How much does a rapid flu test (CPT 87804) cost?

A rapid flu test (CPT 87804) costs an average of $42.93 at urgent care centers and doctor offices. Medicare pays approximately $16 to $20 under the Clinical Laboratory Fee Schedule. Some offices include the test cost in the visit fee, while others bill it separately.

What is the difference between CPT 87804 and combination flu/COVID tests?

CPT 87804 tests only for influenza ($43 average). Combination flu/COVID rapid tests (CPT 87428 or 87426) test for both viruses simultaneously but cost $80 to $100. If your main concern is flu and you have already tested negative for COVID, a flu-only test is cheaper. Ask which test is being performed before agreeing.

CPT (Current Procedural Terminology) codes are five-digit numbers that describe every medical service or procedure. Your doctor, hospital, and insurance company use them to communicate exactly what was done. Every line on your medical bill has a CPT code, and knowing the code lets you look up what Medicare pays for that same service.

Why do providers charge so much more than Medicare pays?

Providers set their own "chargemaster" prices, which are essentially list prices. Medicare pays a fixed rate based on the resources each service actually requires (the RVU system for procedures, or the Clinical Lab Fee Schedule for lab tests). Commercial insurers typically pay 150% to 250% of Medicare rates. Uninsured patients are often billed the full chargemaster price, which can be 2x to 30x what Medicare pays.

Can I use Medicare rates to negotiate my bill?

Yes. Medicare rates are the closest thing to a "fair price" benchmark in U.S. healthcare. When negotiating, ask the provider what they accept from Medicare for the same CPT code. Most providers will accept 150% to 200% of Medicare for cash-pay patients, which is still far less than their chargemaster price. Many hospital financial assistance policies also use a multiple of Medicare as their discount floor.

How are Medicare rates calculated?

For most procedures, Medicare uses the Resource-Based Relative Value Scale (RBRVS). Each CPT code gets three RVU components: Work (physician time and skill), Practice Expense (overhead), and Malpractice. These are multiplied by geographic adjustment factors (GPCIs) and a conversion factor ($33.4009 in 2026). Lab tests (80000-89999 range) use a separate Clinical Laboratory Fee Schedule with flat national rates.

CPT 87804

Rapid Influenza Test (Immunoassay with Direct Optical Observation)

CPT 87804 is the rapid flu test performed at urgent care centers and doctor's offices, providing results in about 15 minutes. Medicare pays approximately $16 to $20, but providers charge an average of $42.93. The critical limitation: rapid flu tests have only 50 to 70% sensitivity, meaning they miss 30 to 50% of actual flu cases. A negative result does not rule out influenza, and during flu season, the test result may not change your treatment plan at all.

Updated May 2026Source: CMS Clinical Lab Fee Schedule

CPT 87804 at a Glance

Medicare CLFS rate: ~$16 to $20
Average provider charge: $42.93
Markup: 2.1 to 2.7x over Medicare rate
Result time: 15 minutes

Sensitivity: 50 to 70% (misses 30-50% of cases)
Beneficiaries (2023): 688,761
Fee schedule: Clinical Laboratory (CLFS)
Combo flu/COVID alternative: $80 to $100

How Lab Pricing Works (Clinical Laboratory Fee Schedule)

CPT 87804 is priced under the Medicare Clinical Laboratory Fee Schedule (CLFS) at a single national rate. This is a CLIA-waived test, meaning it can be performed in a doctor's office or urgent care without a full laboratory setup. The test kit itself costs the provider approximately $8 to $15, and the CLFS rate of $16 to $20 includes a modest margin over kit cost.

Metric	Value
Medicare CLFS Rate	~$16 to $20
Average Provider Charge	$42.93
Markup Ratio	2.1 to 2.7x
Pricing Method	National rate (CLFS), no geographic variation

Ask before testing: During flu season, if you have classic flu symptoms (sudden high fever, severe body aches, dry cough), many doctors will prescribe Tamiflu based on clinical diagnosis alone. The rapid test costs $43 and has a 30 to 50% chance of giving a false negative. Before agreeing to the test, ask: "Will the result change my treatment? If it is negative, will you still treat me for flu based on my symptoms?"

Lab tests are priced under the Clinical Laboratory Fee Schedule, not the Physician Fee Schedule. Medicare lab rates are set nationally and do not vary by geographic location.

What Does a Rapid Flu Test Measure?

The rapid influenza test (CPT 87804) detects influenza viral antigens (proteins on the surface of the virus) in a nasal swab or throat swab sample. A healthcare worker swabs your nose or throat, applies the sample to a test strip, and reads the result visually in about 15 minutes. Most tests distinguish between Influenza A and Influenza B.

Test Performance

Sensitivity: 50 to 70% (misses many true cases)
Specificity: 90 to 99% (positive result is reliable)
Best within: First 3 to 4 days of symptoms
Result time: 10 to 15 minutes
Bottom line: Positive = trust it. Negative = unreliable.

Alternative Flu Tests

Rapid molecular (87502): 95%+ sensitivity, $100 to $200
Combo flu/COVID (87428): Tests both, $80 to $100
Viral culture: Gold standard, takes days, rarely used
Clinical diagnosis: Free, based on symptoms during flu season

The accuracy problem explained simply: If 100 people with actual flu take a rapid test, only 50 to 70 will get a positive result. The other 30 to 50 will be told "negative" despite actually having the flu. This is why doctors sometimes treat for flu even with a negative rapid test, especially during peak flu season when clinical symptoms are highly predictive on their own.

Where to Get a Flu Test for Less

Rapid flu tests are point-of-care tests performed where you are being seen. You cannot take the test home or go to a separate lab. However, where you choose to be seen affects the total cost:

Retail Clinics (CVS MinuteClinic, Walgreens): $25 to $40 (test only)

Retail clinics typically have lower visit fees and transparent test pricing. Some include the flu test in the visit cost. Total visit plus test: $75 to $130. This is often the cheapest option for a flu evaluation.

Urgent Care Centers: $30 to $50 (test only)

Urgent care centers bill the test separately from the office visit. Total visit plus test: $125 to $200. Freestanding urgent care centers are generally cheaper than hospital-affiliated ones. Ask before your visit whether the test is included in the visit fee or billed separately.

Emergency Departments: $50 to $100+ (test only)

Emergency rooms charge the most for flu testing, and the ER visit itself costs $500 or more. For uncomplicated flu symptoms in otherwise healthy adults, an ER visit is almost never necessary. Use urgent care or a retail clinic instead.

At-Home Rapid Tests: $15 to $30 (OTC)

Over-the-counter flu rapid tests (like Lucira and others) are now available at pharmacies for $15 to $30. These have the same sensitivity limitations as office tests but avoid the visit fee entirely. If you test positive at home, call your doctor for a Tamiflu prescription without needing an office visit.

What Insured Patients Actually Pay for a Rapid Flu Test

Insurance coverage for rapid flu tests depends on your plan. The test is usually covered as diagnostic testing, but your cost-sharing applies:

Your Situation	What You Likely Pay	How It Works
Copay plan (deductible met or N/A)	$0 to $5	Test often covered at 100%, you pay visit copay only
Coinsurance plan (deductible met)	$3 to $4	20% of negotiated rate ($16 to $20)
High-deductible plan (deductible NOT met)	$16 to $43	Full negotiated rate applied to your deductible
Medicare Part B	$0	Medicare covers clinical lab tests at 100% (no coinsurance)

Common Billing Problems with CPT 87804

Combo flu/COVID test billed when only flu was needed

Many offices now default to combination flu/COVID rapid tests (CPT 87428 or 87426, costing $80 to $100) even when you only wanted a flu test. If you already know your COVID status or COVID is not a concern, ask specifically for a flu-only test (87804 at $43) rather than the more expensive combination. Some offices only stock combo tests, in which case you have no choice.

Rapid test plus molecular test on the same visit

Some clinics perform a rapid test (87804, $43) and then also send a molecular PCR test (87502, $100 to $200) for "confirmation." Having both is rarely necessary for routine clinical care. If you already have a positive rapid test, a confirmatory molecular test adds cost without changing your treatment. If the rapid is negative and your doctor suspects flu anyway, they should treat empirically or order just the molecular test.

Flu test billed separately when included in visit fee

Some clinics advertise "flu visit" packages that include the test in the visit fee but then bill the test separately to insurance as well. Check your EOB: if the visit charge seems high enough to include testing, and you also see a separate 87804 charge, you may be double-paying.

Frequently Asked Questions

How much does a rapid flu test cost at urgent care?

The rapid flu test itself (CPT 87804) costs $30 to $50 at most urgent care centers, with the national average at $42.93. This is in addition to the urgent care visit fee ($100 to $150). Total out-of-pocket for uninsured patients: $130 to $200. Retail clinics like CVS MinuteClinic are generally cheaper overall ($75 to $130 total).

How accurate is a rapid flu test?

Rapid flu tests have 50 to 70% sensitivity and 90 to 99% specificity. In plain language: if the test says positive, you almost certainly have the flu. But if it says negative, there is a 30 to 50% chance you still have the flu. Accuracy is highest in the first 3 to 4 days of symptoms and during peak flu season when the virus is circulating widely.

Will a rapid flu test change my treatment?

Not always. During peak flu season, if you have classic flu symptoms, many doctors will prescribe Tamiflu (oseltamivir) based on clinical diagnosis alone. Tamiflu is most effective within 48 hours of symptom onset regardless of test result. A negative rapid test may not change management because the test misses so many cases. Before agreeing to the test, ask: "If this comes back negative, will you still treat me for flu?"

What is the difference between a rapid flu test and a combo flu/COVID test?

CPT 87804 tests only for influenza A and B ($43 average). Combination flu/COVID tests (CPT 87428 or 87426) test for both influenza and SARS-CoV-2 in a single swab but cost $80 to $100. If you only need to know about flu (for example, you already tested negative for COVID at home), the flu-only test saves $40 to $60. Ask which test is being used before it is performed.

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