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Procedure Pricing Comparison

Hip or knee replacement (inpatient stay) Cost

Location: Pikeville, KY Micro Area

MS-DRG Code: 470 (MS-DRG)

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.Near Fair BaseRate Benchmark
1.00×vs. Fair Market Price
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 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.

Compares typical commercial prices against the fair price benchmark after accounting for local wages and case 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).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (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 Logic88Coherence (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 Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash 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 Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian 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.

Factual Overview

A Hip or knee replacement (inpatient stay) in the Pikeville, KY Micro Area area ranges from $16,188 to $16,659 across 3 facilities — real price differences between facilities. Each facility below links to its own page, where its price is checked against the fair BaseRate. Start with the cheapest and compare.

Hospital Comparison Table (Ordered by Price)

Hospital Details Cash Price Actions
Pikeville Medical Center
★ No CMS Rating | |
Unavailable Cost
Highlands Arh Regional Medical Center
★ No CMS Rating | |
Unavailable Cost
Tug Valley Arh Regional Medical Center
★ No CMS Rating | |
Unavailable Cost
Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

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

MS-DRG 470
Fair BaseRate™ $16,188
Medicare Rate $9,389
Self-Pay Cash $16,188
Insurer Median $16,659
Pre-filled with Pikeville Medical Center’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: $14,513 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $14,513

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $14,513).

Step 2 · Cash vs. Insurance Arbitrage Save $23,794 Paying Cash

Self-Pay Cash Rate ($16,188) Beats Your Bill

Pikeville Medical Center's published 45 CFR § 180 self-pay cash rate is $16,188 (vs. $16,659 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$23,794 Above Fair BaseRate

Negotiate Toward $16,188 Fair BaseRate ($9,389 Medicare)

Your bill ($39,982) is $23,794 above the denoised Fair BaseRate ($16,188) and 4.3× the $9,389 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, MS-DRG code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.