Iowa / Lakes Regional Healthcare
CMS certification 160124 · Spirit Lake, IA · 2 entries in CMS's price-transparency list
Lakes Regional Healthcare: charges and Medicare payments
Lakes Regional Healthcare reported 169 Medicare inpatient stays across 9 DRGs in 2024. Across them it charged 2.44 times what it was paid — among the lower ratios in Iowa, number 24 of 27 hospitals with at least 100 stays (state median 3.32×, national 4.15×). Its most frequent stay was DRG 470, Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC: 34 stays at an average charge of $43,362, 53% below the national average. It also billed 729 outpatient services, charging 4.14 times what Medicare paid.
- 1Medicare inpatient stays 169
- 2Charge ÷ paid, inpatient 2.44×
- 3Rank in IA (highest ratio = 1) 24 of 27
- 4CMS price-transparency actions 2
Inpatient stays
For the 9 DRGs that can be compared with the national average, Lakes Regional Healthcare charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 34 | $43,362 | -53% | $13,677 |
| 194 Simple Pneumonia and Pleurisy with CC | 21 | $16,083 | -58% | $6,158 |
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 21 | $18,620 | -79% | $14,247 |
| 291 Heart Failure and Shock with MCC | 19 | $19,755 | -65% | $9,339 |
| 690 Kidney and Urinary Tract Infections without MCC | 19 | $14,778 | -61% | $5,818 |
| 189 Pulmonary Edema and Respiratory Failure | 16 | $20,810 | -64% | $8,900 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 16 | $14,791 | -60% | $5,646 |
| 552 Medical Back Problems without MCC | 12 | $16,159 | -67% | $6,913 |
| 481 Hip and Femur Procedures except Major Joint with CC | 11 | $39,170 | -61% | $14,974 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 1 Intraocular Procedures | 251 | $5,040 | $1,993 |
| Comprehensive Observation Services | 181 | $9,015 | $2,341 |
| Level 5 Musculoskeletal Procedures | 66 | $39,672 | $11,245 |
| Level 4 Musculoskeletal Procedures | 47 | $21,809 | $6,120 |
| Level 2 Upper GI Procedures | 44 | $5,216 | $1,628 |
| Level 1 Laparoscopy and Related Services | 37 | $17,542 | $4,936 |
| Level 3 Musculoskeletal Procedures | 34 | $8,630 | $2,769 |
| Level 6 Musculoskeletal Procedures | 21 | $62,645 | $15,909 |
| Level 1 Nerve Procedures | 20 | $5,496 | $1,652 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 17 | $3,796 | $1,387 |
| Level 2 Urology and Related Services | 11 | $1,343 | $584 |
Against the Iowa average
For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Lakes Regional Healthcare charged $43,362 on average, 25% less than the Iowa average of $57,857, and was paid $13,677 against a state average of $13,856. For Simple Pneumonia and Pleurisy with CC (DRG 194), Lakes Regional Healthcare charged $16,083 on average, 32% less than the Iowa average of $23,660, and was paid $6,158 against a state average of $6,313. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Lakes Regional Healthcare charged $18,620 on average, 63% less than the Iowa average of $49,919, and was paid $14,247 against a state average of $14,771. For Heart Failure and Shock with MCC (DRG 291), Lakes Regional Healthcare charged $19,755 on average, 43% less than the Iowa average of $34,817, and was paid $9,339 against a state average of $9,846. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $5,040 was 47% below the state average of $9,485. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $9,015 was 48% below the state average of $17,461. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $39,672 was 19% below the state average of $49,177. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $21,809 was 35% below the state average of $33,464.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Lakes Regional Healthcare in Spirit Lake, IA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-07-07 (CMS case 5526)
- Met Requirements — 2026-07-15 (CMS case 8282)
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.