How can I find out the cost of a medical procedure before I get it done?

The cost of medical procedures can vary significantly based on location, provider, and your specific insurance plan. To get an estimate for a specific procedure using a CPT code and your location, you can utilize tools like Payerprice. They offer a fee schedule lookup tool that allows you to search for pricing information.

What is a CPT code and why is it important for understanding medical costs?

CPT stands for "Current Procedural Terminology." CPT codes are five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for billing and reimbursement purposes, as they standardize the reporting of services and procedures. Knowing the CPT code for a service helps you understand what you're being billed for and can assist in researching pricing.

Why do medical costs vary so much for the same service?

Medical costs can vary due to several factors, including the geographic location, the specific healthcare provider or facility (e.g., hospital vs. independent clinic), your insurance plan's negotiated rates, the complexity of your individual case, and whether the service is in-network or out-of-network. Different providers may also have different overhead costs and pricing strategies.

How can I compare prices for medical services from different providers?

Comparing prices can be challenging due to the variability in healthcare costs. However, you can start by asking your provider for the CPT code for the service you need. With the CPT code and your specific location, you can use tools like Payerprice's fee schedule lookup tool to search for and compare potential costs across different providers. It's also advisable to contact your insurance company for estimates based on your specific plan benefits.

What should I do if I receive an unexpected or unusually high medical bill?

First, carefully review the bill for any errors and compare it to your Explanation of Benefits (EOB) from your insurance company. If you find discrepancies or have questions, contact your healthcare provider's billing department to request an itemized bill and clarify charges. You can also contact your insurance company for clarification on coverage. If necessary, you may be able to negotiate the bill or set up a payment plan.

Does my health insurance cover 100% of all medical costs?

Generally, no. Most health insurance plans require you to pay a portion of your medical costs, even after meeting your deductible. This can include deductibles (the amount you pay before your insurance starts to cover costs), co-pays (a fixed amount you pay for a service), and co-insurance (a percentage of the cost you pay). Most plans also have an out-of-pocket maximum, which is the most you'll have to pay in a policy year for covered services. It's essential to understand your specific plan's benefits.

CPT 87880 Fee Schedule

Last Verified: September 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.

Infectious Agent Detection By, Infectious Agent Detection By Immunoassay With Directoptical Observation Streptococcus Group A Infectious Agent Detection By Immunoassay With Direct

Key Fact	Detail
Service Type	Pathology and Laboratory Procedures Microbiology Procedures
Common Place of Service	11 - Office 20 - Urgent Care Facility
Common Modifiers	None QW - CLIA Waived Tests 26 - Professional component
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 87880
Medicaid Fee Schedule	View Medicaid rates for 87880

National average reimbursement for CPT 87880 by major payers:

$14.40

$13.20

$17.41

$22.67

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 87880.

CPT 87880

5 of 25 sample ratesHigher to lower in this preview

Swati Gupta
Avenel Iselin Medical Group
NJInternal Medicine PhysicianNPI 1386035772Tax ID 22-1965695
$16.53Published rate
Rajiv Patel
Princeton Healthcare Affiliated Physicians PC
NJInternal Medicine PhysicianNPI 1063434314Tax ID 26-4203938
$16.07Published rate
Alla Roitman
Radu Codel, Md, PC
NJInternal Medicine PhysicianNPI 1699093054Tax ID 20-3130405
$15.69Published rate
Samuel Preschel
Lakewood Immediate Care
NJInternal Medicine PhysicianNPI 1063561413Tax ID 47-3516576
$8.34Published rate
Anjana Chhabra
Mdslim LLC
NJInternal Medicine PhysicianNPI 1780624718Tax ID 10-664279
$7.23Published rate

Get a free rate benchmark for your specialty.

Choose your state and specialty to build a report from payer-published rates.

Build my free benchmark

Use market rates to prepare your payer proposal.

Rate Benchmarking

Compare your rates with similar providers.

Select a published rate, define comparable providers, and see where that rate falls in your market.

See a sample rate comparison

Payer Contract Negotiation

Draft a fee schedule renegotiation letter.

Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.

See a sample payer proposal

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

Check published rates for your payer and codes.

Explore state-level rates by specialty

CPT 87880 vs. Other Microbiology Procedures Codes

The CPT 87880 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 87880 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
87802-CPT	Low	Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Streptococcus Group B
87803-CPT	Low	Test For Intestinal Infection, The Test Detects Toxins Produced By Clostridium Difficile Bacteria Which Causes Diarrhea And Usually Results From Antibiotic Use.
87804-CPT	Low	Test For Flu Virus, Influenza (Flu) Is A Viral Infection Of The Lungs That Causes Fever Cough And Muscle Aches. The Test Checks A Sample From The Nose Or Throat For Influenza A B Or Both Types.
87880-CPT	Low	Infectious Agent Detection By, Infectious Agent Detection By Immunoassay With Directoptical Observation Streptococcus Group A Infectious Agent Detection By Immunoassay With Direct

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87880. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 87880 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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 87880) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

CPT 87880 Fee Schedule

Swati Gupta

Rajiv Patel

Alla Roitman

Samuel Preschel

Anjana Chhabra