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

T1000Private duty/independent nsgHome Health

Average paid per claim across 32 reporting states. National median $351.83. District of Columbia pays $369.85, 5% above 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 9% of Nebraska’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
NY — New York	$628.47	+79%	4,851	4	29%
CO — Colorado	$624.99	+78%	202,627	15	31%
PA — Pennsylvania	$571.01	+62%	63,500	10	16%
TN — Tennessee	$566.08	+61%	162,678	12	26%
NE — Nebraska	$540.48	+54%	7,349	1	9%
NM — New Mexico	$537.49	+53%	58,193	5	31%
TX — Texas	$492.84	+40%	6,938,925	140	27%
WA — Washington	$485.03	+38%	363,180	14	14%
KS — Kansas	$480.33	+37%	621,873	14	30%
NJ — New Jersey	$468.75	+33%	35,769	9	36%
LA — Louisiana	$414.79	+18%	1,920	1	20%
NC — North Carolina	$403.69	+15%	2,853,793	72	24%
MI — Michigan	$375.64	+7%	597,368	16	28%
WV — West Virginia	$371.99	+6%	115,363	3	24%
DC — District of Columbia	$369.85	+5%	107,184	5	27%
OK — Oklahoma	$352.75	+0%	620,565	9	20%
IN — Indiana	$350.91	−0%	80,883	2	15%
UT — Utah	$345.93	−2%	224,082	7	16%
IL — Illinois	$335.69	−5%	236,069	1	11%
KY — Kentucky	$316.54	−10%	88,470	2	23%
RI — Rhode Island	$309.01	−12%	93,506	2	35%
MO — Missouri	$295.71	−16%	1,146,063	17	35%
OH — Ohio	$273.29	−22%	1,776,807	58	23%
FL — Florida	$266.37	−24%	52,969	4	17%
IA — Iowa	$180.13	−49%	814	1	23%
CA — California	$121.44	−65%	18,471	2	17%
SD — South Dakota	$118.91	−66%	147,809	28	35%
MN — Minnesota	$62.51	−82%	411	1	24%
ME — Maine	$49.12	−86%	14,531	13	38%
MD — Maryland	$17.17	−95%	42,358	5	21%
ID — Idaho	$13.41	−96%	14,651	6	15%
MT — Montana	$11.14	−97%	39,244	1	44%

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.