How many shoppable procedure prices are published for Monroe County Medical Center?

Monroe County Medical Center in Tompkinsville, KY currently has 97 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Monroe County Medical Center's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Monroe County Medical Center's median negotiated commercial rate is 0.9× the regionally adjusted fair BaseRate benchmark.

What is Monroe County Medical Center's CMS Care Compare overall star rating?

CMS Care Compare assigns Monroe County Medical Center 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 - Other 49 Beds · rural Updated: 2026-08-14

Monroe County Medical Center

529 Capp Harlan Road, Tompkinsville, KY 42167 · 97 Priced Procedures · 67% Patient Recommendation

CMS Overall Rating 1 / 5 Stars

Good Deal · Below Fair Market

0.93×vs. Fair Market Price

Typical commercial prices here are 7% below the fair benchmark (0.93×) after accounting for local nurse/doctor wages and patient complexity.

81/100 · Corroborated

81/100Self-Pay Cash Beats Insurance 35% of the Time

File Completeness95

Price Logic62

Peer Alignment78

Clean Billing73

Real Cash Discount99

Regional Value Leader

4-Star CMS clinical quality rating paired with 0.93× fair market pricing.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Monroe County Medical Center prices routine shoppable procedures near 0.9× Medicare (p50 0.84×) while skewing captive emergency, lab, and upper-quartile codes to 1.3× Medicare (p75 1.29×, +54% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#23 of 68 in KY · 32nd State Percentile#852 of 3,385 in U.S. · 25th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 7% below peer Fair BaseRate (0.93×)
Self-pay cash beats commercial insurance on 35% of shoppable procedures (99/100 Cash Honesty)
1-Star CMS clinical rating with 67% patient recommendation (72/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (45.8% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.1× markup over Medicare rates
Captive ER (1.3×) & laboratory (1.2×) services average 1.44× higher multiples than routine shoppable care (0.9×)
Upper-quartile procedures (Q75 1.29×) jump +54% above the median procedure ratio (Q50 0.84×)
Unnegotiated chargemaster list prices average 4.8× Medicare (26¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

0.9× Medicare

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

Back-Door Captive & ER1.44× Divergence

1.3× Medicare

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

Quantile Tail Spread+54% Upper Tail

Q25 0.52× · Q50 0.84× · Q75 1.29×

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

0.9× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.1× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.4× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.3× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.2× MedicareGood

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

1.1× MedicareGood

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

35% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

1 CMS · 72/100Fair

Procedure Prices at Monroe County Medical Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 97 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	$10,387	$10,387	$19,432	0.5×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	$8,968	$8,968	$19,087	0.5×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	$5,483	$5,483	$8,223	0.7×
Colonoscopy (diagnostic) CPT Code: `45378`	$917	$917	$981	0.9×
Upper endoscopy with biopsy CPT Code: `43239`	$917	$917	$987	0.9×
Colonoscopy with biopsy CPT Code: `45380`	$917	$917	$1,256	0.7×
MRI, brain (with and without contrast) CPT Code: `70553`	$1,247	$705	$511	unverified
Rabies immune globulin HCPCS Code: `90375`	$649	$649	$322	2.0×
Blood transfusion CPT Code: `36430`	$509	$509	$498	1.0×
MRI, lower back (no contrast) CPT Code: `72148`	$856	$352	$338	1.0×
MRI, brain (no contrast) CPT Code: `70551`	$1,580	$317	$343	0.9×
MRI, knee or other leg joint CPT Code: `73721`	$851	$317	$369	0.9×
X-ray, chest (two views) CPT Code: `71046`	$223	$223	$93	2.4×
Speech therapy (language evaluation) CPT Code: `92507`	$172	$172	$86	2.0×
X-ray, lower back CPT Code: `72110`	$192	$192	$112	1.7×
Hepatitis B immune globulin HCPCS Code: `90371`	$270	$176	$151	1.2×
CT scan, head (with and without contrast) CPT Code: `70470`	$873	$200	$258	0.8×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$1,267	$193	$448	0.4×
X-ray, foot CPT Code: `73630`	$147	$147	$92	1.6×
X-ray, hand CPT Code: `73130`	$147	$147	$93	1.6×
CT scan, pelvis CPT Code: `72192`	$565	$167	$163	1.0×
CT scan, chest (no contrast) CPT Code: `71250`	$468	$167	$167	1.0×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$464	$167	$168	1.0×
CT scan, neck (cervical spine) CPT Code: `72125`	$464	$167	$169	1.0×
CT scan, head (with contrast) CPT Code: `70460`	$643	$160	$242	0.7×
X-ray, hip CPT Code: `73502`	$116	$116	$93	1.2×
Screening mammogram (both breasts) CPT Code: `77067`	$119	$109	$123	0.9×
CT scan, head (no contrast) CPT Code: `70450`	$457	$134	$160	0.8×
CT scan, sinuses CPT Code: `70486`	$438	$134	$166	0.8×
Breathing treatment (nebulizer) CPT Code: `94640`	$136	$136	$201	0.7×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,365	$149	$583	0.3×
X-ray, shoulder CPT Code: `73030`	$92	$92	$92	1.0×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$170	$116	$148	0.8×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,276	$108	$272	0.4×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,006	$107	$303	0.4×
Pneumococcal vaccine HCPCS Code: `90732`	$291	$291	$140	2.1×
Typhoid vaccine HCPCS Code: `90675`	$495	$205	$347	0.6×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$70	$50	$56	0.9×
New patient office visit (30-44 min) CPT Code: `99203`	$187	$65	$110	0.6×
Office visit, established patient (30-39 min) CPT Code: `99214`	$153	$66	$123	0.5×
Drug screening test HCPCS Code: `G0480`	$62	$62	$116	0.5×
Flu vaccine injection HCPCS Code: `G0008`	$82	$82	$48	unverified
Pneumonia vaccine injection HCPCS Code: `G0009`	$81	$81	$49	unverified
Colorectal cancer screening HCPCS Code: `G0010`	$81	$81	$49	unverified
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$36	$23	$14	1.6×
Blood test, ferritin (iron stores) CPT Code: `82728`	$58	$19	$14	1.4×
Blood test, vitamin D CPT Code: `82306`	$51	$40	$31	1.3×
X-ray, chest (single view) CPT Code: `71045`	$46	$46	$92	0.5×
X-ray, neck (cervical spine) CPT Code: `72040`	$46	$46	$93	0.5×
X-ray, ankle CPT Code: `73610`	$46	$46	$93	0.5×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$163	$54	$111	0.5×
X-ray, pelvis CPT Code: `72170`	$46	$46	$110	0.4×
Ultrasound, abdomen (complete) CPT Code: `76700`	$556	$56	$134	0.4×
Blood test, vitamin B12 CPT Code: `82607`	$50	$21	$16	1.3×
Office visit, established patient (20-29 min) CPT Code: `99213`	$105	$42	$87	0.5×
Ultrasound, pelvis CPT Code: `76856`	$450	$43	$130	0.3×
Ultrasound, abdomen (limited) CPT Code: `76705`	$463	$40	$126	0.3×
Ultrasound, thyroid and neck CPT Code: `76536`	$282	$40	$132	0.3×
Diagnostic procedure preparation HCPCS Code: `G0279`	$58	$58	$35	unverified
Blood test, glucose (blood sugar) CPT Code: `82947`	$17	$6	$4	1.5×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$77	$6	$4	1.5×
Blood test, lipase CPT Code: `83690`	$45	$10	$7	1.4×
Blood test, calcium CPT Code: `82310`	$46	$7	$5	1.4×
Blood test, creatinine (kidney) CPT Code: `82565`	$67	$7	$5	1.4×
Blood test, sodium CPT Code: `84295`	$77	$7	$5	1.4×
Blood test, complete blood count (CBC) CPT Code: `85025`	$32	$11	$8	1.4×
Culture, blood CPT Code: `87040`	$80	$15	$11	1.4×
Blood test, thyroid (TSH) CPT Code: `84443`	$97	$24	$18	1.3×
Blood test, clotting time (PTT) CPT Code: `85730`	$61	$8	$6	1.3×
Culture, bacterial CPT Code: `87070`	$84	$12	$9	1.3×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$34	$13	$10	1.3×
Blood test, amylase CPT Code: `82150`	$84	$9	$7	1.3×
Blood test, magnesium CPT Code: `83735`	$40	$9	$7	1.3×
Hepatitis C antibody test CPT Code: `86803`	$47	$19	$15	1.3×
Blood test, potassium CPT Code: `84132`	$37	$6	$5	1.2×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$25	$6	$5	1.2×
Blood test, hemoglobin CPT Code: `85018`	$15	$3	$3	1.0×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$38	$24	$25	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$49	$18	$20	0.9×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$47	$9	$11	0.8×
Flu vaccine (high dose) HCPCS Code: `90656`	$36	$20	$25	0.8×
Blood test, PSA (prostate screen) CPT Code: `84153`	$64	$15	$19	0.8×
Blood test, basic metabolic panel CPT Code: `80048`	$43	$7	$9	0.8×
Blood test, liver function panel CPT Code: `80076`	$122	$7	$9	0.8×
Electrical stimulation therapy HCPCS Code: `G0283`	$57	$10	$14	0.7×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$50	$2	$3	0.7×
Physical therapy (manual therapy) CPT Code: `97140`	$88	$20	$34	0.6×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$87	$20	$35	0.6×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$98	$22	$40	0.6×
Prosthetic fitting and training CPT Code: `97761`	$82	$23	$45	0.5×
Orthotic fitting and training CPT Code: `97760`	$92	$25	$51	0.5×
Occupational therapy (self-care training) CPT Code: `97535`	$64	$16	$38	0.4×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$109	$15	$38	0.4×
Physical therapy (gait training) CPT Code: `97116`	$95	$13	$33	0.4×
Blood antibody screen CPT Code: `86850`	$83	$13	$46	0.3×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$101	$14	$64	0.2×
Hospital observation (per hour) HCPCS Code: `G0378`	$97	$12	$86	0.1×

Showing top 25 high-impact procedures of 97 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 45.8%

Audit a Bill or Quote at Monroe County Medical Center (Zero PHI Required)

CMS CCN: 180105

CPT 470

Select Procedure to Audit:

Fair BaseRate™ $19,432

Medicare Rate $14,044

Self-Pay Cash $10,387

Insurer Median $10,387

1. Amount on Your Bill or Quote ($) Pre-filled with Monroe County Medical Center’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: $5,726 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $5,726

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (45.8% of gross = $5,726).

Step 2 · Cash vs. Insurance Arbitrage Save $2,127 Paying Cash

Self-Pay Cash Rate ($10,387) Beats Your Bill

Monroe County Medical Center's published 45 CFR § 180 self-pay cash rate is $10,387 (vs. $10,387 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target Target: $19,432 Fair BaseRate

Negotiate Toward $19,432 Fair BaseRate ($14,044 Medicare)

Your entered amount is at or below the modeled Fair BaseRate benchmark ($19,432).

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 (45.8% 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 Composite72/100

Would Recommend67%

Rated 9 or 10 (HCAHPS)76%

Median ER Wait122 min

Left ER Before Seen1%

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

CMS Price Transparency Administrative Enforcement Log

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

2024-02-27·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (169 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

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Monroe County Medical Center.

Price Index: 0.69× regional baseline

Quality: 68/100 CMS composite

Median Household Income$49,430U.S. Census ACS

Local Uninsured Share5.5%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 81/100 · Corroborated CMS CCN 180105

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

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 180105) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileReports.aspx

Publication / Vintage2026-08-14 · 10.41 MB

Validated Rate Rows740 (CMS v3.0.0)

File Integrity Digestd69975fb4fb0d0b216fe…

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.

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