Stanford Health Care
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 253 procedure codes: J9271 at 2.5× median, 78815 at 4.2× 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 $1,371.57 per claim for 78815 (PET imaging for limited area) — 4.2× the national median of $325.10.
Bills $2,053.21 per claim for J9035 (Injection, bevacizumab, 10 mg) — 47.0× the national median of $43.71.
Bills $766.03 per claim for 70553 (MRI brain without contrast, then with contrast) — 5.7× the national median of $133.68.
Billing in the top 1% nationally for 3 procedure codes: 99284, 99283, 99281.
This is a statistical summary, not an accusation. See our methodology.
Compared to General Acute Care Hospital Peers
Total spending distribution among 156 providers in this specialty
This provider's total spending of $264.8M is at the 75th percentile among 156 General Acute Care Hospital providers.
Total Paid
$264.8M
$264,820,794
Total Claims
3.9M
Beneficiaries
3.1M
1.3 claims/patient
Avg Cost/Claim
$67
#303 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Stanford Health Care is a General Acute Care Hospital provider based in Stanford, CA. From the 2018–2024 period, this provider received $264.8M in Medicaid payments across 3.9M claims.
Why This Matters
This provider received $264.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,102 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 (J9271 (Injection, pembrolizumab, 1 mg)) accounts for 9% of total spending.
Injection, pembrolizumab, 1 mg
$24.5M
2K claims · 9.3%
Emergency room visit
$11.3M
126K claims · 4.3%
Revenue code, clinic services
$8.1M
227K claims · 3.0%
PET imaging for limited area
$7.5M
5K claims · 2.8%
Injection, bevacizumab, 10 mg
$7.0M
3K claims · 2.7%
$6.9M
9K claims
$766.03
$133.68
MRI brain without contrast, then with contrast
$6.9M
9K claims · 2.6%
$6.2M
12K claims
$497.05
$260.56
Intensity modulated radiation treatment delivery, complex
$6.2M
12K claims · 2.3%
CT abdomen and pelvis with contrast
$5.8M
22K claims · 2.2%
Emergency dept visit, high complexity
$5.5M
11K claims · 2.1%
$5.2M
798 claims
$6,490.01
$3,562.28
Nivolumab (Opdivo) injection, 1 mg
$5.2M
798 claims · 2.0%
$5.0M
1K claims · 1.9%
Comprehensive metabolic panel
$4.5M
220K claims · 1.7%
$4.3M
158 claims
$27,114.55
$17,264.74
Ocrelizumab (Ocrevus) injection, 1 mg
$4.3M
158 claims · 1.6%
$4.1M
27K claims
$152.67
$100.62
Respiratory virus detection, 3-5 targets, nucleic acid
$4.1M
27K claims · 1.5%
$4.0M
867 claims
$4,600.90
$1,942.13
Injection, trastuzumab, ten milligrams
$4.0M
867 claims · 1.5%
$3.9M
50K claims
$77.71
$60.05
COVID-19 test, nucleic acid detection, CDC lab only
$3.9M
50K claims · 1.5%
Injection, denosumab, one milligram
$3.8M
2K claims · 1.4%
$3.8M
4K claims
$919.03
$470.36
Injection, onabotulinumtoxinA, 1 unit
$3.8M
4K claims · 1.4%
$3.5M
175K claims
$19.72
$15.37
Telehealth originating site facility fee
$3.5M
175K claims · 1.3%
$3.1M
7K claims
$437.17
$42.48
Emergency dept visit, moderate complexity
$3.1M
7K claims · 1.2%
$3.0M
1K claims
$2,550.16
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$3.0M
1K claims · 1.1%
$2.9M
1K claims · 1.1%
$2.8M
12K claims
$226.58
$54.68
Echocardiography, transthoracic, complete, with Doppler
$2.8M
12K claims · 1.0%
$2.7M
379 claims
$7,171.57
$2,797.07
Injection, natalizumab, one milligram
$2.7M
379 claims · 1.0%
$2.7M
8K claims
$324.74
$52.03
Emergency dept visit, minimal complexity
$2.7M
8K claims · 1.0%
$2.7M
68K claims
$39.50
$12.93
Office/outpatient visit, minimal complexity
$2.7M
68K claims · 1.0%
CT chest with contrast
$2.6M
12K claims · 1.0%
$2.5M
115K claims
$22.13
$26.41
Hospital outpatient clinic visit
$2.5M
115K claims · 1.0%
$2.4M
32K claims
$75.35
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$2.4M
32K claims · 0.9%
Injection, aflibercept, 1 mg
$2.3M
2K claims · 0.9%
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