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CPT 86900: What It Costs and What's Fair

CPT 86900  · Medicare rate: $136  · National avg charge: $143  · BillKarma data from 9 providers

Reviewed 2026-11-13  · Pricing data year: 2026

CPT 86900 (CPT 86900) is an outpatient procedure or diagnostic test performed in a hospital, clinic, or ambulatory care setting. It is typically completed in a single visit, and most patients return to normal activities the same day or within 24 hours.

Cost by Billing Grade

Grade Avg Hospital Charge Medicare Rate Est. Patient Cost* Hospitals
D $108 $136 $22 1
F $147 $136 $29 8

*Estimated patient cost assumes 20% coinsurance after deductible is met. Actual cost depends on your specific plan, deductible status, and network.

Cost Range Across Hospitals

Min: $31 Max: $196
Medicare: $136 Avg: $143
Grade A (≤2x Medicare) Grade B (2–3x) Grade C (3–5x) Grade D/F (5x+)

What This Procedure Typically Costs by Facility Type

Hospital
9 providers
$31 — $196 | Avg: $143 (1.1x Medicare)

Find Providers Near You for This Procedure

Showing 10 lowest-markup providers nationally across hospitals, surgery centers, and imaging centers. Enter ZIP code to compare local providers side by side.

Provider Type Location Grade Charge Benchmark Markup
AdventHealth Waterman Hospital Tampa, FL F $31 $136
Medicare OPPS
 0.2x
AdventHealth East Orlando Hospital Orlando, FL D $108 $136
Medicare OPPS
 0.8x
AdventHealth South Overland Park Hospital Tampa, FL F $115 $136
Medicare OPPS
 0.8x
AdventHealth Lenexa Hospital Tampa, FL F $115 $136
Medicare OPPS
 0.8x
Aiken Regional Medical Centers Hospital Aiken, SC F $133 $136
Medicare OPPS
 1.0x
AdventHealth Winter Park Hospital Winter Park, FL F $196 $136
Medicare OPPS
 1.4x
AdventHealth Kissimmee Hospital Orlando, FL F $196 $136
Medicare OPPS
 1.4x
AdventHealth Celebration Hospital CELEBRATION, FL F $196 $136
Medicare OPPS
 1.4x
AdventHealth Winter Garden Hospital Tampa, FL F $196 $136
Medicare OPPS
 1.4x

What Is a Fair Price for This Procedure?

Medicare pays $136 for CPT 86900 (CPT 86900). This rate is set by CMS based on the actual cost of delivering the procedure, including physician time, overhead, and equipment. It's the most reliable national benchmark for what the procedure is worth.

A hospital charging $272 (2x Medicare) or less earns an A billing grade — these are the most fairly priced facilities for this procedure. The national average charge is $143 (1.1x Medicare).

If your bill shows more than $408 (3x Medicare) for this procedure, it may be worth reviewing the charges carefully. Upload your bill to check

Frequently Asked Questions

Is CPT 86900 covered by insurance?
CPT 86900 (CPT 86900) is generally covered by most insurance plans when medically necessary, but coverage varies by plan type and medical necessity criteria. Medicare pays $136 for this procedure. Always confirm your benefit coverage and any prior authorization requirements with your insurer before scheduling.
Why might I be billed separately for CPT 86900 by multiple providers?
When CPT 86900 is performed at a hospital outpatient facility, you may receive separate bills from the hospital (facility fee) and from the physician or specialist who performed or interpreted the procedure. This split billing—professional fee plus facility fee—is common. The national average hospital charge is $143, so make sure each individual bill reflects only the services that were actually provided.
How can I find out what my insurance will pay for CPT 86900 before I go?
Call the member services number on your insurance card and ask for a cost estimate or Explanation of Benefits preview for CPT 86900. Also confirm whether the facility you're considering is in-network. Medicare's reference rate for this procedure is $136—if a hospital charges significantly more, you may owe more out-of-pocket than expected even with insurance.

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