Ohio / Grand Lake Health System
CMS certification 360032 · Saint Marys, OH · 3 entries in CMS's price-transparency list
Grand Lake Health System: charges and Medicare payments
Grand Lake Health System reported 168 Medicare inpatient stays across 8 DRGs in 2024. Across them it charged 2.11 times what it was paid — among the lower ratios in Ohio, number 95 of 104 hospitals with at least 100 stays (state median 4.01×, national 4.15×). Its most frequent stay was DRG 291, Heart Failure and Shock with MCC: 37 stays at an average charge of $20,935, 63% below the national average. It also billed 526 outpatient services, charging 6.14 times what Medicare paid.
- 1Medicare inpatient stays 168
- 2Charge ÷ paid, inpatient 2.11×
- 3Rank in OH (highest ratio = 1) 95 of 104
- 4CMS price-transparency actions 3
Inpatient stays
For the 8 DRGs that can be compared with the national average, Grand Lake Health System 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 |
|---|---|---|---|---|
| 291 Heart Failure and Shock with MCC | 37 | $20,935 | -63% | $10,397 |
| 193 Simple Pneumonia and Pleurisy with MCC | 32 | $22,324 | -63% | $10,404 |
| 683 Renal Failure with CC | 19 | $18,701 | -54% | $7,626 |
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 19 | $31,272 | -65% | $16,149 |
| 682 Renal Failure with MCC | 18 | $21,325 | -68% | $11,598 |
| 189 Pulmonary Edema and Respiratory Failure | 17 | $21,444 | -63% | $10,181 |
| 603 Cellulitis without MCC | 15 | $15,818 | -58% | $7,710 |
| 378 Gastrointestinal Hemorrhage with CC | 11 | $26,072 | -46% | $8,202 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 207 | $12,608 | $2,332 |
| Level 1 Nerve Procedures | 60 | $8,480 | $1,651 |
| Level 2 Upper GI Procedures | 47 | $8,042 | $1,627 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 35 | $6,395 | $1,387 |
| Level 3 Urology and Related Services | 32 | $9,252 | $1,742 |
| Level 3 Musculoskeletal Procedures | 29 | $12,831 | $2,616 |
| Level 1 Laparoscopy and Related Services | 26 | $25,800 | $4,934 |
| Level 2 Urology and Related Services | 26 | $5,467 | $584 |
| Level 5 Musculoskeletal Procedures | 20 | $42,797 | $11,242 |
| Level 5 Urology and Related Services | 16 | $17,258 | $4,425 |
| Level 4 Musculoskeletal Procedures | 15 | $25,368 | $6,118 |
| Level 3 Vascular Procedures | 13 | $16,719 | $2,559 |
Against the Ohio average
For Heart Failure and Shock with MCC (DRG 291), Grand Lake Health System charged $20,935 on average, 51% less than the Ohio average of $42,986, and was paid $10,397 against a state average of $10,652. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Grand Lake Health System charged $22,324 on average, 46% less than the Ohio average of $41,598, and was paid $10,404 against a state average of $10,716. For Renal Failure with CC (DRG 683), Grand Lake Health System charged $18,701 on average, 35% less than the Ohio average of $28,967, and was paid $7,626 against a state average of $7,599. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Grand Lake Health System charged $31,272 on average, 51% less than the Ohio average of $64,290, and was paid $16,149 against a state average of $15,664. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $12,608 was 26% below the state average of $17,044. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $8,480 was 20% below the state average of $10,568. For Level 2 Upper GI Procedures (outpatient APC 5302), its average charge of $8,042 was 22% below the state average of $10,363. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $6,395 was 37% below the state average of $10,162.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Grand Lake Health System in Saint Marys, OH, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2024-10-07 (CMS case 2779)
- Closure Notice — 2025-01-14 (CMS case 2779)
- Warning Notice — 2026-06-17 (CMS case 8099)
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.