How many shoppable procedure prices are published for Middlesboro Arh Hospital?

Middlesboro Arh Hospital in Middlesboro, KY currently has 90 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Middlesboro Arh Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Middlesboro Arh Hospital's median negotiated commercial rate is 0.8× the regionally adjusted fair BaseRate benchmark.

What is Middlesboro Arh Hospital's CMS Care Compare overall star rating?

CMS Care Compare assigns Middlesboro Arh Hospital an overall hospital quality rating of 1 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 46 Beds · rural Updated: 1/1/2026

Middlesboro Arh Hospital

3600 West Cumberland Avenue, Middlesboro, KY 40965 · 90 Priced Procedures · 56% Patient Recommendation

CMS Overall Rating 1 / 5 Stars

Good Deal · Below Fair Market

0.81×vs. Fair Market Price

Typical commercial prices here are 19% below the fair benchmark (0.81×) after accounting for local nurse/doctor wages and patient complexity.

81/100 · Corroborated

81/100Self-Pay Cash Beats Insurance 57% of the Time

File Completeness66

Price Logic95

Peer Alignment66

Clean Billing76

Real Cash Discount100

Regional Value Leader

3-Star CMS clinical quality rating paired with 0.81× fair market pricing.

Behavioral Pricing FingerprintLow Shoppable & Low Captive Rates

Uniform Value Leader · Low-Cost Across Departments

Middlesboro Arh Hospital maintains low, disciplined commercial pricing across both routine shoppable procedures (0.7× Medicare, p50 0.79× Fair BaseRate) and emergency/ancillary services (1.0× Medicare, p75 0.94× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.

#13 of 68 in KY · 17th State Percentile#310 of 3,385 in U.S. · 9th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 19% below peer Fair BaseRate (0.81×)
Self-pay cash beats commercial insurance on 57% of shoppable procedures (99/100 Cash Honesty)
1-Star CMS clinical rating with 56% patient recommendation (62/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (33.3% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (0.81× 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.
Captive ER (1.0×) & laboratory (3.2×) services average 1.43× higher multiples than routine shoppable care (0.7×)
Upper-quartile procedures (Q75 0.94×) jump +19% above the median procedure ratio (Q50 0.79×)
Consolidated metro market (HHI 7,317) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

0.7× Medicare

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

Back-Door Captive & ER1.43× Divergence

1.0× Medicare

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

Quantile Tail Spread+19% Upper Tail

Q25 0.64× · Q50 0.79× · Q75 0.94×

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

0.7× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.9× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.0× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.0× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

3.2× MedicareElevated

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.4× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

57% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

1 CMS · 62/100Elevated

Procedure Prices at Middlesboro Arh Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 90 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$16,777	$19,087	unverified
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$6,733	$8,223	unverified
Trauma team activation HCPCS Code: `G0390`	$1,603	$907	$1,453	0.6×
Sleep study (overnight, in lab) CPT Code: `95810`	$3,184	$697	$1,021	0.7×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$2,375	$376	$583	0.6×
Blood transfusion CPT Code: `36430`	$547	$300	$498	0.6×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$4,283	$245	$448	0.5×
MRI, brain (with and without contrast) CPT Code: `70553`	$4,344	$245	$511	0.5×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$806	$166	$272	0.6×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$3,258	$166	$303	0.5×
MRI, lower back (no contrast) CPT Code: `72148`	$3,067	$166	$338	0.5×
MRI, brain (no contrast) CPT Code: `70551`	$3,022	$166	$343	0.5×
MRI, knee or other leg joint CPT Code: `73721`	$4,533	$166	$369	0.4×
Hepatitis B immune globulin HCPCS Code: `90371`	$2,938	$134	$151	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$247	$139	$201	0.7×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$730	$98	$148	0.7×
CT scan, head (with contrast) CPT Code: `70460`	$1,591	$122	$242	0.5×
CT scan, head (with and without contrast) CPT Code: `70470`	$2,260	$122	$258	0.5×
Office visit, established patient (30-39 min) CPT Code: `99214`	$416	$83	$123	0.7×
Screening mammogram (both breasts) CPT Code: `77067`	$186	$81	$123	0.7×
Typhoid vaccine HCPCS Code: `90675`	$1,326	$314	$347	0.9×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$244	$115	$111	unverified
Drug screening test HCPCS Code: `G0480`	$94	$114	$116	unverified
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$173	$59	$56	1.1×
Hospital observation (per hour) HCPCS Code: `G0378`	$78	$78	$86	0.9×
X-ray, pelvis CPT Code: `72170`	$230	$73	$110	0.7×
X-ray, chest (single view) CPT Code: `71045`	$214	$60	$92	0.7×
X-ray, shoulder CPT Code: `73030`	$346	$60	$92	0.7×
X-ray, foot CPT Code: `73630`	$359	$60	$92	0.7×
X-ray, lower back CPT Code: `72110`	$446	$73	$112	0.7×
X-ray, chest (two views) CPT Code: `71046`	$251	$60	$93	0.6×
X-ray, neck (cervical spine) CPT Code: `72040`	$262	$60	$93	0.6×
X-ray, hand CPT Code: `73130`	$347	$60	$93	0.6×
X-ray, hip CPT Code: `73502`	$236	$60	$93	0.6×
X-ray, ankle CPT Code: `73610`	$377	$60	$93	0.6×
Colorectal cancer screening HCPCS Code: `G0010`	$52	$32	$49	0.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$193	$56	$87	0.6×
New patient office visit (30-44 min) CPT Code: `99203`	$179	$70	$110	0.6×
Ultrasound, abdomen (limited) CPT Code: `76705`	$519	$73	$126	0.6×
Ultrasound, pelvis CPT Code: `76856`	$716	$73	$130	0.6×
Ultrasound, thyroid and neck CPT Code: `76536`	$643	$73	$132	0.6×
Ultrasound, abdomen (complete) CPT Code: `76700`	$857	$73	$134	0.5×
CT scan, head (no contrast) CPT Code: `70450`	$1,453	$73	$160	0.5×
CT scan, pelvis CPT Code: `72192`	$1,714	$73	$163	0.4×
CT scan, sinuses CPT Code: `70486`	$1,474	$73	$166	0.4×
CT scan, chest (no contrast) CPT Code: `71250`	$1,788	$73	$167	0.4×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,884	$73	$168	0.4×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,987	$73	$169	0.4×
Speech therapy (language evaluation) CPT Code: `92507`	$199	$73	$86	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$151	$11	$11	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$70	$10	$10	1.0×
Blood test, vitamin D CPT Code: `82306`	$223	$30	$31	1.0×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$110	$36	$39	0.9×
Hepatitis B vaccine HCPCS Code: `90744`	$102	$34	$37	0.9×
Orthotic fitting and training CPT Code: `97760`	$126	$43	$51	0.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$50	$32	$38	0.8×
Blood antibody screen CPT Code: `86850`	$52	$37	$46	0.8×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$255	$41	$64	0.6×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$58	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$76	$5	$5	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$78	$5	$5	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$215	$14	$14	1.0×
Diagnostic procedure preparation HCPCS Code: `G0279`	$42	$11	$35	0.3×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$149	$33	$40	unverified
Prosthetic fitting and training CPT Code: `97761`	$126	$38	$45	unverified
Blood test, glucose (blood sugar) CPT Code: `82947`	$111	$4	$4	1.0×
Blood test, lipase CPT Code: `83690`	$164	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$10	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$72	$5	$5	1.0×
Blood test, sodium CPT Code: `84295`	$78	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$64	$4	$4	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$71	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$260	$6	$6	1.0×
Culture, bacterial CPT Code: `87070`	$88	$9	$9	1.0×
Blood test, thyroid (TSH) CPT Code: `84443`	$158	$17	$18	0.9×
Blood test, vitamin B12 CPT Code: `82607`	$106	$15	$16	0.9×
Hepatitis C antibody test CPT Code: `86803`	$131	$14	$15	0.9×
Culture, blood CPT Code: `87040`	$179	$10	$11	0.9×
Blood test, basic metabolic panel CPT Code: `80048`	$130	$8	$9	0.9×
Blood test, liver function panel CPT Code: `80076`	$164	$8	$9	0.9×
Blood test, amylase CPT Code: `82150`	$37	$6	$7	0.9×
Physical therapy (gait training) CPT Code: `97116`	$126	$28	$33	0.8×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$135	$31	$38	0.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$113	$4	$5	0.8×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$157	$28	$35	0.8×
Occupational therapy (self-care training) CPT Code: `97535`	$143	$30	$38	0.8×
Physical therapy (manual therapy) CPT Code: `97140`	$184	$26	$34	0.8×
Blood test, hemoglobin CPT Code: `85018`	$55	$2	$3	0.7×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$214	$13	$14	unverified
Blood test, PSA (prostate screen) CPT Code: `84153`	$184	$18	$19	unverified

Showing top 25 high-impact procedures of 90 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 33.3%

Audit a Bill or Quote at Middlesboro Arh Hospital (Zero PHI Required)

CMS CCN: 180020

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash Request Quote

Insurer Median $16,777

1. Amount on Your Bill or Quote ($) Pre-filled with Middlesboro Arh Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $13,420 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $13,420

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (33.3% of gross = $13,420).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Middlesboro Arh 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 +$21,178 Above Fair BaseRate

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

Your bill ($40,265) is $21,178 above the denoised Fair BaseRate ($19,087) and 2.9× 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 (33.3% 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 Overall3/5 Stars (3/5)

Safety Composite62/100

Would Recommend56%

Rated 9 or 10 (HCAHPS)69%

Median ER Wait176 min

Left ER Before Seen3%

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 (121 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 Value & Quality Leader Pareto Frontier (Price + Quality)

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

Price Index: 1.00× regional baseline

Quality: 52/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Humana

-56.6%

Median Household Income$32,403U.S. Census ACS

Local Uninsured Share6.7%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 81/100 · Corroborated CMS CCN 180020

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 180020) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage1/1/2026

Validated Rate Rows1,769 (CMS v3.0.0)

File Integrity DigestVerified · CCN 180020

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