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 Payment (avg)
$1.05
What Medicare actually pays
Billed Charge (avg)
$1.65
What providers submit
Markup
1.6x
58% above Medicare rate
46.3M
Total Services
585.8K
Beneficiaries
416
Providers
39
States with Data

Price Range Across States

Lowest State Avg
$0.18
Pennsylvania
Highest State Avg
$1.10
California

What You Might Pay

Est. Commercial Insurance
$2.34
Range: $1.64 – $3.28
Est. Cash / Self-Pay
$1.24
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: 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 — 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.

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. 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 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. 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 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?

The national 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 (CPT P9603) is $1.05, while providers typically bill $1.65. Prices vary significantly by state, ranging from $0.18 to $1.10.

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). Without insurance, the estimated cash price is $1.24. 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 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 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 has the highest at $1.10. This $0.92 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

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?

Nationally, 416 providers billed Medicare 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 in 2023, performing 46.3M total services for 585.8K beneficiaries across 39 states and territories.

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 58% 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