Sec. 54.605  Determining the urban rate.

    (a) If a rural health care provider requests an eligible service to 
be provided over a distance that is less than or equal to the ``standard 
urban distance,'' as defined in paragraph (d) of this section, for the 
state in which it is located, the urban rate for that service shall be a 
rate no higher than the highest tariffed or publicly-available rate 
charged to a commercial customer for a similar service provided over the 
same distance in the nearest large city in the state, calculated as if 
it were provided between two points within the city.
    (b) If a rural health care provider requests an eligible service to 
be provided over a distance that is greater than the ``standard urban 
distance'' for the state in which it is located, the urban rate shall be 
no higher than the highest tariffed or publicly-available rate charged 
to a commercial customer for a similar service provided over the 
standard urban distance in the nearest large city in the state, 
calculated as if the service were provided between two points within the 
city.
    (c) The ``nearest large city'' is the city located in the eligible 
health care provider's state, with a population of at least 50,000, that 
is nearest to the health care provider's location, measured point to 
point, from the health care provider's location to the point on that 
city's jurisdictional boundary closest to the health care provider's 
location.
    (d) The ``standard urban distance'' for a state is the average of 
the longest diameters of all cities with a population of 50,000 or more 
within the state, calculated by the Administrator.