Commercial healthcare reimbursement in Ohio
How Ohio compares with the nation, by payer, specialty and procedure.
Ohio at a glance
What the data shows
Ohio ranks 27th of 51 states for commercial reimbursement, with an index of 99 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Ohio run a median 156% of Medicare.
UnitedHealthcare has the highest index in the state (115) and Aetna the lowest (88), a 27-point gap, in the files analyzed.
CPT 67028 (Injection eye drug) is the strongest relative to the national median (132% of it, a 32% premium); CPT 26055 (Incise finger tendon sheath) is furthest below (79% of the national median, 21% lower).
By specialty, Ohio is strongest for diagnostic radiology (ranks 15th of 51 states for that specialty) and weakest for orthopedic surgery (40th of 51).
Against Medicare, gastroenterology has the highest ratio in Ohio (173% of Medicare) and dermatology the lowest (93%).
Payer ranking in Ohio
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 115 | 1 | 228 | 802 | 496 | |
| Blue Cross Blue Shield | 95 | 2 | 228 | 893 | 705 | |
| Cigna | 95 | 3 | 227 | 806 | 523 | |
| Aetna | 88 | 4 | 228 | 711 | 521 |
Reimbursement index by specialty in Ohio
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Diagnostic radiology | 112 | 15 of 51 | 167% | 49 | 129 | |
| Urology | 105 | 21 of 50 | 169% | 37 | 112 | |
| Cardiology | 103 | 21 of 51 | 154% | 38 | 117 | |
| Gastroenterology | 96 | 27 of 50 | 173% | 36 | 123 | |
| Internal medicine | 96 | 29 of 51 | 107% | 25 | 120 | |
| Dermatology | 95 | 31 of 50 | 93% | 44 | 115 | |
| Ophthalmology | 93 | 31 of 50 | 111% | 42 | 111 | |
| Orthopedic surgery | 89 | 40 of 51 | 125% | 39 | 110 |
Specialty by payer in Ohio
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 117 | 75 | 94 | 87 |
| Dermatology | 119 | 75 | 93 | 87 |
| Ophthalmology | 100 | 79 | 89 | 93 |
| Cardiology | 119 | 98 | 101 | 95 |
| Orthopedic surgery | 101 | 80 | 83 | 87 |
| Diagnostic radiology | 127 | 98 | 106 | 114 |
| Urology | 131 | 81 | 101 | 101 |
| Gastroenterology | 115 | 82 | 89 | 86 |
Ohio compared with Midwest region states
Procedures that pay most and least in Ohio vs the nation
Highest vs national
| Code | Ohio | National | Gap | Prov. |
|---|---|---|---|---|
| 67028 Injection eye drug | $181 | $137 | +32% | 110 |
| 93298 Rem interrog dev eval scrms | $67 | $52 | +28% | 117 |
| 51720 Treatment of bladder lesion | $134 | $111 | +20% | 110 |
| 71045 X-ray exam chest 1 view | $39 | $33 | +20% | 124 |
| 51700 Irrigation of bladder | $92 | $77 | +19% | 110 |
| 74176 Ct abd & pelvis w/o contrast | $337 | $287 | +18% | 127 |
| 11104 Punch bx skin single lesion | $94 | $81 | +17% | 115 |
| 72125 Ct neck spine w/o dye | $287 | $249 | +15% | 127 |
| 93297 Rem interrog dev eval icpms | $60 | $52 | +15% | 117 |
| 72131 Ct lumbar spine w/o dye | $286 | $248 | +15% | 127 |
| 71250 Ct thorax dx c- | $287 | $250 | +15% | 127 |
| 71046 X-ray exam chest 2 views | $52 | $45 | +15% | 128 |
| 77080 Dxa bone density axial | $76 | $66 | +15% | 127 |
| 76642 Ultrasound breast limited | $138 | $120 | +15% | 128 |
| 74174 Cta abd&plvs w/contrast | $686 | $601 | +14% | 127 |
Lowest vs national
| Code | Ohio | National | Gap | Prov. |
|---|---|---|---|---|
| 26055 Incise finger tendon sheath | $485 | $614 | -21% | 110 |
| 88342 Imhchem/imcytchm 1st antb | $79 | $95 | -17% | 114 |
| 20550 Njx 1 tendon sheath/ligament | $63 | $74 | -15% | 110 |
| 29848 Wrist endoscopy/surgery | $698 | $817 | -15% | 110 |
| 99497 Advncd care plan 30 min | $93 | $108 | -14% | 120 |
| 88312 Special stains group 1 | $83 | $97 | -14% | 237 |
| 65820 Goniotomy | $819 | $955 | -14% | 108 |
| 67036 Removal of inner eye fluid | $959 | $1,117 | -14% | 109 |
| 64721 Carpal tunnel surgery | $602 | $700 | -14% | 110 |
| 96910 Photchmtx tar&uvb/ptrltm&uvb | $108 | $125 | -14% | 115 |
| 52224 Cystoscopy and treatment | $398 | $459 | -13% | 109 |
| 27130 Total hip arthroplasty | $1,874 | $2,158 | -13% | 110 |
| 29827 Sho arthrs srg rt8tr cuf rpr | $1,481 | $1,701 | -13% | 110 |
| 20611 Drain/inj joint/bursa w/us | $102 | $117 | -13% | 110 |
| 23472 Reconstruct shoulder joint | $2,022 | $2,318 | -13% | 110 |
Frequently asked questions
How do commercial reimbursement rates in Ohio compare with the rest of the country?
Ohio ranks 27th of 51 states with an index of 99, across 228 procedure codes. Median commercial rates run 156% of the Medicare rate.
Which payer has the highest rates in Ohio?
In the files we analyzed, UnitedHealthcare has the highest index (115) and Aetna the lowest (88). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Ohio?
Diagnostic radiology ranks 15th of 51 states.
How many providers does this Ohio page cover?
937 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Ohio and the national median?
CPT 67028 (Injection eye drug) is highest relative to the nation at 132% of the national median; CPT 26055 (Incise finger tendon sheath) is lowest at 79%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Ohio contracts
Compare your negotiated rates with these state medians by payer and specialty.