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Direct Test For Pneumocystis Pneumonia

Colorado rates for HCPCS 87281

A laboratory test that looks directly for Pneumocystis, a fungus that causes serious pneumonia in people whose immune systems are weakened, in a sample of sputum or fluid washed from the lungs. Antibodies tagged with a fluorescent dye attach to the organism, making it visible under a special microscope. It gives a rapid answer because this organism cannot be grown in ordinary culture.

Rates data updated October 2026.

How much does Direct Test For Pneumocystis Pneumonia cost?

$12.02

Typical negotiated rate. In Colorado, October 2026.

Insurers have agreed to pay about $12.02 for this service. The price depends on where it is billed: about $9.12 from a physician practice, and about $34.67 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$9.12$8.32 to $12.02
FacilityA hospital or hospital-owned outpatient department$34.67$21.88 to $41.69

How much rates vary

Facilitymedian $35 · 10th to 90th $9 to $55Professionalmedian $9 · 10th to 90th $7 to $21
$10$20$50$100facility $35professional $9

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$9.12
Median
$25.12
Typical High
$54.95
Aetna
Setting
Professional
Modifier
None
Typical Low
$8.32
Median
$9.12
Typical High
$12.02
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$13.49
Median
$36.31
Typical High
$54.95
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$7.24
Median
$9.12
Typical High
$24.55
Cigna
Setting
Facility
Modifier
None
Typical Low
$7.08
Median
$14.45
Typical High
$36.31
Cigna
Setting
Professional
Modifier
None
Typical Low
$6.17
Median
$8.71
Typical High
$16.98
Denver HMP
Setting
Facility
Modifier
None
Typical Low
$9.12
Median
$12.88
Typical High
$23.99
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$9.55
Median
$17.38
Typical High
$46.77
Select Health
Setting
Facility
Modifier
None
Typical Low
$12.02
Median
$22.39
Typical High
$25.12
Select Health
Setting
Professional
Modifier
None
Typical Low
$8.32
Median
$8.32
Typical High
$12.02
United
Setting
Facility
Modifier
None
Typical Low
$14.45
Median
$14.45
Typical High
$14.45
United
Setting
Professional
Modifier
None
Typical Low
$5.01
Median
$7.08
Typical High
$9.55
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$4.47
Median
$4.57
Typical High
$6.03
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$1.78
Median
$1.82
Typical High
$2.40

Where Colorado sits

The same service costs 4.5 times more in Kansas than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Colorado· 26th of 51

$12.02

KS $38.02NJ $8.51

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.