What do doctors typically charge for Severe Acute Respiratory Syndrome Coronavirus 2 Covid-19 Vaccine?

The nationwide median physician charge for Severe Acute Respiratory Syndrome Coronavirus 2 Covid-19 Vaccine (CPT 91305) is $0.10. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 91305?

The standard insurance baseline reimbursement rate is $0.01. This represents the customary allowable amount established across standard fee schedules.

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CPT 91305Medical Service

Severe Acute Respiratory Syndrome Coronavirus 2 Covid-19 Vaccine

Severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, tris-sucrose formulation, for intramuscular use. Clinical pricing breakdown and utilization metrics across 5 practicing doctors nationwide.

$0.10

Peer Median Charge

Gross billed rate

$0.01

Standard Baseline

Customary allowable

10.0x

National Markup

Charge vs baseline

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $0.10. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $0.01 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 91305 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"