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

H0036Comm psy face-face per 15minBehavioral Health

Average paid per claim across 37 reporting states. National median $84.19. South Carolina pays $74.89, 11% 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
AZ — Arizona	$2,102.70	+2398%	198	2	27%
WV — West Virginia	$464.80	+452%	149,821	24	24%
TN — Tennessee	$434.07	+416%	229,133	12	26%
ID — Idaho	$300.96	+257%	636	2	15%
MI — Michigan	$297.50	+253%	1,462,312	93	28%
NJ — New Jersey	$205.24	+144%	2,997,693	390	36%
VA — Virginia	$177.05	+110%	111,130	54	26%
DE — Delaware	$161.77	+92%	261,096	21	22%
PA — Pennsylvania	$113.85	+35%	1,264,179	96	16%
NY — New York	$108.94	+29%	1,160,465	96	29%
MA — Massachusetts	$106.13	+26%	2,804	2	37%
IA — Iowa	$104.08	+24%	507	3	23%
KS — Kansas	$100.45	+19%	2,574,457	63	30%
TX — Texas	$100.06	+19%	21,448	6	27%
GA — Georgia	$97.59	+16%	19,223	9	5%
NC — North Carolina	$93.37	+11%	872,258	170	24%
KY — Kentucky	$88.38	+5%	212	1	23%
DC — District of Columbia	$87.65	+4%	9,083,318	57	27%
MT — Montana	$84.19	−0%	1,747,310	90	44%
LA — Louisiana	$76.48	−9%	6,315,555	461	20%
SC — South Carolina	$74.89	−11%	4,325	2	19%
AL — Alabama	$70.24	−17%	4,823,022	12	21%
CT — Connecticut	$67.50	−20%	858	1	41%
NE — Nebraska	$66.60	−21%	1,176	3	9%
MD — Maryland	$64.60	−23%	561,884	4	21%
IL — Illinois	$60.94	−28%	62	1	11%
MS — Mississippi	$59.73	−29%	1,065,564	28	21%
OH — Ohio	$55.33	−34%	8,953,934	739	23%
FL — Florida	$48.37	−43%	1,299	3	17%
OK — Oklahoma	$39.63	−53%	48,695	6	20%
OR — Oregon	$26.79	−68%	37,725	17	9%
CO — Colorado	$26.11	−69%	116,323	33	31%
MO — Missouri	$23.54	−72%	10,564,213	24	35%
WA — Washington	$14.19	−83%	565,073	30	14%
RI — Rhode Island	$12.88	−85%	1,296,085	89	35%
ME — Maine	$0.00	−100%	25	1	38%
VT — Vermont	$0.00	−100%	335	1	24%

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.