Lake Cumberland Regional Hospital
Lake Cumberland Regional Hospital in Somerset, KY charges 9.4x the Medicare reimbursement rate across 47 analyzed procedures at this for-profit facility.
Somerset, KY 42503 · Acute Care Hospitals · CMS Rating: 1/5
About the analyst
David Park researches procedure pricing and insurance reimbursement patterns at BillRazor Research. He specializes in cost comparison across care settings and metropolitan areas. Expertise: procedure pricing, insurance reimbursement, cost comparison.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
F
Very high
Avg markup vs Medicare
9.45x
Charge / Medicare rate
Max markup
14.37x
Worst procedure
Procedures analyzed
47
With pricing data
Outlier procedures
2.1%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| CELLULITIS WITHOUT MCC | 603 | $69,549 | $34,775 | — | 14.4x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC | 247 | $164,737 | $82,368 | — | 14.2x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC | 282 | $49,668 | $24,834 | — | 13.4x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC | 066 | $50,720 | $25,360 | — | 13.1x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC | 310 | $34,929 | $17,464 | — | 13x |
| ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC | 392 | $54,514 | $27,257 | — | 11.8x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC | 309 | $46,044 | $23,022 | — | 11.7x |
| SIMPLE PNEUMONIA AND PLEURISY WITH CC | 194 | $60,323 | $30,161 | — | 11.6x |
| GASTROINTESTINAL OBSTRUCTION WITH CC | 389 | $50,651 | $25,326 | — | 11.5x |
| KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC | 690 | $52,794 | $26,397 | — | 11.3x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC | 287 | $65,614 | $32,807 | — | 11.1x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC | 281 | $60,373 | $30,187 | — | 11x |
| CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC | 190 | $75,606 | $37,803 | — | 10.9x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC | 641 | $50,878 | $25,439 | — | 10.8x |
| OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC | 394 | $55,162 | $27,581 | — | 10.6x |
| EXTRACRANIAL PROCEDURES WITHOUT CC/MCC | 039 | $72,383 | $36,192 | — | 10.3x |
| NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC | 071 | $67,494 | $33,747 | — | 10.2x |
| RENAL FAILURE WITH CC | 683 | $54,060 | $27,030 | — | 10.1x |
| PULMONARY EDEMA AND RESPIRATORY FAILURE | 189 | $78,244 | $39,122 | — | 10.1x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS | 065 | $60,039 | $30,019 | — | 10x |
| PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES O | 246 | $202,567 | $101,284 | — | 9.9x |
| NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC | 070 | $100,134 | $50,067 | — | 9.8x |
| KIDNEY AND URINARY TRACT INFECTIONS WITH MCC | 689 | $68,968 | $34,484 | — | 9.8x |
| SIMPLE PNEUMONIA AND PLEURISY WITH MCC | 193 | $79,784 | $39,892 | — | 9.6x |
| GASTROINTESTINAL HEMORRHAGE WITH CC | 378 | $55,543 | $27,771 | — | 9.4x |
| INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC | 853 | $309,254 | $154,627 | — | 9.3x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC | 872 | $60,581 | $30,290 | — | 9.2x |
| RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS | 208 | $156,817 | $78,409 | — | 8.8x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $121,462 | $60,731 | — | 8.8x |
| HEART FAILURE AND SHOCK WITH MCC | 291 | $68,069 | $34,034 | — | 8.8x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC | 481 | $116,319 | $58,160 | — | 8.7x |
| RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC | 177 | $98,224 | $49,112 | — | 8.6x |
| HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC | 482 | $87,921 | $43,961 | — | 8.3x |
| CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC | 308 | $62,093 | $31,046 | — | 8.1x |
| SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC | 871 | $105,400 | $52,700 | — | 8.1x |
| GASTROINTESTINAL HEMORRHAGE WITH MCC | 377 | $86,658 | $43,329 | — | 8x |
| ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC | 280 | $80,922 | $40,461 | — | 7.8x |
| RENAL FAILURE WITH MCC | 682 | $75,068 | $37,534 | — | 7.7x |
| PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE | 175 | $67,160 | $33,580 | — | 7.6x |
| RED BLOOD CELL DISORDERS WITHOUT MCC | 812 | $41,963 | $20,982 | — | 7.3x |
| INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC | 064 | $84,735 | $42,368 | — | 6.7x |
| SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS | 870 | $284,928 | $142,464 | — | 6.1x |
| MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC | 640 | $52,037 | $26,018 | — | 6x |
| DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC | 442 | $33,651 | $16,825 | — | 6x |
| CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC | 286 | $77,110 | $38,555 | — | 5.6x |
| SEIZURES WITH MCC | 100 | $67,593 | $33,797 | — | 5.4x |
| PSYCHOSES | 885 | $33,902 | $16,951 | — | 4x |
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use