What is the standard insurance baseline for CPT 87806?

The standard insurance baseline reimbursement rate is $32.11. This represents the customary allowable amount established across standard fee schedules.

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CPT 87806Medical Service

Detection Test by Immunoassay with Direct Visual Observation for Hiv-1 Antigen

Q: What do doctors typically charge for Detection Test by Immunoassay with Direct Visual Observation for Hiv-1 Antigen?

The nationwide median physician charge for Detection Test by Immunoassay with Direct Visual Observation for Hiv-1 Antigen (CPT 87806) is $62.72. Doctor billed charges vary based on geographic region, setting, and overhead.

Detection test by immunoassay with direct visual observation for hiv-1 antigen, with hiv-1 and hiv-2 antibodies. Clinical pricing breakdown and utilization metrics across 17 practicing doctors nationwide.

$62.72

Peer Median Charge

Gross billed rate

$32.11

Standard Baseline

Customary allowable

2.0x

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 $62.72. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $32.11 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 87806 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"