Kentucky / Pikeville Medical Center
CMS certification 180044 · Pikeville, KY · 3 entries in CMS's price-transparency list
Pikeville Medical Center: charges and Medicare payments
Pikeville Medical Center reported 1,916 Medicare inpatient stays across 58 DRGs in 2024. Across them it charged 4.6 times what it was paid — mid-range in Kentucky, number 21 of 51 hospitals with at least 100 stays (state median 4.06×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 298 stays at an average charge of $81,227, 10% below the national average. It also billed 2,485 outpatient services, charging 7.73 times what Medicare paid.
- 1Medicare inpatient stays 1,916
- 2Charge ÷ paid, inpatient 4.6×
- 3Rank in KY (highest ratio = 1) 21 of 51
- 4CMS price-transparency actions 3
Inpatient stays
For the 58 DRGs that can be compared with the national average, Pikeville Medical Center charged more than the national average in 14 (24%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 298 | $81,227 | -10% | $18,279 |
| 291 Heart Failure and Shock with MCC | 142 | $62,685 | +11% | $12,358 |
| 193 Simple Pneumonia and Pleurisy with MCC | 102 | $58,205 | -3% | $11,786 |
| 177 Respiratory Infections and Inflammations with MCC | 62 | $85,863 | +22% | $15,106 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 54 | $79,688 | +5% | $14,766 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 54 | $39,212 | -20% | $9,645 |
| 689 Kidney and Urinary Tract Infections with MCC | 52 | $47,134 | -8% | $10,525 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 45 | $238,011 | +4% | $49,612 |
| 690 Kidney and Urinary Tract Infections without MCC | 43 | $29,074 | -23% | $7,125 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 42 | $32,251 | -20% | $7,577 |
| 274 Percutaneous and Other Intracardiac Procedures without MCC | 41 | $103,286 | -34% | $28,761 |
| 189 Pulmonary Edema and Respiratory Failure | 40 | $49,049 | -15% | $11,107 |
| 313 Chest Pain | 40 | $36,323 | -9% | $6,381 |
| 481 Hip and Femur Procedures except Major Joint with CC | 39 | $76,347 | -24% | $19,464 |
| 378 Gastrointestinal Hemorrhage with CC | 36 | $42,699 | -12% | $8,697 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 35 | $37,672 | -26% | $9,764 |
| 870 Septicemia or Severe Sepsis with MV >96 Hours | 35 | $328,331 | +2% | $62,483 |
| 682 Renal Failure with MCC | 34 | $56,372 | -15% | $13,604 |
| 683 Renal Failure with CC | 33 | $40,136 | -1% | $8,170 |
| 194 Simple Pneumonia and Pleurisy with CC | 32 | $32,390 | -16% | $7,478 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 31 | $113,538 | -1% | $17,680 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 29 | $32,977 | -9% | $6,566 |
| 308 Cardiac Arrhythmia and Conduction Disorders with MCC | 28 | $76,769 | +36% | $12,187 |
| 312 Syncope and Collapse | 26 | $41,775 | -8% | $7,932 |
| 698 Other Kidney and Urinary Tract Diagnoses with MCC | 26 | $86,504 | +18% | $16,356 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 25 | $72,051 | +13% | $9,901 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 24 | $76,058 | -24% | $18,045 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 24 | $146,890 | +8% | $27,638 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 24 | $68,263 | -33% | $19,246 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 21 | $43,534 | -22% | $9,001 |
| 069 Transient Ischemia without Thrombolytic | 20 | $38,099 | -24% | $7,049 |
| 603 Cellulitis without MCC | 20 | $32,151 | -14% | $7,808 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 20 | $65,458 | +9% | $11,915 |
| 377 Gastrointestinal Hemorrhage with MCC | 19 | $80,629 | -6% | $15,882 |
| 310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC | 18 | $28,239 | -2% | $6,224 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 17 | $31,196 | -16% | $6,905 |
| 236 Coronary Bypass without Cardiac Catheterization without MCC | 16 | $147,297 | -30% | $39,473 |
| 321 Percutaneous Cardiovascular Procedures with Intraluminal... | 16 | $167,420 | +2% | $25,830 |
| 812 Red Blood Cell Disorders without MCC | 16 | $32,383 | -27% | $8,045 |
| 191 Chronic Obstructive Pulmonary Disease with CC | 15 | $30,517 | -23% | $7,487 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 15 | $46,547 | -8% | $8,441 |
| 480 Hip and Femur Procedures except Major Joint with MCC | 15 | $117,901 | -15% | $25,957 |
| 638 Diabetes with CC | 15 | $36,437 | -13% | $8,472 |
| 699 Other Kidney and Urinary Tract Diagnoses with CC | 15 | $36,496 | -23% | $9,467 |
| 286 Circulatory Disorders except AMI, with Cardiac... | 14 | $98,420 | -12% | $19,310 |
| 444 Disorders of The Biliary Tract with MCC | 14 | $70,425 | -15% | $16,271 |
| 305 Hypertension without MCC | 13 | $34,916 | -13% | $7,160 |
| 100 Seizures with MCC | 11 | $83,634 | -11% | $17,372 |
| 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale | 11 | $70,344 | +8% | $12,376 |
| 178 Respiratory Infections and Inflammations with CC | 11 | $47,097 | +4% | $8,717 |
| 233 Coronary Bypass with Cardiac Catheterization or Open... | 11 | $344,523 | -11% | $130,469 |
| 267 Endovascular Cardiac Valve Replacement and Supplement... | 11 | $123,470 | -44% | $46,013 |
| 314 Other Circulatory System Diagnoses with MCC | 11 | $106,703 | +13% | $18,607 |
| 394 Other Digestive System Diagnoses with CC | 11 | $37,685 | -20% | $8,251 |
| 418 Laparoscopic Cholecystectomy without C.D.E. with CC | 11 | $67,977 | -27% | $16,687 |
| 432 Cirrhosis and Alcoholic Hepatitis with MCC | 11 | $62,912 | -34% | $18,665 |
| 637 Diabetes with MCC | 11 | $48,664 | -27% | $16,722 |
| 981 Extensive O.R. Procedures Unrelated To Principal Diagnosis... | 11 | $155,850 | -28% | $43,576 |
Outpatient services
Against the Kentucky average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Pikeville Medical Center charged $81,227 on average, 28% more than the Kentucky average of $63,454, and was paid $18,279 against a state average of $14,765. For Heart Failure and Shock with MCC (DRG 291), Pikeville Medical Center charged $62,685 on average, 54% more than the Kentucky average of $40,730, and was paid $12,358 against a state average of $9,552. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Pikeville Medical Center charged $58,205 on average, 33% more than the Kentucky average of $43,745, and was paid $11,786 against a state average of $9,962. For Respiratory Infections and Inflammations with MCC (DRG 177), Pikeville Medical Center charged $85,863 on average, 60% more than the Kentucky average of $53,742, and was paid $15,106 against a state average of $12,118. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $22,986 was 13% above the state average of $20,333. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $8,748 was 21% below the state average of $11,097. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $58,461 was 33% below the state average of $87,601. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $3,654 was 17% above the state average of $3,127.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Pikeville Medical Center in Pikeville, KY, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2025-08-01 (CMS case 6061)
- Closure Notice — 2025-08-14 (CMS case 6061)
- Warning Notice — 2026-05-21 (CMS case 7838)
A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.