New data reveal that a knee replacement can cost more than twice as much at one hospital than at another just a short drive away, highlighting how hospital monopolies drive up health‑care expenses.
Price gap illustrated by two North Carolina hospitals
At Catawba Valley Medical Center in Hickory, a knee‑replacement procedure billed to a Blue Cross Blue Shield plan averaged about $16,000 this year, according to pricing information gathered by Serif Health. By contrast, the same procedure at Mission Hospital in Asheville, which was formed by merging the two largest local hospitals, was priced at roughly $40,000 under the identical insurance plan.
In Melbourne, Florida, Holmes Regional Medical Center charged a Cigna‑insured patient twice the amount that a hospital two hours north billed for the same knee surgery. Similar patterns appear in Colorado, where a Greeley facility demanded $20,000 more than a Denver hospital for an identical operation.
These examples line up with findings from health economists who say that hospitals with few nearby competitors tend to set higher prices. The trend has become easier to track since the Centers for Medicare & Medicaid Services began requiring hospitals to publish price data in 2021, allowing companies like Serif Health to compile detailed comparisons.
Related: New School Programs Boost Literacy for Young Readers
How monopolies affect insurers and consumers
When hospitals charge more, insurers absorb the extra cost and typically pass it on to policyholders through higher premiums. The ripple effect means that even people who never need a knee replacement feel the financial impact of hospital consolidation.
Insurance premiums have risen sharply in recent years. The average family plan cost more than $27,000 in 2025, up from $21,000 six years earlier, according to the Kaiser Family Foundation. Employers in regions dominated by a single hospital system report that their workers face higher out‑of‑pocket costs and larger contributions to health‑care plans.
In Asheville, where Mission Hospital is the only major acute‑care provider, local businesses have voiced concern. One restaurant owner, who runs a 100‑employee establishment, says the hospital’s pricing forces employers to shoulder higher insurance expenses, leaving workers with fewer options for affordable coverage.
The American Hospital Association argues that mergers can improve quality and lower costs by creating a “fiscally sustainable environment,” but data suggest otherwise. A Yale University associate professor who studies hospital markets noted that greater bargaining power consistently translates into higher prices, and that hospital costs have risen faster than those in any other sector over the past 25 years.
One might expect that competition would curb excessive pricing, but the opposite often occurs when a single system dominates a market. The lack of alternatives reduces pressure on hospitals to keep charges in line with the value they deliver.
Related: When to shed baby weight matters
Regulators may face increasing pressure to intervene. A recent Federal Trade Commission memo called for a task force to examine health‑care mergers that appear to inflate prices or diminish quality. Still, the agency has blocked only about one percent of proposed hospital mergers since 2002, according to a Yale study.
State lawmakers have taken steps, too. Minnesota, California, and Oregon have enacted statutes aimed at limiting anticompetitive hospital consolidations, requiring notice periods and granting agencies the authority to block deals that threaten competition.
Given the current trajectory, it is plausible that without stronger oversight, hospital systems will keep leveraging their market position to secure higher reimbursements, which in turn will continue to push up insurance costs for a broad swath of Americans.
Price gaps hurt patients.
In the specific case of Mission Hospital, the price differences extend beyond knee replacements. A breast biopsy there costs $7,500 for a UnitedHealthcare patient, compared with $1,700 at Catawba Valley. For a hernia repair, the figures are $17,700 versus $9,600 respectively.
Related: Sorry, you have been blocked
Hospital representatives argue that direct comparisons can be misleading because facilities differ in size, trauma‑level designation, and patient populations. Mission Hospital, they note, is nearly three times larger than Catawba Valley and serves a broader regional catchment area.
Nevertheless, independent analyses show that Mission Hospital’s charges are well above the state benchmark. A Rand Corporation study found that Mission’s prices were 334 % of Medicare rates, while Catawba Valley’s were 237 %. The state average sits at 280 % of Medicare, highlighting the relative excess of the Asheville hospital’s pricing.
Patient experiences reinforce the numbers. One local resident who initially planned a knee surgery at Mission Hospital was quoted more than $9,000, a figure that prompted her to seek care at an outpatient center where the bill was under one third of that amount. When she balked at the high charge, the hospital offered a 20 % discount for upfront payment, a tactic that further raises questions about pricing transparency.
Regulatory scrutiny has intensified after a series of safety concerns at Mission Hospital, including three “immediate jeopardy” findings by state health inspectors and a recent incident where an elderly patient died after a missed blood transfusion. Such issues add another layer to the debate over whether market dominance compromises both cost and quality.
