What an Ambulance Ride Costs: Medicare's 2026 Rate in Every State

What a 10-mile 911 ride works out to

Take the middle fee area, an advanced life support crew and a 10-mile ride to the ER. On Medicare, you pay 20% of the approved amount once you have met the Part B deductible4, which is $283 in 20263.

Our math on the CMS rates. Medigap or a Medicare Advantage plan can change your share.

The six kinds of ambulance ride

An ambulance bill is a base rate for the level of care plus mileage. Medicare sets each level as a multiple of one national base rate, then adjusts 70% of it for local costs1. Here is each level in the middle fee area, city rate:

1. BLS, scheduledbasic life support, not an emergency$294
2. BLS, 911basic life support, emergency$470
3. ALS, scheduledadvanced life support, not an emergency$352
4. ALS, 911advanced life support level 1, emergency$558
5. ALS level 2three or more IV drugs, or a procedure like intubation$807
6. Critical carespecialty care transport between hospitals$954

Middle (median) of the 107 fee areas in the 50 states and DC. Mileage is billed on top.

A real bill can be four times the Medicare rate

Medicare caps what it pays, but nothing federal caps what an ambulance company bills a patient with private insurance or no insurance. Ground ambulances were left out of the No Surprises Act's balance-billing ban; the law set up a federal advisory committee to study ground ambulance billing instead6. In Riverside County, California, the county EMS agency posts the rates each ambulance company charges. AMR, the main 911 provider in Riverside, Hemet, Palm Springs and Blythe, posted a base rate of $2,610.88 plus $63.49 a mile for 2023-245. Medicare's 2026 rate for the same county is $588.54 plus $9.331.

That is 4.8 times the Medicare amount for the same 10 miles. The rate sheet is for 2023-24 and the Medicare rate is for 2026; both change every year, so check the county's current sheet before you compare your own bill.

Where Medicare pays the most and least

Medicare's rate follows local costs, so it is highest around San Francisco and San Jose and lowest in rural, lower-cost states. Highest 911 ALS city rate in each state:

1. CaliforniaSan Jose-Sunnyvale-Santa Clara (Santa Clara County)$722
2. WashingtonSeattle (King County)$639
3. MassachusettsMetropolitan Boston$626
4. New YorkNyc Suburbs/Long Island$624
5. District of Columbia$620
6. New JerseyNorthern Nj$613
7. Hawaii$604
8. OregonPortland$594

Lowest:

1. Arkansas$497
2. Mississippi$498
3. Missouri$498
4. West Virginia$501
5. Alabama$503
6. Louisiana$507
7. Kentucky$509
8. Georgia$510

Rural rides pay more, not less

Medicare adds more for rural pickups, and much more in the least-populated ZIP codes (CMS's lowest-quartile rural areas). In Texas outside the big metros, a 911 ALS pickup is $531.79 in a town but $658.36 in the most rural ZIP codes1. Rural mileage is $14.13 a mile for the first 17 miles and $9.42 after that, against $9.33 in a city.

Before you pay an ambulance bill

• Ask for the itemized bill. Check the level (BLS or ALS, emergency or not) and the miles. A 911 call coded as ALS when the crew only gave oxygen, or extra miles, is worth questioning.
• Find your area's Medicare rate in the table below. It is a fair reference point when you call to negotiate a self-pay bill.
• If you have Medicare, a company that takes assignment can only charge you your 20% share after the deductible4.
• Check your state. Some states and cities cap ambulance charges or protect insured patients from balance bills. Your county EMS agency often posts the local rates, as Riverside's does.

Medicare ambulance rates, every state

CMS 2026 rates for the base charge only12. Where a state has more than one Medicare fee area, you see the low and high. "ALS 911" and "BLS 911" are city rates; the last column is the most rural ZIP codes. Add $9.33 per loaded mile in a city or $14.13 for the first 17 rural miles.

Puerto Rico and Virgin Islands have their own fee areas and are left out of this table. The Hawaii fee area also covers Guam. Source file: the CY 2026 public use file on the CMS ambulance fee schedule page.

How we got these numbers

We read every row of CMS's CY 2026 ambulance fee schedule file, which lists the rate for each service code in each Medicare locality, and matched each locality to its state with the 2026 locality key2. "City" is the urban column, "most rural" is CMS's rural lowest-quartile (super rural) column. The middle figure is the median across fee areas, not weighted by population. Nothing here is a price an ambulance company has quoted; it is what Medicare approves.