Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled
What Medicare pays for P9603, what providers bill, and how the price varies across 39 states, drawn from CMS 2023 claims data.
P9603 · the short answer
For travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled, Medicare pays about $1.05 on average across 39 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $1.05
- Providers bill
- $1.65
- States with data
- 39
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
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: Pathology Services 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 |
|---|---|---|
| California | $1.10 | $1.57 |
| Delaware | $1.09 | $2.11 |
| Connecticut | $1.09 | $2.77 |
| Washington | $1.09 | $3.29 |
| Minnesota | $1.09 | $3.55 |
| Indiana | $1.09 | $1.11 |
| Oregon | $1.09 | $1.25 |
| South Carolina | $1.09 | $1.99 |
| Utah | $1.09 | $1.11 |
| Mississippi | $1.09 | $1.96 |
| Georgia | $1.09 | $1.24 |
| Colorado | $1.09 | $3.25 |
| North Dakota | $1.09 | $2.78 |
| New Jersey | $1.09 | $1.14 |
| Nevada | $1.09 | $1.32 |
| Maryland | $1.09 | $1.22 |
| Massachusetts | $1.08 | $3.43 |
| Illinois | $1.08 | $2.13 |
| Michigan | $1.08 | $2.23 |
| Oklahoma | $1.08 | $1.11 |
| Missouri | $1.08 | $1.36 |
| Maine | $1.08 | $1.10 |
| Texas | $1.07 | $2.03 |
| Alabama | $1.07 | $1.80 |
| Arizona | $1.07 | $1.43 |
| New York | $1.07 | $1.19 |
| Florida | $1.07 | $1.83 |
| Tennessee | $1.07 | $2.17 |
| Arkansas | $1.06 | $1.42 |
| Virginia | $1.06 | $1.13 |
| North Carolina | $1.06 | $1.20 |
| Kansas | $1.06 | $1.25 |
| Ohio | $1.05 | $1.08 |
| Louisiana | $1.05 | $1.07 |
| Wisconsin | $1.04 | $1.19 |
| Rhode Island | $0.97 | $1.02 |
| Kentucky | $0.96 | $1.50 |
| Iowa | $0.75 | $2.81 |
| Pennsylvania | $0.18 | $0.27 |
What the Data Says About Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled
Across 39 states with reporting providers, CPT code P9603 (Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled) shows a national average Medicare payment of $1.05 against an average billed charge of $1.65. That gap, a 1.6x markup, or 58% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Pathology Services procedures like this one saw 46.3M services billed to Medicare in 2023 by 416 distinct providers, serving 585.8K unique beneficiaries. State-level variation is significant: Pennsylvania reports the lowest average payment at $0.18, while California reports the highest at $1.10. A 500% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Pathology Services category (2.24x), the estimated commercial insurance price lands near $2.34, with self-pay cash discounts commonly bringing the figure closer to $1.24. Within Pathology Services, Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled ranks #20 of 20 tracked procedures by national average Medicare payment.
What to do with this
If you may have travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled cost?
Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled (CPT P9603) shows unusually wide state-to-state pricing: Medicare pays $1.05 on average nationally, but the $0.18-$1.10 range across states spans more than double from cheapest to priciest.
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 Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled cost with insurance?
With commercial insurance, travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled costs an estimated $2.34 on average (range: $1.64-$3.28), a moderate premium over Medicare's $1.05. Without insurance, the estimated cash price is $1.24.
Which state has the lowest cost for Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled?
Pennsylvania has by far the lowest average Medicare payment for Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled at $0.18, while California pays more than double at $1.10 - a $0.92 gap.
How many providers perform Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled?
Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled is comparatively uncommon: only 416 providers nationally billed Medicare for it in 2023, serving 585.8K beneficiaries via 46.3M total services.
What is the billed-to-Medicare markup for Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled?
Providers bill 1.6x what Medicare pays for Travel Allowance One Way In Connection With Medically Necessary Laboratory Specimen Collection Drawn From Home Bound Or Nursing Home Bound Patient; Prorated Miles Actually Travelled - a markup within the typical range at 58% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.