CPT stands for Current Procedural Terminology. CPT codes are five-digit numeric codes used by healthcare providers, insurance companies, and government entities to describe medical, surgical, and diagnostic services. They provide a uniform language for documenting and reporting healthcare services and procedures.

How can I find out the cost of a medical procedure?

Finding the exact cost of a medical procedure can be complex due to various factors like your insurance plan, geographic location, and specific provider. You can often start by contacting your insurance company directly or the healthcare provider's billing department. For specific pricing lookups based on CPT code and location, tools like Payerprice can be very helpful.

What factors influence the cost of healthcare?

Several factors influence healthcare costs, including: Geographic location (costs vary significantly by state, city, and even neighborhood); Provider type (prices differ between hospitals, outpatient centers, and individual physician practices); Insurance coverage (your specific health plan, deductible, co-pay, and co-insurance will impact your out-of-pocket costs); Complexity of the procedure (more complex procedures generally cost more); Facility fees (hospitals often charge separate facility fees); and Negotiated rates (insurance companies negotiate different rates with various providers).

Why do prices vary so much for the same procedure?

Price variations for the same procedure are common and can be attributed to several reasons: Negotiated rates (each insurance company negotiates unique rates with different hospitals and providers); Hospital vs. outpatient setting (procedures performed in a hospital setting typically cost more due to overhead and facility fees compared to an outpatient clinic); Provider reputation and expertise (highly specialized or renowned providers may charge more); Geographic location (the cost of living and operating a healthcare facility varies significantly by region); Technology and equipment (some facilities may use more advanced or expensive technology); and Profit margins (for-profit healthcare systems may price services differently than non-profit ones).

Where can I look up specific prices for a CPT code in my area?

To look up specific prices for a CPT code in your area, you can use specialized tools designed for healthcare price transparency. I recommend using Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to find pricing information. This can help you compare costs and make informed decisions.

What is the difference between an in-network and out-of-network provider?

In-network providers have a contract with your health insurance plan, agreeing to accept negotiated rates for services. When you see an in-network provider, your out-of-pocket costs (like co-pays, deductibles, and co-insurance) are typically lower, and your insurer covers a larger portion of the bill. Out-of-network providers do not have a contract with your insurance plan. While your plan might still cover some services, you'll generally pay a higher share of the cost, often subject to a separate, higher out-of-network deductible and co-insurance. You might also be responsible for the difference between the provider's charge and what your insurance pays (balance billing).

What does "price transparency" mean in healthcare?

Healthcare price transparency refers to the movement and regulations aimed at making the cost of healthcare services clear and accessible to consumers *before* they receive care. The goal is to empower patients to understand potential costs, compare prices among different providers, and make more informed decisions about their healthcare, ultimately promoting competition and potentially lowering costs.

CPT 87186 Fee Schedule

Q: What factors affect fee schedules?

Medicare & Medicaid Rates (Government-set reimbursement amounts), Private Insurance Rates (Negotiated rates between providers and insurance companies), Geographic Location (Costs may be higher in urban areas), Provider Type (Hospital providers may have different rates than private practice).

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Test Antibiotic Effectiveness, Lab Test To Determine How Responsive A Bacteria Is To Various Antibiotics. The Result Identifies The Antibiotic Likely To Be Most Effective In Treating The Infection.

Key Fact	Detail
Service Type	Pathology and Laboratory Procedures Microbiology Procedures
Common Place of Service	81 - Independent Laboratory 11 - Office
Common Modifiers	None 26 - Professional component 90 - Reference Laboratory
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 87186
Medicaid Fee Schedule	View Medicaid rates for 87186

National average reimbursement for CPT 87186 by major payers:

$8.36

$6.15

$10.56

$12.61

Compare published rates across providers.

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CPT 87186

5 of 25 sample ratesHigher to lower in this preview

Abigail Hall
Slocum Dickson Medical Group PLLC
NYMedical Physician AssistantNPI 1750891974Tax ID 20-0362623
$9.94Published rate
Justin Hunt
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLHospitalist PhysicianNPI 1912291238Tax ID 59-3238640
$5.19Published rate
Jonathan Zager
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLSurgical Oncology PhysicianNPI 1629080304Tax ID 59-3238640
$5.19Published rate
Ann Guastella
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLNurse PractitionerNPI 1891768990Tax ID 59-3238640
$4.40Published rate
David Johnson
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
FLPhysician AssistantNPI 1346269065Tax ID 59-3238640
$4.40Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 87186 vs. Other Microbiology Procedures Codes

The CPT 87186 code is part of the Pathology and Laboratory Procedures services used for Microbiology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 87186 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
87181-CPT	Low	Test Antibiotic Effectiveness, Lab Test To Determine How Responsive A Bacteria Is To Various Antibiotics. The Result Identifies The Antibiotic Likely To Be Most Effective In Treating The Infection.
87184-CPT	Low	Test Antibiotic Effectiveness, Lab Test To Determine How Responsive A Bacteria Is To Various Antibiotics. The Result Identifies The Antibiotic Likely To Be Most Effective In Treating The Infection.
87185-CPT	Low	Test Antibiotic Effectiveness, Lab Test To Determine How Responsive A Bacteria Is To Various Antibiotics. The Result Identifies The Antibiotic Likely To Be Most Effective In Treating The Infection.
87186-CPT	Low	Test Antibiotic Effectiveness, Lab Test To Determine How Responsive A Bacteria Is To Various Antibiotics. The Result Identifies The Antibiotic Likely To Be Most Effective In Treating The Infection.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87186. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 87186 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 87186 Fee Schedule

Compare published rates across providers.

Abigail Hall

Justin Hunt

Jonathan Zager

Ann Guastella

David Johnson