Outpatient hospital cost-to-charge ratio: Medicaid rates by state

States publish outpatient hospital cost-to-charge ratio under their own codes, modifiers and units. To compare them, this page picks the rate in each state that matches the same service and provider level.

• Provider level. States are compared at the same provider level wherever the schedule distinguishes one. Rates for other levels on file (any qualified provider) are kept separate, never mixed into this ranking.
• Unit. Of the 3 states, 1 publish their headline rate per outpatient ccr, and 2 schedules print no unit at all (a flat amount per service). The ranking uses the rate as published, so read the unit before comparing two states.
• Variants. 3 of the 3 states publish more than one rate for this service (by modifier, program, setting or provider type); the headline rate is the one that matches the comparison, and the workspace lists every variant.
• Depth. 778 rates for this service are on file across all states, versions and provider levels; this page shows one headline rate per state.

The highest-paying state, North Dakota, pays $24.83; the lowest, South Dakota, pays $0.236, a 105.2x gap. 3 of the 3 states pay above the median of —. Common reasons rates for hospital outpatient services spread this way:

• Many outpatient amounts are hospital-specific or adjusted by hospital type.
• States pay outpatient hospital care under different systems: grouped payments, a fee schedule or a percentage of charges.

Billing notes

Outpatient services are billed per procedure, and some systems package lower-cost items into the payment for the main service.