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Hospital Profile Critical Access Hospital Government - Local 25 Beds · rural Updated: 1/1/2026

Knox County Hospital

80 Hospital Drive, Barbourville, KY 40906 · 85 Priced Procedures · 75% Patient Recommendation

CMS Overall Rating No CMS Rating
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
1.09×vs. Fair Market Price
Position vs. 1.00× Fair Price+9% 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 +9% above the fair benchmark (1.09×) 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).82/100 · Corroborated
82/100Self-Pay Cash Beats Insurance 55% of the Time
File Completeness66Provenance (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 Logic96Coherence (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 Alignment69Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing80Regularity (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.Regional Benchmark Tier
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score70/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER Wait137 minMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

Knox County Hospital maintains elevated commercial insurance contracts (1.09× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 55% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#36 of 68 in KY · 51st State Percentile#1,648 of 3,385 in U.S. · 48th National Percentile
Advantage

Where They're Good (Patient & Payer Edge)

  • Bottom-quartile procedures (Q25) price at 0.95× the peer BaseRate benchmark
  • Self-pay cash beats commercial insurance on 55% of shoppable procedures (99/100 Cash Honesty)
  • CMS clinical safety score (70/100 safety score) with 75% patient recommendation
  • Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling
Watchout

Where You Can Get Burned (Markup Traps)

  • Outpatient surgery & OR suites carry a 3.2× markup over Medicare rates
  • Commercial insurance median sits at 0.99× Fair BaseRate (2.6× Medicare), so insured patients should always compare the self-pay cash price before paying.
  • Upper-quartile procedures (Q75 1.30×) jump +31% above the median procedure ratio (Q50 0.99×)
  • Consolidated metro market (HHI 4,150) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Front-Door ShoppableElective / Imaging
2.6× Medicare

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

Back-Door Captive & ER0.38× Divergence
1.0× Medicare

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

Quantile Tail Spread+31% Upper Tail
Q25 0.95× · Q50 0.99× · Q75 1.30×

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
2.6× MedicareFair
Outpatient Surgery & ORBack-Door Captive
3.2× MedicareElevated
Diagnostic Imaging (CT/MRI)Front-Door Shoppable
3.1× MedicareFair
Back-Door Captive ER VisitsBack-Door Captive
3.8× MedicareElevated
Inpatient Lab & PathologyBack-Door Captive
4.7× MedicareWatchout
Specialty & Infusion Drugs (J-Codes)Back-Door Captive
1.6× MedicareGood
Self-Pay Cash Honesty & 501(r)Integrity & Outcomes
55% Cash Edge · 99/100Good
CMS Clinical Safety & Star ValueIntegrity & Outcomes
3 CMS · 70/100Fair

Procedure Prices at Knox County Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 85 published procedures.

Sort:
Audit a Bill & 501(r) Cap ↓
Procedure & Billing Code This Hospital vs. Fair
Sepsis treatment (inpatient stay)
MS-DRG Code: 871
 $26,571 1.4×
Digestive disorders treatment (inpatient stay)
MS-DRG Code: 392
 $10,664 1.3×
Sleep study (overnight, in lab)
CPT Code: 95810
 $2,477 2.4×
Echocardiogram (heart ultrasound)
CPT Code: 93306
 $2,377 4.1×
Blood transfusion
CPT Code: 36430
 $1,075 2.2×
Ultrasound, pelvis
CPT Code: 76856
 $919 7.1×
Ultrasound, abdomen (complete)
CPT Code: 76700
 $928 6.9×
Ultrasound, leg veins (duplex)
CPT Code: 93970
 $859 3.2×
MRI, lower back (no contrast)
CPT Code: 72148
 $760 2.2×
MRI, brain (no contrast)
CPT Code: 70551
 $760 2.2×
MRI, knee or other leg joint
CPT Code: 73721
 $760 2.1×
MRI, brain (with and without contrast)
CPT Code: 70553
 $760 1.5×
Ultrasound, thyroid and neck
CPT Code: 76536
 $724 5.5×
Ultrasound, abdomen (limited)
CPT Code: 76705
 $664 5.3×
X-ray, lower back
CPT Code: 72110
 $570 5.1×
CT scan, head (no contrast)
CPT Code: 70450
 $569 3.6×
CT scan, head (with contrast)
CPT Code: 70460
 $569 2.4×
CT scan, head (with and without contrast)
CPT Code: 70470
 $569 2.2×
CT scan, abdomen and pelvis (no contrast)
CPT Code: 74176
 $569 1.9×
CT scan, abdomen and pelvis (with contrast)
CPT Code: 74177
 $569 1.3×
CT scan, sinuses
CPT Code: 70486
 $569 unverified
CT scan, chest (no contrast)
CPT Code: 71250
 $569 unverified
CT scan, neck (cervical spine)
CPT Code: 72125
 $569 unverified
CT scan, pelvis
CPT Code: 72192
 $569 unverified
X-ray, ankle
CPT Code: 73610
 $476 5.1×
Showing top 25 high-impact procedures of 85 total
Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Knox County Hospital (Zero PHI Required)

CMS CCN: 181328
CPT 871
Fair BaseRate™ $19,087
Medicare Rate $14,117
Self-Pay Cash Request Quote
Insurer Median $26,571
Pre-filled with Knox County Hospital’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 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Knox County Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$44,683 Above Fair BaseRate

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

Your bill ($63,770) is $44,683 above the denoised Fair BaseRate ($19,087) and 4.5× 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) For-Profit / Non-501(c)(3)

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

Public IRS & CMS ownership records classify Knox County Hospital as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

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

Safety Composite70/100
Would Recommend75%
Rated 9 or 10 (HCAHPS)76%
Median ER Wait137 min
Left ER Before Seen2%
30-Day Mortality vs U.S.same
Unplanned Readmissionsame

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)
C. diff Hospital-Onset Infectionsame

Source: CMS Hospital Care Compare (63 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

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Knox County Hospital.

Price Index: 1.19× regional baseline
Quality: 56/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

UnitedHealthcare
-47.5%
Median Household Income$33,153U.S. Census ACS
Local Uninsured Share6.5%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 82/100 · Corroborated CMS CCN 181328

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

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 181328) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage1/1/2026
Validated Rate Rows1,625 (CMS v3.0.0)
File Integrity DigestVerified · CCN 181328

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