Egleston Children's Hospital at Emory University Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 248 procedure codes: 99285 at 7.8× median, 99283 at 3.9× 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 $669.22 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 7.8× the national median of $85.65.
Bills $166.72 per claim for 99283 (Emergency dept visit, moderate complexity) — 3.9× the national median of $42.48.
Bills $355.36 per claim for 99284 (Emergency dept visit, high complexity) — 5.1× the national median of $69.51.
Billing in the top 1% nationally for 6 procedure codes: 99285, 70551, 70553.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$222.6M
$222,593,125
Total Claims
1.9M
Beneficiaries
1.6M
1.2 claims/patient
Avg Cost/Claim
$115
#382 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Egleston Children's Hospital at Emory University Inc. is a Pediatrics Pediatric Emergency Medicine provider based in Atlanta, GA. From the 2018–2024 period, this provider received $222.6M in Medicaid payments across 1.9M claims.
Why This Matters
This provider received $222.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,824 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 20% of total spending.
$45.5M
68K claims
$669.22
$85.65
Emergency dept visit, high/urgent complexity
$45.5M
68K claims · 20.5%
$28.6M
172K claims
$166.72
$42.48
Emergency dept visit, moderate complexity
$28.6M
172K claims · 12.8%
$26.5M
75K claims
$355.36
$69.51
Emergency dept visit, high complexity
$26.5M
75K claims · 11.9%
$6.1M
17K claims
$354.89
$99.39
Hospital observation service, per hour
$6.1M
17K claims · 2.7%
$5.4M
2,159 claims · 2.4%
$5.2M
1,625 claims
$3,198.30
$1,587.53
Injection, infliximab, excludes biosimilar, 10 mg
$5.2M
1,625 claims · 2.3%
MRI brain without contrast
$4.2M
4,453 claims · 1.9%
$3.8M
2,123 claims
$1,781.73
$133.68
MRI brain without contrast, then with contrast
$3.8M
2,123 claims · 1.7%
Upper GI endoscopy with biopsy
$3.1M
2,094 claims · 1.4%
$2.9M
30K claims
$95.68
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.9M
30K claims · 1.3%
$2.9M
1,754 claims
$1,634.76
$233.73
Polysomnography, sleep study, 6+ hours
$2.9M
1,754 claims · 1.3%
$2.8M
8,086 claims
$345.91
$75.28
Chemotherapy administration, IV infusion, up to 1 hour
$2.8M
8,086 claims · 1.3%
$2.7M
2,678 claims · 1.2%
$2.4M
1,415 claims · 1.1%
$2.2M
1,386 claims
$1,602.34
$331.68
Tonsillectomy and adenoidectomy, under age 12
$2.2M
1,386 claims · 1.0%
$2.0M
23K claims
$84.31
$37.72
Emergency dept visit, low complexity
$2.0M
23K claims · 0.9%
$1.8M
9,808 claims · 0.8%
$1.7M
1,703 claims
$1,021.83
$470.36
Injection, onabotulinumtoxinA, 1 unit
$1.7M
1,703 claims · 0.8%
$1.6M
255 claims · 0.7%
$1.6M
4,130 claims · 0.7%
$1.6M
4,109 claims · 0.7%
Chest X-ray, 2 views
$1.6M
24K claims · 0.7%
$1.6M
948 claims · 0.7%
$1.5M
816 claims · 0.7%
$1.4M
15K claims
$94.49
$54.77
IV infusion, therapeutic/prophylactic/diagnostic, initial, up to 1 hour
$1.4M
15K claims · 0.6%
CT head/brain without contrast
$1.4M
4,163 claims · 0.6%
$1.3M
3,412 claims · 0.6%
$1.3M
2,777 claims
$456.94
$79.28
Duplex scan of arterial inflow and venous outflow, complete
$1.3M
2,777 claims · 0.6%
Tympanostomy, general anesthesia
$1.2M
1,795 claims · 0.6%
$1.2M
367 claims · 0.5%
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