Ohio

What Medicare pays in Ohio

Billed charges against Medicare allowed amounts in Ohio, across the 248 procedures Medicare covers most often.

248Procedures
47,011,309Services covered
3.2xBilled vs allowed
#25Rank of 61

Providers here billed the most above the national figure for identification of organisms by genetic analysis, amplified probe technique. The average was $145.16 against a national $64.75. That is 2.2 times as much.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

The 40 most common procedures in Ohio

ProcedureBilled hereAllowedGapvs national billed
Ground mileage, per statute mile$19.79$9.792.0x0.75x
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled$1.10$1.071.0x0.64x
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$256.40$105.782.4x0.93x
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more$177.76$76.512.3x0.94x
Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes$63.23$21.403.0x0.91x
Insertion of needle into vein for collection of blood sample$17.44$8.522.0x0.80x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes$196.34$72.542.7x0.97x
Blood test, comprehensive group of blood chemicals$49.98$10.324.8x0.81x
Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count$31.33$7.594.1x0.84x
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's$59.62$15.303.9x1.37x
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes$356.89$110.483.2x1.10x
Therapy procedure using functional activities$68.29$29.262.3x0.92x
Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes$66.98$25.522.6x0.92x
Blood test, lipids (cholesterol and triglycerides)$70.36$13.095.4x0.73x
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only$41.71$7.685.4x0.93x
Pathology examination of tissue using a microscope, intermediate complexity$178.19$47.643.7x0.96x
Removal of cataract with insertion of prosthetic lens$414.27$109.813.8x0.40x
Hemoglobin a1c level$45.69$9.494.8x0.79x
Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$179.04$90.192.0x0.85x
Blood test, thyroid stimulating hormone (tsh)$76.49$16.444.7x0.80x
Destruction of precancer skin growth, 2-14 growths$16.36$5.592.9x0.74x
Chiropractic manipulative treatment, 3-4 spinal regions$56.96$36.921.5x0.94x
X-ray of chest, 1 view$54.37$8.456.4x1.04x
Therapy procedure using manual technique, each 15 minutes$63.10$19.263.3x0.93x
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit$260.63$92.292.8x0.94x
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more$386.41$145.352.7x0.95x
Administration of influenza virus vaccine$33.61$27.091.2x0.82x
Emergency department visit with high level of medical decision making$1,291.06$166.397.8x1.05x
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$134.52$65.082.1x0.87x
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes$541.34$161.613.3x0.95x
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more$418.56$145.772.9x1.03x
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more$241.74$95.302.5x0.91x
Removal of fingernails or toenails, 6 or more nails$75.67$40.281.9x0.89x
Injection, bupivacaine liposome, 1 mg$5.98$1.404.3x1.22x
Vitamin d-3 level$158.30$28.965.5x0.86x
Admn sarscov2 vacc 1 dose$44.53$35.221.3x0.88x
Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha)$11.07$10.611.0x0.58x
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes$343.88$120.752.8x0.93x
Imaging of retina$119.82$35.983.3x0.97x
Blood test, basic group of blood chemicals (calcium, total)$47.93$8.275.8x1.00x

The last column compares this state against the national average for the same code. Above 1.00 means providers here billed more.

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

← All states  ·  All procedures