.4M
34K claims
$41.12
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$1.4M
34K claims · 0.5%
$1.4M
4K claims
$317.70
$61.57
IV infusion, hydration, initial, 31 minutes to 1 hour
$1.4M
4K claims · 0.5%
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