Seattle Children's Hospital
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 93 procedure codes: 99214 at 2.4× median, 99212 at 6.4× 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 $159.92 per claim for 99212 (Office/outpatient visit, low complexity) — 6.4× the national median of $25.06.
Bills $162.97 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.8× the national median of $42.48.
Bills $154.92 per claim for 99282 (Emergency dept visit, low complexity) — 4.1× the national median of $37.72.
Billing in the top 1% nationally for 2 procedure codes: D7140, 96366.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$219.5M
$219,534,927
Total Claims
3.6M
Beneficiaries
3.1M
1.2 claims/patient
Avg Cost/Claim
$61
#390 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Seattle Children's Hospital is a Prosthetic/Orthotic Supplier provider based in Seattle, WA. From the 2018–2024 period, this provider received $219.5M in Medicaid payments across 3.6M claims.
Why This Matters
This provider received $219.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,441 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 23% of total spending.
$50.1M
384K claims
$130.47
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$50.1M
384K claims · 22.8%
$13.1M
82K claims
$159.92
$25.06
Office/outpatient visit, low complexity
$13.1M
82K claims · 6.0%
$9.9M
61K claims
$162.97
$42.48
Emergency dept visit, moderate complexity
$9.9M
61K claims · 4.5%
$8.1M
62K claims
$130.64
$84.03
Office/outpatient visit, new patient, mod-high complexity
$8.1M
62K claims · 3.7%
Emergency dept visit, low complexity
$6.9M
45K claims · 3.2%
$6.0M
38K claims
$157.35
$69.51
Emergency dept visit, high complexity
$6.0M
38K claims · 2.7%
$5.8M
3K claims
$2,090.42
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$5.8M
3K claims · 2.6%
$4.9M
12K claims
$428.47
$54.68
Echocardiography, transthoracic, complete, with Doppler
$4.9M
12K claims · 2.2%
$4.9M
3K claims
$1,695.34
$331.68
Tonsillectomy and adenoidectomy, under age 12
$4.9M
3K claims · 2.2%
$4.4M
2K claims · 2.0%
$3.8M
18K claims
$207.67
$99.39
Hospital observation service, per hour
$3.8M
18K claims · 1.7%
$3.5M
5K claims
$755.14
$233.73
Polysomnography, sleep study, 6+ hours
$3.5M
5K claims · 1.6%
$3.3M
8K claims
$429.12
$112.83
Echocardiography, transthoracic, limited
$3.3M
8K claims · 1.5%
Tympanostomy, general anesthesia
$3.3M
3K claims · 1.5%
MRI brain without contrast
$3.2M
10K claims · 1.5%
$3.0M
20K claims
$150.58
$40.11
Office/outpatient visit, new patient, low complexity
$3.0M
20K claims · 1.4%
$2.8M
50K claims
$55.80
$33.11
Therapeutic activities, each 15 min
$2.8M
50K claims · 1.3%
$2.6M
5K claims
$482.42
$38.92
IV infusion, hydration, each additional hour
$2.6M
5K claims · 1.2%
$2.2M
5K claims · 1.0%
$2.2M
5K claims · 1.0%
$2.2M
3K claims · 1.0%
Upper GI endoscopy with biopsy
$2.2M
4K claims · 1.0%
$2.1M
17K claims
$119.97
$74.09
Office/outpatient visit, high complexity
$2.1M
17K claims · 1.0%
$2.0M
4K claims
$473.42
$43.68
Chemotherapy infusion, each additional hour
$2.0M
4K claims · 0.9%
$2.0M
2K claims
$926.55
$57.39
Extraction, erupted tooth or exposed root
$2.0M
2K claims · 0.9%
$1.8M
4K claims
$453.18
$40.12
IV infusion, therapeutic/prophylactic/diagnostic, each additional hour
$1.8M
4K claims · 0.8%
$1.8M
2K claims · 0.8%
$1.8M
9K claims
$188.19
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.8M
9K claims · 0.8%
$1.7M
12K claims
$149.23
$37.35
Ultrasound, retroperitoneal, complete
$1.7M
12K claims · 0.8%
$1.5M
4K claims · 0.7%
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