Wakemed
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $356.73 per claim for 99284 (Emergency dept visit, high complexity), which is 5.1× the national median of $69.51.
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $356.73 per claim for 99284 (Emergency dept visit, high complexity) — 5.1× the national median of $69.51.
Bills $178.14 per claim for 99283 (Emergency dept visit, moderate complexity) — 4.2× the national median of $42.48.
Bills $382.51 per claim for 99285 (Emergency dept visit, high/urgent complexity) — 4.5× the national median of $85.65.
Billing in the top 1% nationally for 2 procedure codes: 90460, 90461.
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 $140.7M is at the 25th percentile among 156 General Acute Care Hospital providers.
Total Paid
$140.7M
$140,710,773
Total Claims
1.5M
Beneficiaries
1.3M
1.1 claims/patient
Avg Cost/Claim
$95
#786 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Wakemed is a General Acute Care Hospital provider based in Raleigh, NC. From the 2018–2024 period, this provider received $140.7M in Medicaid payments across 1.5M claims.
Why This Matters
This provider received $140.7M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,588 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 (99284 (Emergency dept visit, high complexity)) accounts for 47% of total spending.
$65.6M
184K claims
$356.73
$69.51
Emergency dept visit, high complexity
$65.6M
184K claims · 46.6%
$29.7M
167K claims
$178.14
$42.48
Emergency dept visit, moderate complexity
$29.7M
167K claims · 21.1%
Emergency dept visit, low complexity
$6.2M
64K claims · 4.4%
$5.4M
30K claims
$180.52
$91.47
Proprietary lab analysis, genomic sequencing
$5.4M
30K claims · 3.9%
$5.3M
14K claims
$382.51
$85.65
Emergency dept visit, high/urgent complexity
$5.3M
14K claims · 3.7%
$4.0M
24K claims · 2.8%
$2.4M
2K claims
$1,107.24
$763.43
Unlisted procedure, dentoalveolar structures
$2.4M
2K claims · 1.7%
$2.0M
11K claims
$190.23
$99.39
Hospital observation service, per hour
$2.0M
11K claims · 1.4%
$1.7M
47K claims
$36.62
$21.76
Therapeutic/prophylactic/diagnostic IV push, single substance
$1.7M
47K claims · 1.2%
$1.5M
44K claims
$35.06
$7.50
Electrocardiogram, tracing only, without interpretation
$1.5M
44K claims · 1.1%
$1.4M
16K claims
$86.33
$63.08
Infectious disease detection (COVID-19)
$1.4M
16K claims · 1.0%
Chest X-ray, 2 views
$1.3M
25K claims · 1.0%
$1.2M
141K claims
$8.85
$4.71
Complete blood count (CBC) with differential, automated
$1.2M
141K claims · 0.9%
Comprehensive metabolic panel
$905K
82K claims · 0.6%
CT abdomen and pelvis with contrast
$787K
1K claims · 0.6%
$768K
15K claims
$51.15
$14.92
Therapeutic/prophylactic/diagnostic IV push, each additional substance
$768K
15K claims · 0.5%
$578K
7K claims
$81.80
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$578K
7K claims · 0.4%
$544K
7K claims
$74.21
$9.10
Developmental screening, per standardized instrument
$544K
7K claims · 0.4%
$459K
5K claims
$86.78
$65.45
Respiratory virus detection, 3-5 targets, multiplex
$459K
5K claims · 0.3%
$457K
49K claims
$9.41
$4.20
Human chorionic gonadotropin (hCG) quantitative blood test
$457K
49K claims · 0.3%
$428K
5K claims
$81.99
$6.93
Immunization admin, additional vaccine, counseling
$428K
5K claims · 0.3%
$367K
19K claims
$19.44
$12.93
Office/outpatient visit, minimal complexity
$367K
19K claims · 0.3%
$353K
431 claims · 0.3%
$332K
9K claims
$37.57
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$332K
9K claims · 0.2%
$287K
9K claims
$30.79
$24.95
Chlamydia detection, nucleic acid, amplified probe
$287K
9K claims · 0.2%
$283K
9K claims
$30.36
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$283K
9K claims · 0.2%
CT head/brain without contrast
$277K
2K claims · 0.2%
Urinalysis, automated, with microscopy
$255K
65K claims · 0.2%
$243K
8K claims
$28.79
$15.76
Infectious disease detection, COVID-19, antigen
$243K
8K claims · 0.2%
$237K
22K claims
$10.58
$5.31
Urine culture, colony count, with identification
$237K
22K claims · 0.2%
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