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πŸ“–Methodology
βš–οΈCompare States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Updated: Oct 19, 2026

Rate Benchmarks

What each state pays for the same procedure. Start from a code β€” no need to pick a state first.

High-spend codes billed in 20+ states

Restricted to widely-billed codes: a procedure billed in four states cannot tell you whether your rate is unusual.

T1019Personal care ser per 15 minT1015Clinic serviceT2016Habil res waiver per diem99213Office o/p est low 20 minS5125Attendant care service /15m99214Office o/p est mod 30 min99284Emergency dept visit mod mdmH2016Comp comm supp svc, per diem99283Emergency dept visit low mdmH2015Comp comm supp svc, 15 min99285Emergency dept visit hi mdm90837Psytx w pt 60 minutesS5102Adult day care per diem90834Psytx w pt 45 minutesT2021Day habil waiver per 15 minH2017Psysoc rehab svc, per 15 minT1017Targeted case managementT1020Personal care ser per diem90999Unlisted dialysis procedureA0427Als1-emergencyH2019Ther behav svc, per 15 min92507Tx sp lang voice comm indivT2033Res, nos waiver per diemT1000Private duty/independent nsgH2014Skills train and dev, 15 minH0020Alcohol and/or drug services; methadone administration and/or serviceH0004Behavioral health counseling and therapy, per 15 minutes97530Therapeutic activitiesA0429Bls-emergencyH0019Behavioral health; long-term residential (non-medical, non-acute care in aS9124Nursing care, in the home; b97153Adaptive behavior tx by tech97110Therapeutic exercisesT2023Targeted case mgmt per monthT1016Case managementS5130Homaker service nos per 15mH2036A/d tx program, per diemG0463Hospital outpt clinic visitH0036Comm psy face-face per 15minT2031Assist living waiver/diem
90837Psytx w pt 60 minutesBehavioral Health

Average paid per claim across 51 reporting states. National median $85.17. New Hampshire pays $70.69, 17% below the median.

State-by-state detail is in the table below.

Ranked by rate
Coverage differs across these states. Claims represent 44% of Montana’s Medicaid spending but only 5% of Georgia’s. A lower figure here may reflect what this dataset cannot see rather than what the state spends.
StateAvg paid / claimvs medianClaimsProvidersCoverage
AK β€” Alaska$199.22+134%459,99314937%
OR β€” Oregon$143.87+69%3,488,2231,3839%
CA β€” California$141.50+66%12,155,1734,31717%
UT β€” Utah$139.41+64%1,881,95537516%
NE β€” Nebraska$136.89+61%583,6235139%
SC β€” South Carolina$123.82+45%2,156,87864219%
NM β€” New Mexico$118.96+40%2,809,41692331%
MD β€” Maryland$114.65+35%1,151,31544821%
ND β€” North Dakota$109.92+29%162,86314127%
DC β€” District of Columbia$109.47+29%469,53012027%
MA β€” Massachusetts$102.77+21%2,881,1891,02237%
MN β€” Minnesota$102.15+20%6,098,0271,15524%
NY β€” New York$101.83+20%3,796,2021,75329%
MI β€” Michigan$101.41+19%7,265,0721,95928%
CO β€” Colorado$100.65+18%3,837,1441,69131%
MS β€” Mississippi$99.81+17%1,935,34628321%
PA β€” Pennsylvania$93.64+10%2,877,82655816%
VA β€” Virginia$91.25+7%3,603,3211,35026%
RI β€” Rhode Island$90.08+6%383,63136535%
HI β€” Hawaii$89.38+5%573,32344317%
SD β€” South Dakota$88.30+4%322,78918635%
GA β€” Georgia$86.06+1%1,523,8018905%
OH β€” Ohio$85.93+1%12,569,9742,66123%
AL β€” Alabama$85.58+0%1,603,09837921%
CT β€” Connecticut$85.35+0%10,353,1182,18841%
IL β€” Illinois$85.17βˆ’0%1,567,9701,17811%
ID β€” Idaho$85.05βˆ’0%144,59125715%
KS β€” Kansas$84.40βˆ’1%1,110,90873630%
AR β€” Arkansas$83.19βˆ’2%3,604,86143719%
WV β€” West Virginia$79.17βˆ’7%706,54131524%
MT β€” Montana$78.75βˆ’8%2,189,6561,20744%
NV β€” Nevada$78.71βˆ’8%1,712,98797922%
AZ β€” Arizona$78.44βˆ’8%591,99738727%
NC β€” North Carolina$77.00βˆ’10%6,120,2441,71524%
TX β€” Texas$75.52βˆ’11%2,536,7361,71827%
KY β€” Kentucky$75.50βˆ’11%7,504,2271,27223%
IN β€” Indiana$75.37βˆ’12%3,794,86169215%
WI β€” Wisconsin$74.43βˆ’13%1,579,86890315%
IA β€” Iowa$74.22βˆ’13%1,198,96661523%
TN β€” Tennessee$71.91βˆ’16%1,717,36343726%
NH β€” New Hampshire$70.69βˆ’17%786,82819540%
NJ β€” New Jersey$69.62βˆ’18%356,76619436%
MO β€” Missouri$68.44βˆ’20%476,59844235%
WY β€” Wyoming$68.35βˆ’20%162,48713719%
VT β€” Vermont$66.13βˆ’22%1,453,03867024%
WA β€” Washington$62.95βˆ’26%3,854,80494414%
DE β€” Delaware$62.42βˆ’27%787,73524022%
OK β€” Oklahoma$59.35βˆ’30%273,19426720%
FL β€” Florida$52.46βˆ’38%849,34250417%
LA β€” Louisiana$39.30βˆ’54%1,428,45091320%
ME β€” Maine$29.82βˆ’65%282,51214338%

Average paid per claim is a ratio internal to the claims data, so unlike per-enrollee measures it needs no external denominator. It remains subject to one caveat: this extract carries no claim-type field, so fee-for-service claims and managed-care encounter records are mixed together, and states derive encounter amounts inconsistently. The coverage column indicates how much of each state’s program these claims represent.