Kentucky / Lake Cumberland Regional Hospital
CMS certification 180132 · Somerset, KY · 2 entries in CMS's price-transparency list
Lake Cumberland Regional Hospital: charges and Medicare payments
Lake Cumberland Regional Hospital reported 1,155 Medicare inpatient stays across 41 DRGs in 2024. Across them it charged 7.6 times what it was paid — among the higher ratios in Kentucky, number 3 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: 115 stays at an average charge of $121,573, 35% above the national average. It also billed 1,273 outpatient services, charging 13.82 times what Medicare paid.
- 1Medicare inpatient stays 1,155
- 2Charge ÷ paid, inpatient 7.6×
- 3Rank in KY (highest ratio = 1) 3 of 51
- 4CMS price-transparency actions 2
Inpatient stays
For the 41 DRGs that can be compared with the national average, Lake Cumberland Regional Hospital charged more than the national average in 35 (85%). 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 | 115 | $121,573 | +35% | $14,703 |
| 291 Heart Failure and Shock with MCC | 81 | $64,697 | +15% | $9,759 |
| 193 Simple Pneumonia and Pleurisy with MCC | 69 | $79,587 | +33% | $9,944 |
| 885 Psychoses | 65 | $37,893 | -14% | $10,433 |
| 189 Pulmonary Edema and Respiratory Failure | 56 | $72,789 | +26% | $9,631 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 55 | $80,980 | +7% | $11,549 |
| 177 Respiratory Infections and Inflammations with MCC | 52 | $104,369 | +48% | $12,478 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 39 | $63,223 | +25% | $8,864 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 34 | $66,391 | +19% | $8,076 |
| 481 Hip and Femur Procedures except Major Joint with CC | 34 | $121,083 | +20% | $15,635 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 30 | $135,208 | +32% | $15,630 |
| 378 Gastrointestinal Hemorrhage with CC | 27 | $51,582 | +6% | $7,538 |
| 281 Acute Myocardial Infarction, Discharged Alive with CC | 26 | $64,957 | +29% | $7,126 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 26 | $47,833 | +19% | $6,170 |
| 682 Renal Failure with MCC | 25 | $70,371 | +7% | $11,135 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 25 | $282,890 | +24% | $36,614 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 24 | $174,970 | +53% | $14,951 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 24 | $43,747 | +18% | $6,326 |
| 321 Percutaneous Cardiovascular Procedures with Intraluminal... | 20 | $189,696 | +16% | $21,455 |
| 064 Intracranial Hemorrhage or Cerebral Infarction with MCC | 19 | $104,654 | +5% | $14,561 |
| 282 Acute Myocardial Infarction, Discharged Alive without CC/MCC | 19 | $61,410 | +42% | $5,703 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 19 | $43,166 | +20% | $5,909 |
| 377 Gastrointestinal Hemorrhage with MCC | 19 | $83,237 | -3% | $12,582 |
| 689 Kidney and Urinary Tract Infections with MCC | 18 | $54,872 | +7% | $8,789 |
| 690 Kidney and Urinary Tract Infections without MCC | 18 | $50,794 | +34% | $6,447 |
| 194 Simple Pneumonia and Pleurisy with CC | 16 | $68,884 | +79% | $6,467 |
| 603 Cellulitis without MCC | 16 | $53,629 | +44% | $6,812 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 16 | $73,971 | +23% | $10,174 |
| 683 Renal Failure with CC | 16 | $40,218 | -1% | $6,855 |
| 208 Respiratory System Diagnosis with Ventilator Support <=96... | 15 | $150,762 | +11% | $19,073 |
| 310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC | 14 | $33,865 | +18% | $4,441 |
| 389 Gastrointestinal Obstruction with CC | 14 | $46,112 | +18% | $6,379 |
| 069 Transient Ischemia without Thrombolytic | 13 | $80,684 | +60% | $5,887 |
| 287 Circulatory Disorders except AMI, with Cardiac... | 13 | $71,882 | +13% | $8,090 |
| 638 Diabetes with CC | 13 | $43,102 | +3% | $7,069 |
| 812 Red Blood Cell Disorders without MCC | 13 | $41,466 | -7% | $6,673 |
| 312 Syncope and Collapse | 12 | $43,421 | -5% | $6,802 |
| 637 Diabetes with MCC | 12 | $86,298 | +30% | $10,981 |
| 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale | 11 | $65,488 | +1% | $10,700 |
| 308 Cardiac Arrhythmia and Conduction Disorders with MCC | 11 | $58,203 | +3% | $9,201 |
| 388 Gastrointestinal Obstruction with MCC | 11 | $55,425 | -19% | $11,140 |
Outpatient services
Against the Kentucky average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Lake Cumberland Regional Hospital charged $121,573 on average, 92% more than the Kentucky average of $63,454, and was paid $14,703 against a state average of $14,765. For Heart Failure and Shock with MCC (DRG 291), Lake Cumberland Regional Hospital charged $64,697 on average, 59% more than the Kentucky average of $40,730, and was paid $9,759 against a state average of $9,552. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Lake Cumberland Regional Hospital charged $79,587 on average, 82% more than the Kentucky average of $43,745, and was paid $9,944 against a state average of $9,962. For Psychoses (DRG 885), Lake Cumberland Regional Hospital charged $37,893 on average, 50% more than the Kentucky average of $25,233, and was paid $10,433 against a state average of $10,812. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $36,975 was 82% above the state average of $20,333. For Level 1 Endovascular Procedures (outpatient APC 5191), its average charge of $41,675 was 42% above the state average of $29,393. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $68,388 was 53% above the state average of $44,565. For Level 3 Endovascular Procedures (outpatient APC 5193), its average charge of $130,090 was 49% above the state average of $87,042.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Lake Cumberland Regional Hospital in Somerset, KY, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-04-10 (CMS case 3747)
- Met Requirements — 2025-06-18 (CMS case 5254)
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.