Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Georgia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Georgia only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Georgia (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Egleston Children's Hospital At Emory University, Inc. (NPI 1558416701)

Field	Value
Entity Type	Organization
Organization	Egleston Children's Hospital At Emory University, Inc.
Address	1405 Clifton Rd Ne
City	Atlanta
State	GA
ZIP	30322
Taxonomy	Pediatric Emergency Medicine (Pediatrics) Physician
NPI Enumerated	January 25, 2007

Payer Source	Total Paid
Medicaid	$222.6M
Medicare	$0

Key Findings

EGLESTON CHILDREN'S HOSPITAL AT EMORY UNIVERSITY, INC. reports no Medicare billing on file and $222.6M in lifetime Medicaid revenue, indicating the provider operates effectively as a Medicaid-focused entity rather than a dual-payer facility. The absence of Medicare activity combined with substantial Medicaid receipts concentrates the provider’s reimbursement exposure and contracting dynamics around Medicaid payers and programs.

Revenue is heavily concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes (99285, 99283, 99284) together account for 62.7% of the provider’s total Medicaid revenue. Individually those codes generate $45.5M (28.3%) from 99285, $28.6M (17.8%) from 99283, and $26.5M (16.5%) from 99284, signaling that high-acuity and mid-acuity ED visits are the dominant revenue drivers.

The code mix is consistent with a pediatric emergency and acute care operation: large volumes of ED E/M services (99285/99284/99283) are complemented by hospital observation care (G0378, $6.1M) and a mix of high-cost therapeutics and specialty procedures such as J1569 ($5.4M), J1745 ($5.2M), and J9312 ($1.6M). This pattern suggests the organization manages both acute pediatric emergencies and downstream specialty interventions (infusions, biologics, advanced imaging) within the hospital setting.

On statewide competitive standing, the provider is a dominant outlier for ED volume: 99285 ranks #3 of 139 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code), 99283 ranks #2 of 237 (100th percentile; extreme outlier), and 99284 ranks #5 of 231 (98th percentile; extreme outlier). Those ranks indicate market leadership in pediatric ED services within Georgia and a service footprint much larger than typical peers for these codes.

Beyond ED care, the provider shows leadership in several specialty areas with limited peers: P9016 (red blood cells) generates $2.7M and ranks #1 of 9 providers in-state (100th percentile), J1745 generates $5.2M and ranks #1 of 2 providers (100th percentile), and J9312 generates $1.6M but has no peer comparison available (rank #1 of 1). These items reflect capacity to deliver high-cost therapies and transfusion services at volumes uncommon among peers.

Certain ancillary service lines are notable but more typical in-state: advanced neuro and body MRI codes such as 70551 ($4.2M, ranks #2 of 26, 96th percentile) and 70553 ($3.8M, ranks #4 of 22, 86th percentile) and sleep studies like 95810 ($2.9M, ranks #2 of 10, 89th percentile) represent meaningful additional revenue without the extreme outlier labeling seen in ED E/M codes. Observation services (G0378, $6.1M) are described as typical/unremarkable volume (85th percentile), suggesting standard hospital throughput for observation-level care.

This provider’s NPI was enumerated on 2007-01-25 (~19 years ago), indicating long-tenured participation in the Medicaid program; that tenure aligns with the large, concentrated Medicaid volume and likely reflects an established pediatric emergency referral and specialty-service profile. The longevity supports the interpretation that the high Medicaid volumes and code concentrations are structural to the organization rather than transient.

Several codes outside the top three still show above-typical state volume: 99282 produces $2.0M and ranks #4 of 50 providers (94th percentile; notably above typical state volume for this code), and 96365 produces $1.4M and ranks #4 of 29 providers (89th percentile; notably above typical). At the same time, many high-cost drug and procedure codes are labeled “typical, unremarkable volume” despite high per-claim pricing, indicating a mix of distinctive ED dominance alongside more standard specialty service utilization patterns.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

584 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	68,050	$670	$45.5M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	171,540	$170	$28.6M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	74,520	$360	$26.5M
G0378	Hospital observation service, per hour	17,140	$360	$6.1M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	2,160	$2,500	$5.4M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,630	$3,200	$5.2M
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	4,450	$950	$4.2M
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	2,120	$1,780	$3.8M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	2,090	$1,470	$3.1M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	30,170	$100	$2.9M

Showing 1–10 of 584

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Georgia providers billing the same CPT/HCPCS codes.

Claims Volume vs. Georgia Distribution

Egleston Children's Hospital At Emory University, Inc. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

584 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	10	1,420	$1,740	$4.4M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	1,010	$3,000	$3M
44970	Laparoscopy, surgical, appendectomy	3	10	20	$4,080	$2.5M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	1	10	650	$2,620	$2.5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	3	140	200	$280	$1.9M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	2	10	360	$1,510	$1.6M
J9312	Injection, rituximab, 10 mg	1	10	260	$6,400	$1.6M
70543	The provider obtains multi–sequence and multi–planar images of the orbits, face, and/or neck initially without the use of contrast and then injects contrast to see additional images and diagnose…	2	10	470	$1,970	$1.5M
95812	Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. Extended monitoring is a routine…	2	10	380	$460	$1.3M
72197	In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the pelvis first without using contrast and again after injecting contrast material.	2	10	290	$1,900	$1.2M

Showing 1–10 of 584

Related Providers

Other providers that share a Tax Identification Number (TIN) with Egleston Children's Hospital At Emory University, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arthur M. Blank Hospital, Inc.	GA	Children's Hospital	$0	$116.5M

Nearby Providers

Other providers in the same ZIP code as Egleston Children's Hospital At Emory University, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Chris Bergstrom	GA	Ophthalmology Physician	$2M	$0
The Emory Clinic Inc	GA	Ambulatory Surgical Clinic/Center	$1.6M	$0
Ashesh Jani	GA	Radiation Oncology Physician	$563K	$0
George Hubbard	GA	Ophthalmology Physician	$553K	$0
Karen Godette	GA	Radiation Oncology Physician	$482.1K	$0
Blaine Cribbs	GA	Ophthalmology Physician	$453.6K	$0
Sibo Tian	GA	Radiation Oncology Physician	$417.5K	$0
Egleston Pediatric Group	GA	Pediatrics Physician	$0	$398.8K
Samuel Milton	GA	Physical Medicine & Rehabilitation Physician	$324.8K	$0
Justin Mcclain	GA	Body Imaging Physician	$255.6K	$240

Egleston Children's Hospital At Emory University, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References