Medical Supplies · A0425

Ground Mileage, Per Statute Mile

Medicare Payment (avg)
$7.35
What Medicare actually pays
Billed Charge (avg)
$24.62
What providers submit
Markup
3.3x
235% above Medicare rate
99.5M
Total Services
4.0M
Beneficiaries
10.0K
Providers
55
States with Data

Price Range Across States

Lowest State Avg
$6.34
New Jersey
Highest State Avg
$10.28
Northern Mariana Islands

What You Might Pay

Est. Commercial Insurance
$20.67
Range: $14.47 – $28.94
Est. Cash / Self-Pay
$13.69
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Medical Supplies procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Prices by State

State Medicare Payment Billed Charge
Northern Mariana Islands $10.28 $15.00
Vermont $8.53 $20.51
Maine $8.34 $20.55
Hawaii $8.33 $35.42
Alaska $8.30 $22.80
New Hampshire $8.17 $37.83
Guam $8.16 $23.73
Kentucky $8.04 $17.35
Iowa $7.98 $18.82
Mississippi $7.97 $24.82
Delaware $7.94 $25.17
Oregon $7.88 $26.22
Montana $7.88 $22.83
Wyoming $7.81 $32.08
Wisconsin $7.78 $26.73
Idaho $7.76 $19.09
Oklahoma $7.76 $20.68
Kansas $7.76 $16.96
South Dakota $7.74 $17.14
North Dakota $7.72 $23.36
Minnesota $7.71 $31.26
Arkansas $7.71 $21.03
Missouri $7.69 $17.26
Ohio $7.61 $19.30
North Carolina $7.54 $15.15
Washington $7.51 $25.74
Alabama $7.51 $16.62
New Mexico $7.51 $13.48
Arizona $7.49 $22.66
Indiana $7.48 $22.59
Utah $7.48 $40.63
West Virginia $7.46 $17.32
Michigan $7.44 $19.91
Tennessee $7.44 $23.50
Virginia $7.43 $17.30
Nevada $7.43 $33.84
Colorado $7.40 $29.46
Louisiana $7.34 $31.91
Illinois $7.33 $28.32
Pennsylvania $7.32 $17.13
New York $7.28 $25.79
Texas $7.23 $24.10
Nebraska $7.23 $21.24
California $7.11 $52.16
Maryland $7.06 $13.76
Florida $7.01 $15.13
South Carolina $6.96 $15.96
Georgia $6.95 $21.44
Connecticut $6.93 $23.58
Massachusetts $6.88 $53.55
District of Columbia $6.83 $18.36
Rhode Island $6.73 $37.65
U.S. Virgin Islands $6.67 $9.00
Puerto Rico $6.44 $8.45
New Jersey $6.34 $21.05

What the Data Says About Ground Mileage, Per Statute Mile

Across 55 states with reporting providers, CPT code A0425 (Ground Mileage, Per Statute Mile) shows a national average Medicare payment of $7.35 against an average billed charge of $24.62. That gap — a 3.3x markup, or 235% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.

Medical Supplies procedures like this one saw 99.5M services billed to Medicare in 2023 by 10.0K distinct providers, serving 4.0M unique beneficiaries. State-level variation is significant: New Jersey reports the lowest average payment at $6.34, while Northern Mariana Islands reports the highest at $10.28. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Medical Supplies category (2.24x), the estimated commercial insurance price lands near $20.67, with self-pay cash discounts commonly bringing the figure closer to $13.69. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.

Frequently Asked Questions

How much does Ground Mileage, Per Statute Mile cost?

The national average Medicare payment for Ground Mileage, Per Statute Mile (CPT A0425) is $7.35, while providers typically bill $24.62. Prices vary significantly by state, ranging from $6.34 to $10.28.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Ground Mileage, Per Statute Mile cost with insurance?

With commercial insurance, Ground Mileage, Per Statute Mile costs an estimated $20.67 on average (range: $14.47 – $28.94). Without insurance, the estimated cash price is $13.69. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.

Which state has the lowest cost for Ground Mileage, Per Statute Mile?

New Jersey has the lowest average Medicare payment for Ground Mileage, Per Statute Mile at $6.34, while Northern Mariana Islands has the highest at $10.28. This $3.94 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Ground Mileage, Per Statute Mile?

Nationally, 10.0K providers billed Medicare for Ground Mileage, Per Statute Mile in 2023, performing 99.5M total services for 4.0M beneficiaries across 55 states and territories.

What is the billed-to-Medicare markup for Ground Mileage, Per Statute Mile?

Providers bill 3.3x what Medicare pays for Ground Mileage, Per Statute Mile — a 235% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.

Related

Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial