Medicine · 91320 Drug

Sarscv2 Vac 30mcg Trs-Suc Im

Medicare Payment (avg)
$126.99
What Medicare actually pays
Billed Charge (avg)
$151.08
What providers submit
Markup
1.2x
19% above Medicare rate
3.4M
Total Services
3.4M
Beneficiaries
46.7K
Providers
54
States with Data

Price Range Across States

Lowest State Avg
$122.40
Rhode Island
Highest State Avg
$128.48
Guam

What You Might Pay

Est. Commercial Insurance
$273.03
Range: $191.12 – $382.25
Est. Cash / Self-Pay
$136.79
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: Medicine procedures average 2.15x 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
Guam $128.48 $137.09
U.S. Virgin Islands $128.48 $132.74
District of Columbia $128.45 $164.08
Idaho $128.32 $145.59
North Dakota $127.99 $149.34
Pennsylvania $127.95 $153.45
Hawaii $127.90 $152.46
Maryland $127.81 $156.44
Iowa $127.74 $150.01
Maine $127.60 $154.46
Massachusetts $127.56 $151.81
Oregon $127.47 $150.49
West Virginia $127.46 $154.71
Virginia $127.44 $152.87
California $127.41 $154.64
Arkansas $127.39 $162.17
New Jersey $127.38 $150.59
Nebraska $127.37 $152.01
Washington $127.33 $154.15
Alabama $127.29 $148.91
New York $127.27 $152.49
New Hampshire $127.26 $145.98
Montana $127.20 $149.42
Mississippi $127.19 $145.10
Ohio $127.19 $144.57
Kentucky $127.09 $176.28
Connecticut $127.08 $149.41
Texas $127.06 $151.39
Arizona $127.06 $144.59
Georgia $127.06 $145.56
Indiana $127.00 $151.09
North Carolina $126.97 $154.86
Delaware $126.85 $143.95
South Dakota $126.82 $141.65
Utah $126.81 $163.72
Kansas $126.81 $145.22
Vermont $126.71 $145.16
Louisiana $126.69 $169.48
Michigan $126.67 $152.55
Puerto Rico $126.64 $145.77
Nevada $126.63 $145.74
Oklahoma $126.58 $152.99
Missouri $126.53 $148.29
Florida $126.51 $147.64
Tennessee $126.45 $182.64
South Carolina $126.29 $151.34
Illinois $126.25 $150.54
Wisconsin $126.17 $154.22
Minnesota $126.06 $154.36
New Mexico $125.58 $149.64
Wyoming $124.87 $140.45
Alaska $124.66 $137.85
Colorado $124.45 $140.43
Rhode Island $122.40 $140.51

What the Data Says About Sarscv2 Vac 30mcg Trs-Suc Im

Across 54 states with reporting providers, CPT code 91320 (Sarscv2 Vac 30mcg Trs-Suc Im) shows a national average Medicare payment of $126.99 against an average billed charge of $151.08. That gap — a 1.2x markup, or 19% 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.

Medicine procedures like this one saw 3.4M services billed to Medicare in 2023 by 46.7K distinct providers, serving 3.4M unique beneficiaries. State-level variation is significant: Rhode Island reports the lowest average payment at $122.40, while Guam reports the highest at $128.48. 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 Medicine category (2.15x), the estimated commercial insurance price lands near $273.03, with self-pay cash discounts commonly bringing the figure closer to $136.79. 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 Sarscv2 Vac 30mcg Trs-Suc Im cost?

The national average Medicare payment for Sarscv2 Vac 30mcg Trs-Suc Im (CPT 91320) is $126.99, while providers typically bill $151.08. Prices vary significantly by state, ranging from $122.40 to $128.48.

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 Sarscv2 Vac 30mcg Trs-Suc Im cost with insurance?

With commercial insurance, Sarscv2 Vac 30mcg Trs-Suc Im costs an estimated $273.03 on average (range: $191.12 – $382.25). Without insurance, the estimated cash price is $136.79. 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 Sarscv2 Vac 30mcg Trs-Suc Im?

Rhode Island has the lowest average Medicare payment for Sarscv2 Vac 30mcg Trs-Suc Im at $122.40, while Guam has the highest at $128.48. This $6.08 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.

How many providers perform Sarscv2 Vac 30mcg Trs-Suc Im?

Nationally, 46.7K providers billed Medicare for Sarscv2 Vac 30mcg Trs-Suc Im in 2023, performing 3.4M total services for 3.4M beneficiaries across 54 states and territories.

What is the billed-to-Medicare markup for Sarscv2 Vac 30mcg Trs-Suc Im?

Providers bill 1.2x what Medicare pays for Sarscv2 Vac 30mcg Trs-Suc Im — a 19% 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