Rate Benchmarks

What each state pays for the same procedure. Start from a code — 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 min T1015Clinic service T2016Habil res waiver per diem 99213Office o/p est low 20 min S5125Attendant care service /15m 99214Office o/p est mod 30 min 99284Emergency dept visit mod mdm H2016Comp comm supp svc, per diem 99283Emergency dept visit low mdm H2015Comp comm supp svc, 15 min 99285Emergency dept visit hi mdm 90837Psytx w pt 60 minutes S5102Adult day care per diem 90834Psytx w pt 45 minutes T2021Day habil waiver per 15 min H2017Psysoc rehab svc, per 15 min T1017Targeted case management T1020Personal care ser per diem 90999Unlisted dialysis procedure A0427Als1-emergency H2019Ther behav svc, per 15 min 92507Tx sp lang voice comm indiv T2033Res, nos waiver per diem T1000Private duty/independent nsg H2014Skills train and dev, 15 min H0020Alcohol and/or drug services; methadone administration and/or service H0004Behavioral health counseling and therapy, per 15 minutes 97530Therapeutic activities A0429Bls-emergency H0019Behavioral health; long-term residential (non-medical, non-acute care in a S9124Nursing care, in the home; b 97153Adaptive behavior tx by tech 97110Therapeutic exercises T2023Targeted case mgmt per month T1016Case management S5130Homaker service nos per 15m H2036A/d tx program, per diem G0463Hospital outpt clinic visit H0036Comm psy face-face per 15min T2031Assist living waiver/diem

H0020Alcohol and/or drug services; methadone administration and/or serviceBehavioral Health

Average paid per claim across 48 reporting states. National median $15.00. Wisconsin pays $10.32, 31% 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.

State	Avg paid / claim	vs median	Claims	Providers	Coverage
ME — Maine	$106.80	+612%	1,211,923	14	38%
WV — West Virginia	$99.77	+565%	936,934	17	24%
SC — South Carolina	$98.16	+555%	115,419	23	19%
TN — Tennessee	$97.48	+550%	591,646	26	26%
KY — Kentucky	$82.13	+448%	1,964,043	31	23%
AK — Alaska	$81.59	+444%	1,026,647	8	37%
NJ — New Jersey	$75.94	+406%	2,645,260	59	36%
MD — Maryland	$74.86	+399%	6,928,818	108	21%
AL — Alabama	$62.90	+319%	1,029,657	8	21%
IL — Illinois	$62.00	+313%	180,279	51	11%
FL — Florida	$57.64	+284%	1,895,727	94	17%
RI — Rhode Island	$45.21	+202%	2,642,488	31	35%
NC — North Carolina	$42.40	+183%	7,711,845	93	24%
MO — Missouri	$37.92	+153%	673,567	11	35%
VT — Vermont	$35.04	+134%	3,498,446	9	24%
NY — New York	$30.43	+103%	17,845,854	124	29%
OH — Ohio	$29.42	+96%	10,247,030	117	23%
NM — New Mexico	$24.90	+66%	7,914,651	17	31%
IA — Iowa	$21.17	+41%	9,824	3	23%
HI — Hawaii	$20.81	+39%	320,069	4	17%
CA — California	$19.75	+32%	43,741,827	91	17%
GA — Georgia	$18.94	+26%	351,794	12	5%
IN — Indiana	$16.36	+9%	10,958,388	28	15%
CO — Colorado	$15.06	+0%	6,361,686	56	31%
WA — Washington	$14.93	−0%	16,532,245	60	14%
UT — Utah	$14.31	−5%	1,766,949	21	16%
MA — Massachusetts	$14.03	−6%	26,299,318	41	37%
CT — Connecticut	$12.90	−14%	59,189,646	25	41%
MN — Minnesota	$12.88	−14%	10,028,041	20	24%
SD — South Dakota	$12.53	−16%	1,713	1	35%
MT — Montana	$12.33	−18%	736	1	44%
TX — Texas	$11.58	−23%	2,482,752	41	27%
DC — District of Columbia	$11.24	−25%	1,643,562	5	27%
LA — Louisiana	$11.24	−25%	7,330,811	14	20%
ND — North Dakota	$10.69	−29%	462,281	5	27%
WI — Wisconsin	$10.32	−31%	9,257,956	241	15%
MI — Michigan	$10.25	−32%	18,561,177	43	28%
NH — New Hampshire	$10.19	−32%	4,531,219	9	40%
NV — Nevada	$9.63	−36%	1,015,036	18	22%
VA — Virginia	$9.04	−40%	15,650,243	51	26%
OR — Oregon	$9.01	−40%	8,621,022	32	9%
PA — Pennsylvania	$8.29	−45%	11,055,245	77	16%
DE — Delaware	$6.60	−56%	6,761,831	13	22%
AZ — Arizona	$3.35	−78%	8,709,334	75	27%
AR — Arkansas	$3.06	−80%	24,751	1	19%
MS — Mississippi	$2.31	−85%	97,863	2	21%
ID — Idaho	$0.37	−98%	28,437	2	15%
KS — Kansas	$0.00	−100%	60	1	30%

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.