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Hospital Profile Acute Care Hospital Voluntary non-profit - Other 434 Beds · urban Updated: 2026-06-04

Baptist Health Lexington

1740 Nicholasville Road, Lexington, KY 40503 · 14 Priced Procedures · 84% Patient Recommendation

CMS Overall Rating 4 / 5 Stars
Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Above Fair Market · Negotiate
1.21×vs. Fair Market Price
Position vs. 1.00× Fair Price+21% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

Typical commercial prices here are +21% above the fair benchmark (1.21×) even after accounting for local nurse/doctor wages and patient complexity.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).84/100 · Corroborated
84/100Self-Pay Cash Beats Insurance 29% of the Time
File Completeness85Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic78Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing72Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount100Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High Quality · Fair Price
CMS Star Rating4/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score79/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait181 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

4-Star CMS clinical quality rating paired with 1.21× fair market pricing.

Behavioral Pricing FingerprintHigh-HHI Market Leverage

Consolidated System Premium Pricer

Operating in a concentrated regional market (CBSA HHI 2,973), Baptist Health Lexington commands a 1.21× BaseRate commercial premium across insurers. Self-pay cash quotes, in-state peer hospitals, and freestanding outpatient facilities offer critical leverage against consolidated system pricing.

#43 of 68 in KY · 61st State Percentile#2,035 of 3,385 in U.S. · 60th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.89× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 29% of shoppable procedures (99/100 Cash Honesty)
  • 4-Star CMS clinical rating with 84% patient recommendation (79/100 safety score)
  • IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (36.8% AGB cap)
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 1.2× markup over Medicare rates
  • Captive ER (2.0×) & laboratory (2.6×) services average 1.20× higher multiples than routine shoppable care (1.0×)
  • Even at low-cost facilities (1.21× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
  • Consolidated metro market (HHI 2,973) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
1.0× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.20× Divergence
1.2× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+3% Upper Tail
Q25 0.89× · Q50 0.97× · Q75 1.00×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.
Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×
Front-Door Shoppable CareFront-Door Shoppable
1.0× MedicareGood
Outpatient Surgery & ORBack-Door Captive
1.2× MedicareGood
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
2.3× MedicareFair
Back-Door Captive ER VisitsBack-Door Captive
2.0× MedicareGood
Inpatient Lab & PathologyBack-Door Captive
2.6× MedicareFair
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
0.9× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
29% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
4 CMS · 79/100Fair

Procedure Prices at Baptist Health Lexington

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 14 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $16,900 0.9×
Heart stent placement (inpatient stay)
MS-DRG Code: 322
 $16,825 0.9×
Hip or knee replacement (inpatient stay)
MS-DRG Code: 470
 $16,781 0.9×
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $7,094 0.9×
Residential mental health treatment
HCPCS Code: H2036
 $1,613 unverified
Trauma team activation
HCPCS Code: G0390
 $1,414 1.0×
Hospital observation (per hour)
HCPCS Code: G0378
 $199 2.3×
Drug screening test
HCPCS Code: G0480
 $116 1.0×
Diagnostic procedure preparation
HCPCS Code: G0279
 $38 1.1×
Flu vaccine injection
HCPCS Code: G0008
 $50 1.0×
Pneumonia vaccine injection
HCPCS Code: G0009
 $50 1.0×
Colorectal cancer screening
HCPCS Code: G0010
 $50 1.0×
Electrical stimulation therapy
HCPCS Code: G0283
 $14 1.0×
Prostate cancer screening (blood test)
HCPCS Code: G0103
 $19 0.9×
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.9%

Audit a Bill or Quote at Baptist Health Lexington (Zero PHI Required)

CMS CCN: 180103
CPT 871
Fair BaseRate™ $19,087
Medicare Rate $14,117
Self-Pay Cash $49,266
Insurer Median $16,900
Pre-filled with Baptist Health Lexington’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $24,206 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $24,206

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.9% of gross = $24,206).

Step 2 · Cash vs. Insurance Arbitrage Save $16,422 Paying Cash

Self-Pay Cash Rate ($49,266) Beats Your Bill

Baptist Health Lexington's published 45 CFR § 180 self-pay cash rate is $49,266 (vs. $16,900 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$46,601 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($65,688) is $46,601 above the denoised Fair BaseRate ($19,087) and 4.7× the $14,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold
Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier
Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported
26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (36.9% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall4/5 Stars (4/5)
Safety Composite79/100
Would Recommend84%
Rated 9 or 10 (HCAHPS)82%
Median ER Wait181 min
Left ER Before Seen0%
30-Day Mortality vs U.S.better
Unplanned Readmissionsame
Hip/Knee Complication Rate2.7%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)
Central-Line Bloodstream Infectionbetter
C. diff Hospital-Onset Infectionbetter

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Baptist Health Lexington. Prior administrative notices do not necessarily reflect current compliance status.

  • 2024-03-29·administrative_or_closure

    Closure Notice

    Recorded
  • 2024-02-27·warning_notice

    Warning Notice

    Recorded
  • 2023-04-26·administrative_or_closure

    Met Requirements

    Recorded

Source: CMS Hospital Care Compare (1,597 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Baptist Health Lexington.

Price Index: 1.95× regional baseline
Quality: 92/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Ambetter (Centene)
+166.7%
Median Household Income$67,631U.S. Census ACS
Local Uninsured Share6.8%Regional ACS estimate
200% FPL (1 Person)$31,920Common free-care ceiling
400% FPL (Family of 4)$128,600Common AGB cap ceiling
45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 84/100 · Corroborated CMS CCN 180103

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 180103) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileReports.aspx
Publication / Vintage2026-06-04 · 264.79 MB
Validated Rate Rows2,265 (CMS v3.0.0)
File Integrity Digest7e377d5c3abd9e7fc6cf…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy